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The health care system of the U.S has been the subject in national circles. On one extreme of this debate, there are people who argue that the system is the best in the world pointing to the state of art facilities and clear cut technology (Davidson, 2010). On the other extreme of this debate, there are people who argue that the health system is inefficient and fragmented. They point to the fact the America spend than any other country in terms of health yet still suffers from insurance and uneven provision of services.
To critically determine the basis of two extremes, necessitates understanding the U.S health care system. The private element over dominates the public element. Over 62% of non-elderly Americans received the private employer-sponsored insurance coverage with 5% purchasing from the private non-group. Only 15% enrolled to the public insurance providers such as Medicaid. Public Health insurers include programs such as Medicare that covers for individual aged over 65 years, as well as disabled ones. Medicare, on the other hand, covers for low income groups and disabled.
As a requirement of federal law states need to cover the insurance for very poor pregnant women, children and the elderly. Other include the S-CHIP for children, VA for the veterans in the military. The private insurance providers include the employer-sponsored. This forms the way in which Americans achieve health care. The private non-group provides the coverage for the self-employed. The health care system in America is financed from two streams of money.
The collection of the money after the provision of the services and reimbursements of the service providers. There is the cost sharing both by the government and the private insurance companies (Davidson, 2010). The United States spends more in health care in comparison to other developed countries. The US has a higher childhood deaths and low levels of life expectancy. Maternal mortality records 32% with the recommended being 5-15%. Disparities to accessibility of health care and insurance dominate the system in America.
Just like the American health care system, Costa Rica components of health care include both public and private sectors. The public sector is dominated by autonomous institutions charged with the responsibility of purchasing and delivering much of the health services in the Costa Rica. Caja Costarricense de Seguro Social (CCSS) is financed from the contributions made by the affiliates such as the employers and the state (La Forgia, 2005). It has extensive involvement in the management of maternity and illness, disability, the elderly and the non-contributive part of the society.
CCSS has the capability of providing the services within its own facilities but can contract the private providers. The private sector, on the other hand, encompass a broad range of services that offer both ambulatory and health care (La Forgia, 2005). The services are paid out of pocket with private health insurance firms contributing. The Ministry of Health remains the steward coordinating the functionalities within the public and private health care providers. With every standard in mind, Cost Rica has the best health care system in Latin America with new improvements in terms of infrastructural facility. Statistics from the WHO places Costa Rica as a top country in terms of high levels of life expectancy. Health insurance is made available to all Costa Ricans (La Forgia, 2005).
The affordability of the health care reduces the disparity in the access of the facilities. In comparison to the U.S private care, Costa Rica is relatively cheaper for the average visits. Dental work is relatively cheaper prompting a common term called medical tourism. Private hospitals are known for private practice by the doctor offer services at a cheaper rate than the U.S private practitioners (Langenbrunner, Cashin & O'Dougherty, 2009).
Despite the success in the provision of health care services in Latin America, Costa Rica public health system is in a dire critical condition. The public health care system is in the verge of collapsing due to financial illness (La Forgia, 2005). The social security system is also known as Caja had a deficit amounting to 82 million dollars risking the 1.4 million people enrolled to the system. The annual budget for Caja is 1.8 billion dollars.
Internal audits revealed that Caja had several shortcomings with overdue payments for the service providers and suppliers of medical equipment. This poses major challenges to the health care system if the creditors fail to do business with the Caja (Langenbrunner, Cashin & O'Dougherty, 2009). The financial woes for Caja worsened when the Ministry of Health ordered closure of operating rooms due to poor conditions that could compromise the safety of the patients. Ironically, the government even owe money to Caja. Money could not be blamed for the challenges faced by the Social Security Fund, rather the social changes that make the Caja not keep apace. Some of these changes include a decrease in life expectancy and lifestyle disorders such as diabetes and high blood pressure.
Unlike the lower rates of funding in the public health system of Costa Rica, the U.S healthcare system faces a myriad of challenges. There is diminishing access to healthcare facilities in the U.S unlike that of Costa Rica. 15% of American population live without any form of health insurance. The medical costs in U.S are on the rise with the country spending over than 15% of its GDP on the health. There are many bureaucracies in the health system with a high percentage of the money meant for healthcare spent on paperwork (Jonas, Goldsteen & Goldsteen, 2007).
The rising cost of the medical bill makes many people bankrupt. A survey done in 2006 indicated that more than 25% of Americans experience difficulty in paying the medical bill. The ranking of the health care system of the U.S is 37 in the world with sub-optimal care given. This is indicated by low life expectancy and high infant mortality. The health care system seems to be minting huge profits at the expense of provision of equitable care. The system is confusing to the citizens with many people in the mix not knowing what to choose that will be beneficial in the long run. This relates to health insurance premiums both at the private and public sector (Jonas, Goldsteen & Goldsteen, 2007).
The pros of American Healthcare systems reflect in the public health sector where there are initiatives such as Medicaid, Medicare, VA, and Affordable Care (Naden, 2010). Programs such as Medicaid ensure that old people and the disabled have access to healthcare while Medicare ensures that the people reigning from the poor background can access health. Initiative such as VA takes the interests of military veterans in provision of healthcare. Affordable Care is a recent promising health care for the low income groups.
This will guarantee health coverage to these groups that are not insured. People will be capable of accessing basic preventive care before the full-blown illness (Naden, 2010). The cons of the system are that a huge stake is run by the private sector. Disparity in health care has risen with many people unable to access basic health care. Opponents of the universal health care argue that people should pay in order to obtain the service. It is also difficult to guarantee the types of services to be rendered under the public health system. Opponent argues that the above initiatives will lead to moral hazards since people understand that there is guaranteed health coverage (Naden, 2010).
The biggest advantage of the Costa Rican health care system is that it is low cost. Contribution to the healthcare entails as little as 10-11.5%. Unlike the American Healthcare system, it is available even in small clinics and other health care centers. Caja has excelled majorly in the provision of preventative medical care. This entails regular checkup for diseases such as blood tests and mammograms. Caja acts as a Social Security Fund with customers automatically qualifying for pension when they reach the age of 65 and above. The main disadvantage of the system is a long wait time (Davidson, 2010. At the local clinics, people have to arrive one hour earlier to access the medical care. The prescription drugs used in Caja are of generic origin. Furthermore, with Caja people are limited in the choice of the medical provider.
In Costa Rica, the health insurance coverage reached 87.6% of the whole population in 2009 with the percentage remaining constant in the later years (La Forgia, 2005). This comprises of 61.9 per cent economically active persons and 53.6 per cent relying on the pension insurance. The number of uninsured citizens represents 390,000. In the U.S, the number of uninsured people represents 15% of the population. As of 2012, the number of uninsured American fell to 15.4 per cent. This represents 48 million of the population proportion that is high in comparison to the Costa Rican (La Forgia, 2005).
The government in the two countries have an important role to play in ensuring workable health care system. Since the market cannot adequately support the health care needs of the citizens, the government should intervene and bridge all the gaps that exist in situations where there is unfairness.
The government should have a huge concern in creating the necessary environment for partnership Jonas, Goldsteen & Goldsteen, 2007). Other Government-based intervention include decentralized delivery systems, developing health care workforce and evaluating the adopted technologies and practices (Davidson, 2010). The government shoulders the responsibility of ensuring that the health care is readily available and affordable by cutting down the budgeted money on the sector. The government in Costa Rica has the role of creating a level play field that will ensure that the country can get sufficient funding for the Caja. The custodian of health that is the Ministry should be capable of getting extra funding for the running of Caja.
Costa Rican Health Care system is the best among the two. Despite the country being behind the U.S in terms of economy, it has made huge strides in health (Naden, 2010). The choice is based on the low percentage of the population that is uninsured compared to the American. A good health care system should ensure accessibility and affordability. The Costa Rican health care system is accessible and affordable to many citizens unlike in the U.S where there is huge health disparity (Jonas, Goldsteen & Goldsteen, 2007).
Davidson, S. (2010). Still broken (1st ed.). Stanford, Calif.: Stanford Business Books.
Jonas, S., Goldsteen, R., & Goldsteen, K. (2007). An introduction to the U.S. health care system (1st ed.). New York: Springer.
La Forgia, G. (2005). Health system innovations in Central America (1st ed.). Washington, D.C.: World Bank.
Langenbrunner, J., Cashin, C., & O'Dougherty, S. (2009). Designing and implementing health care provider payment systems (1st ed.). Washington, D.C.: World Bank.
Naden, C. (2010). Health care (1st ed.). Tarrytown, NY: Marshall Cavendish Benchmark.
Strategy is a crucial element in the management. The development of a strategy entails high level planning in order to achieve set goals given conditions and time. Planners make use of four tools in their analysis to establish the state of the business and develop a good strategy. The SWOT analysis is a common phenomenon in the field of business that helps in establishing the state of the business. Remarkably, planners understand that the history of a company or business is always an essential starting point in strategic planning. In details the SWOT analysis focuses on the strengths, weaknesses, opportunities and threats to the company. The study, capability and clinical success article presents relevant facts and cases in the field of health care that are critical to a detailed analysis. During the study, the main focus is on the internal factors that threaten the success of the health care as well as the untapped opportunities.
1. SWOT Analysis
One of the key goals highlighted in the article is the recognition and building of existing assets. In doing this, the main focus is to reduce cases of resignation and to control the number of dependants. As the writer explains, most of the less privileged people survive under very limited opportunities and resource. Instead of using formula solutions, their wisdom and strategies for survival could be turned into great programs that will not only apply to the target group but also to other players in the economy.
Another objective towards realization of clinical success is continuous assessment of patients on their capability to maintain a healthy diet and exercise. This can be implemented when patients visit the hospital for treatment (Ferrer & Varela, 2010). The assessment involves general questions such as the availability of fruits and vegetable where the patients live. Data collected during this process could be used to connect the less privileged members of the society to opportunities that encourage healthy behaviors.
According to the writer, clinics today operate on the basis of theoretical formulas while most community health workers close their eyes to the actual situations that the patients have to deal with. In most cases, the patients receive guidelines on how to improve their health but they face resource limitations and the situations that surround them. The article recommends an involving policy where everybody takes part in the process. This shall go a long way in easing the management of chronic diseases.
The local connector is a significant method of connecting the guide to healthy practices and the available resources. Through the connector method, patients are allowed to choose appropriate resources that best suit their situations. Several tests have been done by experts in the field of health care to verify the viability of the invention. In all the tests, the method has been proven to be highly effective in managing referrals. Other advantages of the connector method include ability to check patients’ progress, provision of reminders and delivering complex behavior change counseling. In addition, the method has been tested in California where the researchers have confirmed that the program is feasible and effective in managing chronic conditions.
The health sector faces a major problem which is poverty among the people. According to the article, the health sector has not been able to reduce the health disparities among low income earners. Such people are known to suffer from a heavy burden financial burden when it comes to dealing with chronic diseases (Ferrer & Varela, 2010). Worse even, the disadvantaged members of the society cannot afford a good lifestyle in terms of diet and the surrounding. The majority of these people live in slum-like areas which are characterized by congestion and an abundant supply of cheap and unhealthy diets. Regardless of the efforts this factor has been and still is causing serious drawback in the health sector. According to research, little progress has been made over the last 20 years.
Another weakness in the health sector is that the medical officers are limited in scope when making their advances to improve the outcome on management of chronic diseases. The external environment, which comprises of the patients and the individual challenges, influence the patient’s confidence, motivation and problem solving capabilities. Important for consideration is the review on national diabetes management education. According to the review, it is evident that patients receive little guidance beyond basic recommendation. The implication here is that medical practitioners fail to account for the social determinants sufficiently.
There exists a potential threat to the management of chronic diseases since the factors that contribute to the success of a management program are highly dependent on the patient. There is a high possibility of discordant outcome. Precisely, the success of a management program for chronic disease depends on the patient’s willingness to drop the unhealthy behaviors and focus on adopting a healthy life (Redman, 2004). Not all patients respond positively to when persuaded to alter their lifestyle since a majority adopt such behaviors as a result of pressing circumstances such as poverty, low income or high levels of illiteracy. Patient empowerment including a holistic program for health literacy, self-management and motivational interviewing are some major strategies that could be implemented to deal with this menace.
A valid opportunity in changing the situation of public health lies in changing people’s perspective on patient’s capability to manage chronic diseases. While several restaurants and food stores encourage the consumption of unhealthy foods, the community is not compelled to consume unhealthy diets “no one is stopping you from eating healthy food” (Ferrer & Varela, 2010). The health practitioners have an opportunity to intervene and encourage healthy lifestyles for the willing but not able embers of the society. With the aid from the government, it is easy to support healthy lifestyles by availing a sports ground to motivate people to engage in physical exercise.
2. Key Situations
The state of the social and physical environment plays a major role in encouraging risky behavior and lifestyle. According to the article, the retail setting in the residential areas for low income earners is characterized by a few supermarkets, many fast-food outlets and liquor stores. This implies that there is an inadequate supply for health foods while substances that threaten the lives of patients are readily available. Even worse the few available supermarkets stock low quality product and a few healthy food options (Institute of Medicine, 2012). Restaurants in residential areas for low income earners are the top advocates for unhealthy feeding. While they too offer healthy options they are highly determined to market the unhealthy dishes that they offer.
The physical environment for the less privileged is characterized by numerous barriers to physical activity. Houses are highly congested with the available space filled up by traders, which leave no room for physical exercise. When the consumption of unhealthy foods is added to less or no physical activity, the result is critical health problems or deterioration of existing ones. This shall increase the capability of customers to adopt and uphold healthy lifestyles.
3. Future Trends in the Article
Capability and clinical success are a possibility given the right conditions and implementation of policies. The article brings forward developments that focus on improving the future of medical clinics and their role in managing chronic diseases. If the recommended projects work efficiently, the nest series for this article shall be a success story for the medical clinics. As medical practitioners face the problem of lifestyle related problems hands on, the world should anticipate a high decrease in the number of people suffering from chronic diseases. In addition to dealing with less privileged in the society, the article should address the issue of chronic among the rich in the society. Clearly, the well up in the society are neither victims of inadequate resources nor physical barriers to physical exercise.
The article has a high impact on the way medical clinic are run. While the current situation just offers formulas for effective management of chronic conditions, the article suggests better methods that fully engage all players. It is important to note that patients have different affiliations and literacy levels. Moreover, there are external factors that compel them to develop the poor behaviors. The article suggests significant reforms such as the active involvement of community health workers in the management process. This involves providing company during physical activity and mobilizing family members and close friend to participate in the management of the condition.
5. Thoughts and Opinions about the Article
The article is a masterpiece of the societal health state representation. Precisely, the writer looks at ordinary issues which are neglected by many, even medical practitioners but have gross repercussions on health. Most people living in underdeveloped areas are very comfortable with the diet with most of them claiming that they cannot afford a better life. Nonetheless, it is crucial to make an effort regardless of the environment or circumstances. From the article, the writer notes that even in the residential areas for the poor there exist healthy food options even if they are few.
The health care system has kept a good record in dealing with short term diseases and as well as controlling outbreaks. However, chronic diseases are a glaring menace that is contributing to the highest percentage of deaths among the rich and the poor. Diseases such as diabetes, cardiovascular diseases and lung disease among other chronic diseases are highly prevalent today. Over the last 20 years, cases of obesity among children under the age of 2-11 years have doubled while those of teenagers have tripled. These statistics are alarming since obesity is closely related to heart diseases, high blood pressure and diabetes (Triple solutions for a healthier America, 2014). If no action is taken to control these cases, statistics show that in the near future in every 3 children born one of them will be exposed to a high likelihood of developing diabetes.
The process of managing chronic disease is a great challenge when left to patients alone. Over the years, patients have been taking up the management program while the medical practitioners supervise without getting involved. Over the years, this program has failed to yield results. The report brings forth significant reforms that might transform the situation in the health sector and free people from chronic diseases.
Triple solutions for a healthier America. (2014). The impact of chronic diseases on health care. Retrieved from:
Redman, B. K. (2004). Patient self-management of chronic disease: The health care provider's challenge. Sudbury, Mass: Jones and Bartlett Publishers.
Institute of Medicine (U.S.). (2012). living well with chronic illness: A call for public health action. Washington, D.C: National Academies Press.
Ferrer. R. & Varela. A.C. (2010) capability and clinical success: annals of family medicine journal. Retrieved from:
For individuals suffering from serious mental illness (SMI), the challenges that they continue to face in their everyday lives are no mean feat. The fact that the mental instability in such individuals poses a real-time threat to the overall well being of the individuals is a cause for serious concern. The need to take care of these individuals for the benefit of the entire society cannot be ignored. The article sought to determine the key challenges that individuals suffering from SMI encounter in their lives. This is an interesting topic seeing that these individuals suffer from a great deal of problems, and determining their main challenges is not only interesting but also highly informative.
The hypotheses that the study sought to validate were all hinged on the lives of individuals suffering from SMI. The article wanted to determine whether individuals suffering from SMI also suffer from chronic homelessness, as well as poor health. The study was designed to investigate the prevalence of homelessness and poor health conditions among individuals suffering from SMI. The ability to also determine the causal linkages, if any, between SMI and homelessness, as well as between SMI and poor health conditions was also a key point addressed by this article. By testing these hypotheses, the article was able to highlight any possible relationships linking SMI, chronic homelessness and poor health conditions.
The partnership between the Jefferson Department of Family and Community Medicine and Pathways to Housing has proved to be essential to the methodology employed in assessing the linkages between SMI, homelessness and poor health. This partnership seeks to address the healthcare needs for individuals that are within this group. By evaluating this essential partnership through the patient-centered medical home framework, key conclusions can be drawn as to the linkages between SMI, poor health and homelessness (Weinstein et.al., 2013). While these parameters can provide key information on their own, using the “10 Essential Public Health Services” as a baseline to determine the effectiveness of this partnership proved useful. The use of Likert values to rate the 10 essential services helped provide information on the areas that bear close relations to SMI, homelessness and poor health conditions.
Overlaps in the Patient-Centered Medical Home (PCMH) and the 10 Essential Public Health Services espoused the capability of this partnership to meet the pressing public health demands insofar as SMI is concerned (Weinstein et.al., 2013). The coming to fruition of the labors that this partnership endures in dealing with homelessness and poor health in SMI patients represents the growing ability of this partnership to meet even future needs in the SMI health category. These results are extremely significant seeing that they highlight the success of this partnership, as well as the potential of addressing all future SMI needs in so far as healthcare is concerned.
The discovery of the strong linkages between SMI, chronic homelessness and poor health in the name of HIV/AIDS, schizophrenia and substance abuse and addiction helps to cement the relevance of this partnership in society today. Understanding the different roles played by the PCMH and Pathways Housing in alleviating the effects of SMI is key to understanding the relevance of this partnership. The ability of this partnership to address the issues of homelessness, poor health and SMI in the present society is a testament of its relevance and vitality today and in the near future, as well.
Weinstein, L. C., LaNoue, M. D., Plumb, J. D., King, H., Stein, B., & Tsemberis, S. (2013). A Primary Care–Public Health Partnership Addressing Homelessness, Serious Mental Illness, and Health Disparities. The Journal of the American Board of Family Medicine, 26(3), 279-287.
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