The United States has been known to have the best healthcare services in the world but shortcomings are becoming more evident (University of Maine, 2001). The healthcare system is not working as well for all the people of the US. A good healthcare system has to ensure good health to the entire population, be responsive to the people’s expectations of respectful treatment with client orientation by the providers and with fairness in financing according to the ability to pay (WHO, 2000). The US has the costliest health care system, the reasons being innovative and expensive medical technology, costly prescription drugs and high administrative costs (University of Maine, 2001). 21% of total health care expenditure is simply administrative costs. For-profit hospitals showed an increase of 34% while nonprofit ones showed 24.5% and public hospitals 22.9% increase. Aging is also contributing to increased costs. The only developed country which does not provide health care services to all its citizens is the US. The most common indicators of health and well-being of infant mortality rates, life expectancy and disability-adjusted life expectancy showed surprising results for the US (University of Maine, 2001). The US was ranking 26th among industrialized countries for infant mortality rate. It ranked 24th for disability-adjusted life expectancy. For responsiveness, the US was the first-ranker. US was the least fair of all the OECD countries where financing was concerned. It was ranked 15th for overall attainment. Only 40% of people were satisfied with the system (University of Maine, 2001).
Aging is a major problem waiting to trouble Americans in the near future. The elderly deserve a comfortable aging period, safe housing and end-of-life care. Health must be promoted and disability reduced. This is the message that was evident from my parents who remembered the plight of their parents who suffered for want of sufficient care. They were looked after by their own children who had to put together a tidy sum for their benefit. The annual increase of the aging will be 10 million every year for the next decade (Kinsella and Philips, 2005). By 2030, the number of old people will be rising from 12.45 to 20%. The number of people above 85 years would be rising from 3.3% to 5.4% by 2030. Kinsella and Philips (2005) believe that credit must be given to the good Health Care services available in the US along with urbanization and modernization. Statistics have shown that the healthcare expenditures have risen to 12% of the budget (CHSRF, 2004). The American Medicare has indicated that 27-30% of the programs’ costs is utilized by 5-6 % of the aged who die yearly (CHSRF, 2004). The cost of dying must be so changed that every person is able to avail of affordable insurance.
My aunt needed palliative care months after being diagnosed with a late stage of carcinoma of the uterus. Her last days of pain and suffering fifteen years ago informed me about the deficiency in the palliative care and hospice care systems then. She was managed at home as she insisted on that. Palliative care is defined as an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (WHO, 2002 cited in Estfan et al, 2007). About 1479350 patients have been diagnosed with cancer in 2009 (Grant et al, 2009). One in every four deaths is caused by cancer. The numbers will rise with the increase in life expectancy. The situation has definitely changed over the last few years and there are several services now catering palliative care. National guidelines too have recommendations for palliative services to be followed by the care centers (Grant et al, 2009). In spite of a progress in palliative care, barriers still remain. The improvements that could be thought of are effective treatment for distressing symptoms of vomiting and pain, better communications between care-givers and patients, and reducing conflicts with patients and family in preferences for treatment. More palliative care specialists and special care nurses must be trained and posted apart from social workers, psychologists, counselors, nutritionists and staff for rehabilitation work.
At this point I would also like to speak about end-of-life care. End-of-life care is no more in the acute care ward and has been shifted to extended care facilities (Harrison and Ford, 2007). This is a positive feature of the US health services and my family welcomes it. Terminal care may now be provided in the nursing homes, hospice care units or the patient’s residence or in a community center. This may be more acceptable to the dying patients who would like to have familiar faces, friends and relatives around them. They would also be able to move around in familiar surroundings and do whatever they loved doing in their leisure. Seeing their children and grandchildren around and about would provide the spiritual solace they are searching for. The acute care ward may be too stiff for them.
Controlling health care costs in the United States is a great challenge (Bertko, 2007). Several factors which have been identified as leading to enhanced health care costs are cost inflation, enhanced utilization, innovative interventions, drugs and reduced incentives. The number of people without insurance as indicated by the US Census Report was 46.6 million (Hart, 2006). The way health care is financed in the United States needs to be changed (Kennedy, 2009). The current dysfunctional system is liable to lose money and power unless reform is established. The reforms need to make the market work for the physicians and patients. Employment-based insurance could remain the same. New forms of insurance must be made available to the number of people who are uninsured and insured as well; the poorest of the poor must have insurance. The changes may interfere with the established practices of physicians but they need to be open to innovative methods.
The US healthcare system is not the best in the world. Aging is increasing tremendously with its problems of end-of-life care and palliative care. Every person must be provided the care needed at the lowest cost by insurance in their homes, community centers, nursing homes and hospices. Cancer patients constitute a large number of end-of-life care patients or needing palliative care. Controlling health costs is a challenge in the US.
Bertko, J. (2007). Health care for All’s proposals for controlling health care costs. Journal of Ambulatory Care Management, Vol. 30, No. 3, p. 203-205, Wolters/Kluwer Health/ Lippincott Williams and Wilkins
CSHRF Canadian Health Services Research Foundation, (2004). The cost of dying is an increasing strain on the health care system. Journal of Health Services Research and Policy, Vol. 9, No. 4, p. 254-255
Estfan, B., Walsh, D., Shaheen, P.E. and LeGrand, S.B. (2007). The Business of Palliative Medicine-Part 5: Service utilization in a comprehensive integrated program American Journal of Hospice and Palliative Medicine Vol. 24, No. 3 p. 211-218 Sage Publications.
Grant, M., Elk, R., Ferrell, B., Morrison, R.S. and von Gunten, C.F.(2009). Current status of palliative care-Clinical implementation, education and research. CA Cancer Journal Clin, Vol. 59, p. 327-335 American Cancer Society Inc.
Harrison, J.P. and Ford, D. (2007). A comprehensive community-based model for hospice care American Journal of Hospital Palliative Care, Vol. 24, No. 2, p. 119-125 Sage Publications.
Hart, M.A. (2006). Massachusetts: Expanding access to care, AJN, Vol. 106, No. 10, Wolters Kluwer Health
Kennedy, M.S. (2009). Change happens. Editorial, AJN, Vol. 109, No.8, p. 8-9
Kinsella, K. and Philips, D.R. (2005). Global aging: The challenge of success. Population Bulletin, Vol. 60, No. 1, Popular Reference Bureau
University of Maine, Bureau of Labor Education (2001). The US healthcare system: Best in the world or just the most expensive. University of Maine