How Can the Healthcare Sector Deal with the Aging Population and the Decrease in Infant Mortality

Document Type:Thesis

Subject Area:Health Care

Document 1

The secondary research involved conducting a review of published sources to identify the strategies proposed by previous researchers. The primary study was conducted using questionnaires distributed over the internet using the surveymonkey. com. Health funding in public institutions was compared to funding strategies in private institutions to identify how the beneficial strategies can be integrated with either type to achieve optimal results. The strategies proposed as a way to deal with an ageing population and decreasing infant mortality was to provide adequate staff, drugs and equipment. Providing these inputs require finance. Therefore the hospitals require adequate funding that should be optimised to provide for the inputs as dictated by the patient characteristics. The movement of a patient within the hospital should be simplified to eliminate unnecessary movements that may lead to unnecessary waste. Other strategies include the use of vouchers and implementing outcome-based payment strategies. The physicians report that private hospitals are more efficient than public hospitals. Chapter 1 - Introduction and Background Introduction Improvement in the provision of healthcare in the recent past has seen an increase in the number of ageing population and reduced infant mortality (Cleland et al. Whilst the healthcare sector is undergoing a lot of pressure because of a large number of people using the services, there is a lot of wastage and unnecessary expenditure that can be saved. The changing demographics have subsequently introduced a trend of multiple life-threatening conditions and unpredictable disease patterns that necessitate fundamental changes to the current strategies in offering healthcare. Different countries employ different approaches towards healthcare systems.

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The variations include the amount spent, an organisation of funding and the specific place to deliver care (Gearhart, 2016). The organisation of funding further includes taxation and insurance premiums. The places of delivery of care include home, community, primary and secondary care. The approaches consume variable amounts of finances that if not properly regulated, results in misuse of the finances leaving insufficient amounts for delivery of actual care. Developed nations always strive to provide universal access to quality care. However, in most cases, the health institutions are faced with financial challenges making it difficult to meet the aspirations (Bramley-Harker, 2004). The objective measures include patient characteristics such as medical diagnosis, age and ASA classifications. Amidst the difficulties in quantifying the demand for healthcare, the problems of funding are evidential in the delivery of care insufficient to meet patient expectations and inability to address the increasing long-term patient conditions.

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In view of the inconsistencies, the proposed research will examine the different strategies used to provide and utilise funding in private and public healthcare systems and evaluate the strategies to highlight the ones that potentially improves the efficiency. The researcher recognises that the public and private healthcare has significant and distinct differences in operations and patient demographics served. However, the healthcare institutions share equally significant features that make the comparison worthwhile hence the research. In a precipitously ageing global population, the problems mentioned above are imminent. The trend is more remarkable in developed countries than the underdeveloped nations implying that the challenges with financing health care in an ageing population and low infant mortality are more pronounced in developed states than the underdeveloped ones. Scholars have debated about how best to regulate healthcare costs and the possible government actions and strategies to provide or subsidise and what the patients should settle and the rest left to the effect of market forces (Ruiz Morilla et al.

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As previously discussed, most government health funding allocations are dictated by the necessity for rapid response in a politically sensitive area. The usual deliberative procedures in government allocations are done based on the programs and series considered most important. • To determine if the private sector can be a good example to the public sector for this type of service. • To determine if a raise in taxes can deal with lack of funding and the inefficiencies. Chapter 2 - Detailed Literature Review This section will provide the relevant literature resources that have been previously published on the topic and related topics. The section will provide the researcher with an understanding of the present state of healthcare demand and funding while providing more insights into the strategies the previous researchers have used to conduct their studies.

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The review will enable the researcher to narrow down the topic into a measurable and objective one that has implications on the healthcare systems. Ageing is often associated with severe disability that further complicates the healthcare demands of the special group. A report by the OECD highlights a rising life expectancy of people living with the disability because of improved medical care and assistance to people with functional limitations (Marcikić et al. The people living with a disability will need more care with potential ageing. The report further notes that ageing will potentially reduce the supply of individuals available to provide long-term care services. The working population will further shrink making the insurance from employees and employers diminish substantially (Powell & Miller, 2016). Declining out-of-pocket health funding increases the influence of the time factor in determining the demand for healthcare.

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The implication of the above is that the demand for free health as provided by public hospitals should be more sensitive to the changes in the cost of time since time affects free healthcare than paid healthcare (Clark & Thompson, 2015). The cost of time also increases when the distance between the individual and the facility is high. Longer distance increases the transport costs and informational posts about the quality of care. The above suggests that locating the public health centres closer to individuals reduces costs of care and increases access to the facilities. Health Care Funding and Costs Healthcare funding considers the question of how much is needed rather than how much funding is available (Penno, Gauld & Audas, 2013). Researchers have recommended that the governments define the core packages of care by specifying the services and involvement that are covered by government funding (Dawson & Surpin, 2001).

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Defining the core packages provides consistencies over how government spending on health is allocated ensuring that public health expenditure meets the fundamental objectives. The lack of the package in shortfalls necessitates the government to ration the funds in ways that challenge the process of meeting the objectives (Snyder, 2016). The NHS has implemented a package of care called continuing NHS healthcare (CHC) that enrols patients and provides them with care according to their needs. The models have been evaluated for cost-effectiveness and achievement of targets and objectives (Lanzeta, Mar & Arrospide, 2016). The models have provided important means of providing incentives to healthcare efficiency and convincing health workers to function within budgetary confines. Policymakers have proposed population-based funding formulas aimed at balancing resource portion with costs of producing care to specific population groups (Whittington et al.

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These methods are specific to each country and region because healthcare needs vary with demographic characteristics. In most cases, the funds originate from taxation while others originate from mandatory private insurance schemes. Finally, the businesses formulate competitive strategies to gain an advantage over rivals. Since health institutions also provide services and compete for customers (patients), similar models can be used to achieve equitable health funding in hospitals (Bosanquet, 2006). However, the four basic models of health care funding include the Beveridge model, the Bismarck model, the National Insurance Model and the out-of-the-pocket model. The Beveridge Model The Beveridge model was named after William Beveridge who designed Britain’s NHS. The system provides that health is offered and funded by the government through tax systems in a similar manner to the police (Claudio, 2013).

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The model considers the private providers through an insurance program run by the government that every citizen is subscribed (Sledge, 2017). The model needs no marketing and financial motive to deny claims (Goodman & Steiber, 1981). The model also makes no profit is cheaper and simpler to administer than the for-profit insurance (Bodenheimer, 2003; Yi-Wen & Teh-Wei, 2002). The government acts as the single payer and has a higher bargaining power for lower prices. The model has been widely used in Canada leading to lower cost of pharmaceutical products making America tend to buy drugs north of the border. The demand economics considers health care as any other good produced for consumers (Minsu & Minsoo, 2016). The consumers have control over the services they purchase and the price of purchase. The customers and suppliers of healthcare are evenly matched and the suppliers have lower ability to induce demand for healthcare or set rates of charge.

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Suppliers aim to produce efficient services to win patients revenues. The market forces may make production to occur at the lowest possible average cost. The researchers further note that more resources need to be allocated to improve disease surveillance, laboratory, communication, and staff (Hudson, 2015). The most common sources of funds for public health institutions include federal funds, state and local funds, county and city revenues, government-paid insurance, fees and fines and other sources such as donations. The federal funds are allocated using grant programs based on population, incidence and other competitive grants (Powell, 2016). The state and local funds and county and city revenues are allocated depending on state governance and health department structures. The federal funding is subject to congressional authorisation and appropriations in many states. The UK government finances the public health service through taxation that contributes to redistribution of resources to people who require health.

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The tax rates are progressive implying that the low income is least taxed while the older enjoy higher personal allowance (Powell, 2016). The insurance contributions are similar to taxes with the main difference being that they originate from earned income. The employees pay the insurance and employers on a pay as you earn basis. Health Financing In Private Health Institutions Private health financing originates from direct payments, private insurance, and other sources. The public sector pays salaries to the physicians while the physicians are on self-employment in the private sector earning profits from their private practice (Kypridemos et al. Higher wages encourage physicians to increase time spent in public hospitals while subsidies on private healthcare encourage physicians to increase amount of time spent in private hospitals. The government also has the opportunity to tax the private sector to induce their commitment to the public sector and improve efficiency and healthcare service delivery to all.

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Researchers have argued that lower cost of healthcare does not necessarily mean better quality. Moreover, health systems relying on private healthcare are less progressive compared to the ones utilising public finance. The department uses retains a portion of the budget operations and funding other bodies offering public health. The funds are distributed through a weighted capitation formula meaning that the funds are allocated according to the population. The NHS pays service providers an annual cumulative amount of money for services provided locally. The payment model is known as a block contract and depends on patient numbers, work actually carried out and the quality of care provided. More than 50% of the budget allocation in NHS is used to fund acute and emergency care and mental care. annually between 2009/2010 and 2020/21. The challenges imply that NHS is struggling to maintain standards of care in all areas.

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Strategies to Meet the Growing Demand for Healthcare The monograph below shows the patient movement in a typical hospital. Patient flow in a hospital creates random interrelated demand for health services. The patients demand inpatient care or outpatient care that must be scheduled to meet the patient demands. The providers come from the private and public sectors and the outputs to subsidise must be specified (Bhatia et al. The beneficiaries must also be identified. The output-based aid has been integrated with vouchers and implemented by donors who strive to improve aid. A similar strategy can be applied in hospitals to ensure that the government funds services that are used and demanded by the patients. The strategies emphasise incentives for consumers and the quality of the services through the performance-based contracts established with the facilities.

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The voucher schemes have proven effective in enabling regular monitoring of the utilisation of the goods and services. The strategy enables planners to gather accurate data about the outcomes that can be used by the government and funding organisations to evaluate the impacts of their funds (Saji, Ashis & Ronald, 2014). From the literature review, it can be concluded that emergent diseases and health conditions among the ageing population present a significant challenge to health institutions. The increasing population as a result of reduced infant mortality also puts pressure on health resources. Primarily, health institutions obtain their funds from the government and donor agencies. The study will be conducted in tertiary university hospitals and surrounding community hospitals. The tertiary university hospitals will be categorised as private hospitals while the community hospitals will serve as the public hospitals.

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The hospitals will be purposely selected to include those that provide primary care only. Different clinical specialities will be considered to provide variations in age and gender, which are important factors to consider when explaining the cost related challenges in healthcare. Relevant authorities from the hospitals will be identified from 20 hospitals of which 10 will comprise private facilities while 10 will comprise public facilities. The patient demographics were recorded to understand the number of hospital visits made by different age groups. The age group between 0 and 14 years was 15% (3), 14-29 was 10% (2), 30-44 was 20% (4), 45-64 was 40% (8) and 65 years and above was 15% (3). The results confirm the observation made in the introductory section that old age burdens the health facilities. The highest number of hospital visits was recorded among the patients between 45 and 64 years. The numerous hospital visits can be attributed to the onset of chronic illnesses and reduced mobility among the age group.

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Marital status and number of dependants negatively impact the ability to pay since a higher number of dependents increase the cost of healthcare. The studies also reported that patients in urban centres are more willing to pay than those in the rural areas. The finding could have impacted the results collected in this study because it was conducted in an urban locality. Higher socioeconomic status translates to higher disposable income making patients report higher willingness and ability to pay for services. The study did not, however, classify the patients according to their socioeconomic status. Fifty-five per cent of the hospitals experienced challenges with drug unavailability, 25% with equipment shortage and 20% staff shortage. Drugs, equipment and staff are necessary inputs to provide quality healthcare to patients. Drug shortages often result in disruptions in treatment schedules, alterations in dose or missed doses when alternative treatments are not available (Schweitzer, 2013).

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The use of alternative treatments as a result of drug shortages poses risks of suboptimal treatment response. Furthermore, drug shortages lead to higher medical costs when other drugs are to be purchased. Usually, county and district hospitals are underfunded and understaffed leading to the observed and reported inefficiencies. The factors affecting efficiency are not prescribed but vary with individual facility. The point implies that no single policy can be effective in improving resource allocation in all the hospitals. Private hospitals are specialised and offer services such as maternal services and geriatric services. Chapter 5 - Conclusions and Recommendations The study’s primary purpose was to examine how the healthcare sector can deal with the ageing population and decrease in mortality. Outcome-based healthcare emerges as the most promising approach to ensuring that health facilities address the needs of the ageing patient population.

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An outcome-based approach will ensure that the hospitals conduct regular assessments of the population needs and devise strategies for addressing the needs. The hospitals should also prioritise their allocations depending on their patient needs such as drugs, staff and equipment. Shortage of such inputs significantly increases the cost of healthcare to the patient and government. Public health facilities and private hospitals should integrate the strategies that have proved successful in either facility to optimise the resources available. SurveyMonkey does not charge for collecting participant responses thus enabling the researcher to conduct the research within budget. The questionnaire was designed to collect close-ended responses for all the ten questions with an exception of the last question where the respondents were allowed to provide an explanation for their responses. The explanations were recorded in the form of text and a textual analysis conducted to determine the trend of the responses.

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The methodology provided an easier means of collecting qualitative information and presenting these in quantitative formats utilising bar graphs and pie charts for ease of analysis. The results collected aligned with the findings of other researchers as discussed in the literature review. Research questions and objectives guide the research process by ensuring that the report is relevant to the topic. I also learned how to conduct a preliminary literature review to support the need for conducting the study. I learned how to source for information over the internet in journal databases, electronic books, and library. I learned how to synthesise information from these sources and generate a cohesive discussion that led to the practical conclusions and recommendations. I learned how to design a questionnaire and distribute data collection. Introducing voluntary private health insurance in a mixed medical economy: are Hong Kong citizens willing to subscribe?.

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