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Health Care Management

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Questions:
1. Select five OECD metrics that you would use to pick the country with the best healthcare system (see OECD spreadsheet). Provide a rationale for your selections.
 
2. Identify the OECD country that best matches your criteria.
 
3. What best explains the high level of expenditures in McAllen Texas (Gawande 2009, The Cost Conundrum)? List 4 factors.
 
4. Identify five key stakeholders and describe their interests and influences in McAllen Texas?
 
5. What circumstances led to or contributed to the situation in McAllen Texas?
 
6. List at least three causes of the primary care shortage in the US.
 
7. Contrast the US approach to any other country in the training and use of primary care providers.
 
8. Identify four attributes of the US healthcare delivery system that may have contributed to the significant medical or health conditions of patients described in the Gawande article, The Hotspotters.
 
9. What are three innovations discussed in the Hot Spotters might improve the value of healthcare services?
 
10. Why do you think the US does not have a single payer system? List at least 5 reasons why not.
 

11. Why is multidisciplinary care important in cancer? How is value created for patients?
12. How does integration of care actually take place at MD Anderson?
13. In light of trends towards vertical integration in healthcare, how can MD Anderson forward or reverse integrate to shore up its position?
14. What is the Cleveland Clinic’s overall strategy for improving value for patients? List 6 key elements.
15. List and describe four factors that contributed to Geisinger’s success with ProvenCareSM.
16. List and describe the three advantages and three disadvantages for a provider (hospital and/or physician group) becoming an insurer. 

 
Answers:
(1).

According to the OECD metrics, the country with the best healthcare system is Switzerland. All the transaction concerned with health relies on a smartcard which is known the Carte Vitale. The cost of a GP visit is €23 (£17), the smartcard is swiped and the money is remunerated back into the bank account of the patient’s within a period of five days. The poorest individuals as well as the long-term ill are covered in this
The majority of individuals are signed up to a mutuelle which is a semi-private insurance body, frequently associated to job, which tops up the residual sum to be remunerated. If in case a patient is taken to the emergency department of a hospital, for instance, they would present their Carte Vitale, and depending on the health issue, could be refunded entirely by the state.
A huge number of medicines which are prescribed medicines are paid back between 15% and 100%. The country then reimburses them in fraction or in full. The patient possesses liberty to select which service or doctor to visit (Bohmer & Knoop, 2006).
(2).
The presentation of Switzerland is especially remarkable when we consider how financially established it is.  The Government spending on health care in this country is merely 2.7 percent of GDP, undoubtedly the lowest in the developed world. By distinction, in the year 2008, the government of U.S. spent on health care ariund7.4 % of GDP. If it could shift its state health spending to the Swiss levels, it may possibly save more than $700 billion in a single year.
In spite of this evident stinginess, it has achieved worldwide coverage for every of its citizens. It also has access to the most recent technology, just as the Americans do, along with comparably low waiting times for engagements and measures. The Swiss are among the healthiest people in the world (Fuchs, 2013).
(3).
Atul Gawande brought consideration to McAllen in a powerful essay of New Yorker; discovering the geographic disparity in the expenditures of healthcare. For a number of decades now, the researchers of healthcare have recognized regularly spectacular dissimilarities in the variety and quantity of medical care. The researchers, actually, created an Atlas which summarizes these geographic distinctions (Gawande, 2012).
Construct a hospital, the view goes, and general practitioners may possibly discover a method to fill it up with the customers who are paying. The Physicians fill the hospital beds not merely for the reason that hospitals wish for additional income, but also for the reason that when hospitals are close to capacity, the physicians begin managing extra patients’ sickness in the outpatient surroundings, sickness they might be extra relaxed taken care of in the hospital. Novel research demonstrates that patients at the present, also, ought to have credit (or responsibility) for a segment of these geographic disparities
(4).
The unstable movement in American medical expenses appears to have taken place at this point in a particularly concentrated outline. U.S health care is considerably the most expensive in the globe. The aim of health-care modification is not presently to expand medical treatment to everyone but also to convey expenses controlled.. The fiscal burden has smashed the worldwide competitiveness of businesses in America as well as bankrupted several families, even the individuals having insurance. It is demolishing the government too. “The utmost risk to America’s economic health is not societal safety. The question we’re now frantically grappling with is how this came to be, and what can be done about it. McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers (Gordon, 2013). 
 
(5).
The situation of McAllen Texas is involved with the fundamental premises of the reasonable Care Act of 2010 in which much health care is delivered incompetently and that savings in the sector of medical care can be established by reducing needless care in the regions of the country that spends high. This basis is supported in fraction by the Dartmouth Atlas of Health Care, which recognizes huge geographic differences in Medicare spending One article in particular popularized the matter of geographic difference in Medicare spending: Atul Gawande’s 2009 article in the New Yorker contrasting Medicare spending in McAllen, Texas. According to Gawande, the most probable elucidation for the almost double distinction in per head Medicare spending between the two cities was an alteration in McAllen during the mid-1990s, when providers of health care implemented a bigger “capitalist spirit” along with a “culture of money.” (Herzlinger, 2006).
(6).
The three causes of the primary care shortage in the United States (U.S) are as follows:

The first cause involves the rising demand of care in the U.S come from a population of patients which is increasing, growing older, and requires additional care of the chronic diseases. As the population of U.S is expected to increase by 14 % between at present and the ear 2025. The population is ageing and an important impact of this drift will utilize twice as much as physician resources since the population of aging individuals is increasing at a rapid rate.
The second cause involves the insufficient augmentation of supply of caregivers. similar to the increase in demand, several reasons are contributing to this issue, such as aging of the caregivers, costs of medical school, the number of medical students who graduates remains flat, declining interest in the primary care, the dissatisfaction of physician’s job , regional inequalities along with the shortages of nurse practitioner and nurses.
The third cause is that the primary care is not observed as an attractive career today. The primary care physicians very less in comparison to the specialists and the specialists are usually observed to possess a superior level of reputation in comparison to the primary care physicians (Hwang & Christensen, 2008).

(7).
The health care system of U.S is exceptional among the developed nations due to its access to care along with the approach of financial support and it spends around 20% of its Gross Domestic Product (GDP) in the field of healthcare. Novel medical technologies have a significant role to play in the spending of U.S healthcare. The innovations in the field of healthcare are concerned with the processes and products. The product refers to the services or goods for which the customer pays a certain amount. The innovation of processes involves the innovations in the method of delivery or production (Lepore, 2014). It is basically a novel alteration to the act of delivering or producing the product that permits for a noteworthy augmentation in the value conveyed to different stakeholders. This particular innovation generally affects the external as well as the internal infrastructure and also constructs novel business models.
Primary care serves as the keystone for constructing a strong system of healthcare system that makes sure constructive outcomes of health outcomes as well as health equity. Therefore, the speedy advancement of medical technology adds to the stipulation for area of expertise, services and offers a momentum for additional subject development. 
 
(8).
There exists a broad conformation that the U.S healthcare delivery system has contributed to the noteworthy conditions of health of the patients. It spends more money on individual person in comparison to any other nation in the globe. Preventive care is utilized in every possible way. The delivery of healthcare is provided by several distinctive organizations. The facilities of healthcare are mostly owned and controlled by businesses belonging to a private sector. According to the World Health organization (WHO), the United States of America spends excess on healthcare per head and more on the area of healthcare as proportion of its GDP in comparison to any other nation. Around 65-70% of provisions of healthcare and expenditure come from the diverse programs such as Program of Children’s Health Insurance, veterans Health administration, Medicaid, and Medicare. The employees of the public sector are provided with a health insurance by the government (Casale et al., 2007).
(9).
Considering the innovations, healthcare possesses rich evidence. The dissemination of inventions is an important challenge in all the fields of health care. Health care is one of the brilliant in comparison to all the industries with respect to the prosperity of its science foundation. Though there are some gaps in terms of the knowledge, but medical as well as clinical science progresses and regularly provides a coherent basis for selecting the best strategies of diagnosis, surgery and other components of care. Novel medical technologies have a significant role to play in the spending of U.S healthcare. The innovations in the field of healthcare are concerned with the processes and products. The product refers to the services or goods for which the customer pays a certain amount. The innovation of processes involves the innovations in the method of delivery or production. It is basically a novel alteration to the act of delivering or producing the product that permits for a noteworthy augmentation in the value conveyed to different stakeholders. This particular innovation generally affects the external as well as the internal infrastructure and also constructs novel business models (Berwick, 2003). 
 
(10).
Single payer system involving in healthcare is a worldwide system of healthcare in which a single payer pays for the costs of care rather than the private insurers. Single payer is concerned with the process of funding and not delivery. It can involve a system of private healthcare delivery, a delivery system of public, or a blend of the two. An agency can control any fund, but it is characteristically designed and supervised by the government. This describes the mechanism of funding and does not indicate for whom the doctors work or the form of delivery of healthcare. In the U.S, a pure worldwide single payer system of healthcare would be remunerated, in part, all the way through the taxes founded on profit replacing insurance deductibles and premiums. Every plan would possess the similar networks as well as benefits. This may substitute the multi-tiered organization that recompenses earnings with quality of care (Coye, 2001).
(11).
The team of Multidisciplinary care has been identified as a significant part of inclusive care for cancer for several years; but, lately the central role of multidisciplinary care has augmented its significance. Multidisciplinary teams consisting of nurses, administrators, physicians, patient navigators, financial advisors and others assistance to make sure a mutual consultation along the pathway of the treatment of patient (Berwick et al., 2008). Small practices and clinics persist to search for the strategies that will assist to improve the consistency of the team while adding together worth to the patient. It is significant to give emphasis to the importance of interpersonal associations along with leadership in the achievement or non-achievement of a multidisciplinary approach (Porter & Jain, 2013).
(12).
For the integration of care, MD Anderson made collaboration with Orlando Regional Healthcare System. It also provided an access to technical aid, quality audits, research and participation in the several multidisciplinary symposiums under a ten-year agreement. The center for cancer prevention provided comprehensive services for screening of cancer together with the assessment of the risk of cancer, screening exams, strategies of risk-reduction, cessation of tobacco and diet counseling. The center characterized one of the rapidly growing lines of service at MD Anderson. It was engrossed with a multifaceted research for cancer prevention and also included behavioral sciences and epidemiology. The activities of the laboratory supported practical activities along with the advancements with respect to the prevention of cancer (Edwards et al., 2011).
(13).
MD Anderson had initiated to develop the programs of survivorship to assist in understanding the specific psychological and physical requirements of the patients who had suffered from the disease of cancer. Radiation therapy, surgery, chemotherapy all possessed side-effects that may possibly emerge long subsequent to the cessation of the treatments of cancer. The physicians of MD Anderson were busy in managing the needs of the survivors of cancer as well as sponsored the programs of research to differentiate these needs. It had surveyed the survivors of cancer and also made information accessible to the patients about supporting the survivor groups (Shah & Chokshi, 2013). 
 
(14).
Putting the patients initially requires more than world-class clinical care – it necessitates care that addresses each characteristic of a patient’s encounter with Cleveland Clinic, together with the physical comfort of the patient, and their learning, emotional, and religious needs (Gawande, 2011). The team of professionals serves as a recommended supply for critical proposals across the health system of Cleveland Clinic. Health care is one of the brilliant in comparison to all the industries with respect to the prosperity of its science foundation. Though there are some gaps in terms of the knowledge, but medical as well as clinical science progresses and regularly provides a coherent basis for selecting the best strategies of diagnosis, surgery and other components of care. Novel medical technologies have a significant role to play in the spending of U.S healthcare. The innovations in the field of healthcare are concerned with the processes and products.
Additionally, they make available resources along with data analytics; recognize, support, and circulate sustainable practices; as well as work together with a diversity of departments to make sure the constant deliverance of patient-centered care.
It was the first main educational medical center to create patient experience a planned objective, employ a Chief Experience official, along with one of the first to set up an Office of Patient understanding (Gawande, 2009).
(15).
Geisinger Clinic as well as Geisinger Health Plan are collaborating to analyze a superior medical home model and to restore the processes of care so that the team of primary care team can consistently meet the inclusive needs of care of the patients through additional intensive outpatient management. Preventive care is utilized in every possible way. The delivery of healthcare is provided by several distinctive organizations. The facilities of healthcare are mostly owned and controlled by businesses belonging to a private sector. According to the World Health organization (WHO), the United States of America spends excess on healthcare per head and more on the area of healthcare as proportion of its GDP in comparison to any other nation (Span, 2015).
(16).
In the United States, health insurance refers a program which assists for medical expenditures, whether by means of privately obtained insurance, societal insurance or a program for social welfare funded by the government.  In a more scientific sense, the term is used to describe any type of insurance that offers protection against the costs of medical services. This practice comprises programs of private insurance as well as societal insurance such as Medicare, which involves resources and extend the fiscal risk connected with the major medical expenditures across the whole population to defend everybody, in addition to programs of societal welfare such as program of State Children’s Health Insurance Program and Medicaid, which provide aid to those individuals who cannot manage to pay for treatment of health (Hwang & Christensen, 2008). 
 
References
A doctor’s office that’s all about you.(2013). Consumer Reports, 78(7), 20.
Berwick, D. M. (2003). Disseminating innovations in health care. JAMA: Journal of the American Medical Association, 289(15), 1969.
Berwick, D., Nolan, T., & Whittington, J. (2008). The triple aim: Care, health, and cost, 27, no.3 (2008):759-769.Health Affairs, 27(3), 759.
Bohmer&Knoop, 2006, “The Challenge Facing the U.S. Healthcare Delivery System” (606096)
Casale, A. S., Paulus, R. A., Selna, M. J., Doll, M. C., Bothe, A.,Jr, McKinley, K. E., et al. (2007). “ProvenCareSM”: A provider-driven pay-for-performance program for acute episodic cardiac surgical care.Annals of Surgery, 246(4), 613.
Coye, M. J. (2001). No Toyotas in health care: Why medical care has not evolved to meet patients’ needs.Health Affairs, 20(6), 44.
Edwards, J. N., Silow-Carroll, S., &Lashbrook, A. (2011). Achieving efficiency: Lessons from four top-performing hospitals. The Commonealth Fund, (July).
Fuchs, V. (2013).How and why US health care differs from that in other OECD countries. JAMA: Journal of the American Medical Association, 309(1), 33.
Gawande, A. (2009). The cost conundrum.New Yorker, 85(16), 36.
Gawande, A. (2011). The hot spotters. New Yorker, 86(45), 40.
Gawande, A. (2012). Big med.New Yorker, 88(24), 52.
Gordon, T. (2013). Quality of care in the United States: The US experience in defining and measuring quality. . In R. Kray, C. Koch & P. Sawick (Eds.), Qualität in der medizin dynamisch denken versorgung– forschung– markt (1st ed., pp. 95). Wiesbaden: Springer Gabler.
Herzlinger, R. E. (2006). Why innovation in health care is so hard. Harvard Business Review, 84(5), 58.
Hwang, J., & Christensen, C. (2008). Innovation in health care delivery: A framework for business-model innovation.Health Affairs, 27(5), 1329.
Lepore, J. (2014). The disruption machine.The New Yorker.
Porter & Jain, 2013, “The University of Texas MD Anderson Cancer Center: Interdisciplinary Cancer Care” (708487)
Porter &Teisberg, 2014, “The Cleveland Clinic: Growth Strategy 2014” (709473)
Shah, N. R., &Chokshi, D. A. (2013). Should health care systems become insurers? JAMA: Journal of the American Medical Association, 310(15), 1561.
Span, P. (2015, April 14). They’re all just trying to help. The New York Times, pp. 3.
Woolf S.H., Aron L.Y. The US Health Disadvantage Relative to Other High-Income Countries: Findings From a National Research Council/Institute of Medicine Report. JAMA. 2013; 309(8):771-772.

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