Essay Example on Decision-Making in Public Health Spending

Introduction

Funding is one of the most contentious topics in America. The problem arises due to the unequal distribution of health (Getzen, 2013; Adepoju, Preston, & Gonzales, 2015). This inequality owes to the insufficiency of resources available. This problem implies that any decision to allocate resources to the public health systems requires there to be a tradeoff. Therefore, policymakers must answer "who gets what (treatment), and who must give up what" (Getzen, 2013, p. 427). Given these issues, Getzen (2013) posits that the complications ailing the US public care system originate from traditions and practices ingrained into the core of the medical profession, implying the fix should come from within the care system itself. This paper thus evaluates how health professional can affect future financing decisions related to public health policy; describes the two measures policymakers should take to justify the financing of national public health initiatives; and explain the importance of these measures.

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How Health Professional Can Affect Future Financing Decisions Concerning A Public Health Policy

Getzen (2013) uses the path dependence theory to explain that the public health issues the US is facing today, go back to 1965. According to him, the theory implies that "the current system is not only a function of current conditions but also a function of the path taken to get here" (p. 433). The problems Getzen (2013) cites include the prevalence in specialist practitioners as opposed to family doctors, the continual increase in costs, citizens filing for medical bankruptcy because of hospital bills the difficulty to claim employer insurance due to the extensive copays (Shankaran & Ramsey, 2015) paperwork it requires, and the lack the lose of public confidence towards the medical profession (Getzen, 2013). Additionally, the medical system still has path-dependent remnants that fixate the US to past realities. These include a professional built on the 1920s truths, an insurance system dependent on employees benefits of the 1950s and 60s, and academic medical facilities built on the extensive financing of the 1970s. These archaic practices constrain the system, characterize it as structure "rising costs and falling satisfaction" (Getzen, 2013).

For instance, due to the deep-rooted practices and revered traditions of the medical profession, and the constant flow of funding has not undergone the "management, financing, workflow, and information processing that gradually revolutionized" (Getzen, 2013, p. 434) other US industries. Therefore, despite the strides other American's industries have taken in implementing IT-based solutions, physicians still shuffle paper records (Getzen, 2013). Similarly, the Medicare Act provides for the differentiation between inpatient and ambulatory care - a 1960s practice that has lost relevance and whose continual usage prevents effective price bundling (Getzen, 2013). These issues penetrate deep into the psyche of the US's care system, so much so that the path dependence theory implies that any meaningful reform should arise from within the existing systems, say, eradicating flaws and adding some innovative essentials, but not total overhaul (Getzen, 2013).

Therefore, health practitioners can influence the cost of future care downward by transforming the profession to one founded on teamwork (Levesque et al., 2018) and by centers modern IT to the practice of medicine (Stadler, Donlon, Siewert, Franken, & Lewis, 2016). This development will enhance management structures and IT, which will decrease administrative costs and improve outcomes tracking (Getzen, 2013; Stadler et al., 2016). Further, physicians should organize themselves into technical teams administered under the concepts of corporations as opposed to independent practices (Getzen, 2013). Also, the professionals should embrace economic information and cost accounting, which will enable them to integrate (Wilson, Gole, Mishra, & Mishra, 2016) the benefits of comparative decision making into their operations. This move would allow them to understand the difference between actual costs and the actual effectiveness of clinical practice, and lead them to a precise the answer to the tradeoff question between dollars and health this discussion raised in the introduction (Getzen, 2013). More importantly, physicians should emphasize an integrated (Wilson et al.,2016) "assessment of processes in real time rather than examination of each part or profession separately" (p. 438). These measures are likely spur the public's confidence in the health system, which could, in turn, spur political will to implement a public health policy (Gostin & Friedman, 2017).

The two Measures to Justify the Financing of National Public Health Initiatives and Why they are Important

Policymakers should justify national public health initiatives if they include two measures - dynamics efficiency and distribution.

Dynamic Efficiency

The hardest thing in health reforms is never "how to improve efficiency" but "how to make a deal" (Getzen, 2013, p. 430). The latter question is more complicated because changes usually involve tradeoffs, where a significant allocation of resources is going to hurt somebody, which produces resistance (Getzen, 2013). The reason being, those groups that the policy will harm are always skeptical of whether it adequately weigh their concerns (Resnik, MacDougall, & Smith, 2018) or it has proportionally balanced the damage they receive with other benefits they obtain from other programs and policies (Getzen, 2013). Moreover, future pledges of fair treatment are hard to believe the farthest they are in time and how uncertain the compensating gains are (Getzen, 2013), especially in the health sector. An initiative should thus make allocations that balance between present consumption and upcoming productivity. It is evident that the primary challenge a reform initiative must overcome is to be set up in a way facilitates dynamic efficiency (Getzen, 2013). For instance, a policy should provide for both a high-tech as well as an organizational change to advance health and productivity (Getzen, 2013). A plan should forgo some current allocative efficiencies (Greenlaw, Shapiro, Taylor, & OpenStax College, 2018) to, say, allow scientists some time to fiddle with experiments and discover new ideas (Getzen, 2013). The person creating a health policy should refrain from emphasizing on a purely cost-minimizing strategy as this reduces creativity, which is uneconomical in the long-run (Getzen, 2013). That should always remember that dynamic capabilities imply doing the right thing (Teece & Leih, 2016)

Distribution

Health policymakers face contentious distributional questions, including "distribution of resources, the distribution of health, the distribution of medical care, and the distribution of provider incomes" (Getzen, 2013, p. 432). One should not assume that other factors such as the quality of care, the skills of the physicians, or the use of technology are insignificant (Getzen, 2013). However, they are irrelevant if the care ends up going to the "wrong person or at the wrong time" (Getzen, 2013, p. 432). Health economists typically evaluate how appropriate the health care system has applied its resources to achieve its express and implied objectives (Getzen, 2013). Ensuring a policy has a credible distribution is vital for the justification of a health initiative (Resnik et al., 2018) because it helps to solves some contentious problems (Getzen, 2013). These include questions on "personal values, public goods, macro allocation, contentious questions of how the costs and benefits are to be distributed between different groups of producers and consumers, and the political dynamics of change" (Getzen, 2013, p. 432).

References

Adepoju, O. E., Preston, M. A., & Gonzales, G. (2015). Health Care Disparities in the Post-Affordable Care Act Era. American Journal of Public Health, 105(S5), S665-S667. https://doi.org/10.2105/AJPH.2015.302611Getzen, T. E. (2013). Health economics and financing (5th ed). Hoboken: John Wiley & Sons.

Gostin, L. O., & Friedman, E. A. (2017). Global Health: A Pivotal Moment of Opportunity and Peril. Health Affairs, 36(1), 159-165. https://doi.org/10.1377/hlthaff.2016.1492Greenlaw, S. A., Shapiro, D., Taylor, T., & OpenStax College. (2018). Principles of economics 2e.

Hackney, D. D., Friesner, D. L., & Johnson, E. H. (2018). Towards a Working Profile of Medical Bankruptcy. Journal of Financial Counseling and Planning, 29(1), 75-90. https://doi.org/10.1891/1052-3073.29.1.75

Levesque, J.-F., Harris, M. F., Scott, C., Crabtree, B., Miller, W., Halma, L. M., ... Russell, G. (2018). Dimensions and intensity of inter-professional teamwork in primary care: Evidence from five international jurisdictions. Family Practice, 35(3), 285-294. https://doi.org/10.1093/fampra/cmx103

Resnik, D. B., MacDougall, D. R., & Smith, E. M. (2018). Ethical Dilemmas in Protecting Susceptible Subpopulations from Environmental Health Risks: Liberty, Utility, Fairness, and Accountability for Reasonableness. The American Journal of Bioethics, 18(3), 29-41. https://doi.org/10.1080/15265161.2017.1418922

Shankaran, V., & Ramsey, S. (2015). Addressing the Financial Burden of Cancer Treatment: From Copay to Can't Pay. JAMA Oncology, 1(3), 273. https://doi.org/10.1001/jamaoncol.2015.0423

Stadler, J. G., Donlon, K., Siewert, J. D., Franken, T., & Lewis, N. E. (2016). Improving the Efficiency and Ease of Healthcare Analysis Through Use of Data Visualization Dashboards. Big Data, 4(2), 129-135. https://doi.org/10.1089/big.2015.0059

Teece, D., & Leih, S. (2016). Uncertainty, Innovation, and Dynamic Capabilities: An Introduction. California Management Review, 58(4), 5-12. https://doi.org/10.1525/cmr.2016.58.4.5