Limitations and Probable Outcomes in Affecting Change in Society

PAF 505

Carolyn F. Sentino

Arizona State University

Abstract

The policy that I am interested in is the Health Care system.  In a mission for responsibility in the distribution of health services, health care policymakers in both government and private sectors are forming medical training rules, several of which deeply highlight health and pharmacological styles. Hitherto, there are now enough information to support the efficiency of psychotherapeutic measures for a broader variation of certain disorders, and it appears that this day and age is the proper time to transfer these results to health care policymakers and the community.

Limitations and probable outcomes in affecting change in society

The limitations and likely outcomes in affecting change in society are for health and social care specialists, such as doctors, nurses, physiotherapists and social workers, need to work together effectively to take care of patients more efficiently. Regrettably, professionals do not regularly work well together. Training and educational programs have been established as a viable way to improve how professionals work together to take care of patients.

Some ways to improve how professionals can work together and the care they provide to the public, is by improving the working culture in an emergency department and patient satisfaction; reduce mistakes in an emergency department; improve the supervision of the attention delivered to domestic violence victims; and improve the knowledge and skills of professionals providing care to mental health patients. (Barlow, 1996)

Outcomes in Health Care Policy

According to (Reeves, et. al. 2008), “Determining the group of relevant results to measure for any medical condition (or patient population in the context of primary care) should follow several principles. For example, outcomes should include the health circumstances most relevant to patients. They should cover both near-term and longer-term health, addressing a period long enough to encompass the ultimate results of care, and outcome measurement should include sufficient analysis of risk factors or initial conditions to allow for risk adjustment.”

Numerous outcomes equally define success in any condition or population. The difficulty of medicine means that challenging issues (e.g., near-term safety versus long-term functionality) must often be considered against each other.

Improving one outcome can profit others. An example of improving an outcome is that more timely treatment can improve recovery. However, achieving a complete recovery may require more laborious treatment or include a severe risk of complications.

The most important outcome of health care policy is the usage of providers, for whom complete measurement can lead to significant improvement. Outcomes do not need to be reported publicly to benefit patients and providers. To report outcomes to the public, it should be carefully done to win the vendors’ confidence.

Current cost-measurement approaches have also hidden value in health care and led to cost-containment efforts that are incremental, ineffective, and sometimes even counterproductive. Today, health care organizations measure and accumulate costs around departments, physician specialties, separate service areas, and line items such as drugs and supplies; a reflection of the organization and financing of care costs. Outcomes should instead be measured around the patient. Measuring the total costs over a patient's entire care cycle and weighing them against results, will enable structural cost reduction, through steps such as reallocation of spending among types of services, elimination of non–value-adding services, better use of capacity, shortening of cycle time, and the provision of services in the appropriate settings

Much of the total cost of caring for a patient involves shared resources, such as physicians, staff, facilities, and equipment. To measure real costs, shared resource costs must be attributed to individual patients based on actual resource use for their care, not averages. The significant cost differences among medical conditions, and among patients with the same medical condition, reveal additional opportunities for cost reduction.

The failure to arrange value improvement in health care delivery and to measure value has slowed innovation, led to ill-advised cost containment, and encouraged micromanagement of physicians' practices, which imposes substantial costs of its own. Measuring value will also permit reform of the reimbursement system so that it rewards value by providing bundled payments covering the full care cycle or, for chronic conditions, covering periods of a year or more. Aligning reimbursement with value in this way rewards providers for efficiency in achieving good outcomes while creating accountability for substandard care.

As Weinstein, 2001 states, “Health Policy is useful to examine how models have been used to influence resource allocation decisions in health care. Our purpose is only to show that public-sector and private-sector health-care policy makers do pay attention to models. The implication is not necessarily that the models lead to better decisions, but that they are perceived as valuable by organizations entrusted with our health-care dollars.”

The US government has a long history of using and developing models to guide public health policy. Models, rather than direct evidence of cost-effectiveness, have supported vaccine recommendations by the Centers for Disease Control and Prevention (CDC) at least since the late 1960s. The CDC’s report “An Ounce of Prevention” reviewed and endorsed a variety of model-based estimates of gains in quality-adjusted life expectancy and cost-effectiveness ratios. The CDC also used a model to guide its decision concerning screening for thyroid disease in persons exposed to radioactive iodine (I-131) near the Hanford (WA) nuclear weapons facility. Its recommendations that pregnant women increase their consumption of folate-rich foods to prevent neural tube defects were based on a model that synthesized evidence from a variety of sources, rather than on direct proof of benefit.

The US Health Care Financing Administration based its decisions to cover immunization against pneumococcal pneumonia (1981) and influenza (1993) under Medicare on influential models [29, 30]. Then, Medicare has appealed to strong but indirect evidence of cost-effectiveness from models to cover magnetic quality angiography instead of carotid angiography before carotid atherectomy and to cover erythropoietin as adjuvant therapy under the end-stage renal disease program (personal communication: Sheingold S, US Health Care Financing Administration). Evidence supporting the cost-effectiveness of pharmaceuticals is now required in support of coverage decisions in Europe, Canada, and Australia, and guidelines for the use of models have been promulgated. The Academy of Managed Care Plans and several individuals managed care companies in the United States have also issued guidelines for standards.