I have been researching the issue of health care recently, as readers may know. It all started with the "unbinding" message of the story of Lazarus, Jesus and the role of the community. This issue has so many tails and tales! In this post I try to sort out a few tails to grasp to begin to understand how it could happen that all would have health care when they need it.
The first tail. Let's begin with the person who needs health care. This person has to know that they have a need, that there is someone/somewhere to meet their need, that they can actually receive services to meet their need and that they can afford the care. The person also has to know what they can do for themselves and what they cannot.
Yesterday, I heard this story. A woman of about 65 years old who has a very low income receives health care services from a local clinic. She recently had what was probably influenza and has ended up quite ill with a sinus infection. She called the clinic and told them that she is very ill, too ill to use public transportation. (She doesn't have a car.) She asked them to prescribe antibiotics for her. The clinic refused and said they needed for her to come in. She said she was too sick. There was an impasse. The clinic does not make house calls. Taking an ambulance is not an option. The woman resists the idea of paying cab fare, because she is so poor. She is angry and feels left out of a system that she views as uncaring.
However, in our area there are non-medical transportation services, potential volunteers to drive people to medical appointments and agencies that would probably pay for cab fare in such a circumstance. However, this woman doesn't know how to access any of these services. Moreover the clinic receptionist did not provide that kind of information, and perhaps didn't know that information. Nor did the receptionist connect her with someone in the clinic who could help her access those services, listen to her distress or help her find a solution to her dilemma.
The second tail. Service providers, whether they are clinics, hospitals, wellness centers, individual practitioners or group practices, whether they are completely medical or integrative health care, for- profit or non-profit, large or small, all have a multiplicity of pressures and demands to satisfy. There are governmental licensing requirements, professional standards to meet, cost pressures both like and unlike those of any other business, competitive factors, and the need to make enough money for a surplus (whether that is called 'profit' or not).
As an example, let's take a local clinic which provides training to medical residents, and which treats many low-income people. It is not-for-profit, and has a well-trained medical staff, most of whom have been at the clinic for many years. This clinic receives much of its funding from insurances, the medical assistance program and private pay. It also receives some support from educational institutions which place trainees in various disciplines there for internships and practical experience. This clinic has had to cut back in some "non-essential" services because of budgetary constraints. It must generate some kind of surplus from some source if it is to incorporate anything new or improved, as it must have the funds to add staff, equipment, technology or space. Whatever is required to make the improvement will cost money.
The third tail. Health care financing is perhaps the tail that wags this dog. It is this tail that requires the making of difficult decisions by those who need health care services and those who provide them. Health care financing comes from many different sources: out of pocket private pay, health insurances through employment or private purchase, governmental programs such as medical assistance and medicare, private foundations, and local governments. There is considerable debate about what needs to be done in relation to health care financing to increase access to health care services and to provide sufficient revenue to service providers so that they will continue to provide those services. Further, there is much discussion about how to reduce health care costs within the whole complex system. United States health care costs are extremely high, and health outcomes are fairly low compared with those of other industrialized nations.
The fourth tail. Governmental regulations specify who will be covered for health services paid for by government funds; who can provide health care services at all, and under what conditions; and how the various funders must conduct themselves. There are governmental regulations regarding health care services, providers and funders at all levels of government: local, state and federal.
The fifth tail. Health care information and education is provided to consumers by an array of service providers, public agencies, the media, and governmental organizations. Professional training in providing health care services takes place in colleges, universities and technical colleges operated by governments, private non-profits, church institutions, and foundations.
The sixth tail. Health care knowledge, technology, information and mystique also play a role in what health care consumers know and want, what service providers make available, and what funders will pay for. There are some fairly strong trends towards, for example, use of complementary, supplemental, integrative or alternative therapies, much of which consumers are paying for outside the usual health care financing system. Health care professionals are increasingly being trained to offer or to work within integrative systems that include alternative health care services such as massage, therapeutic touch, herbalism, energy healing modalities, hypnosis, acupuncture, etc.
Image is from http://necsi.org/projects/
No comments:
Post a Comment