Tag Archives: budget

Marketing Plans in Health Care

Health care marketing is interesting when considering military treatment facilities. Naval Hospital Pensacola, according to Ludvigsen and Carroll (2003), is limited in the scope and manner that administrators are allowed to use federal monies to fund marketing efforts. Since budget cuts forced many military installations to close, and with them the attached military treatment facilities, efforts have been made, through programs like Tricare, to redirect the military health care market to the civilian care providers; however, hospitals that remain in operation, such as Naval Hospital Pensacola, have found that their market share has decreased sharply over time.

Naval Hospital Pensacola developed a marketing plan in 2003 to address the 5,000 enrollment opportunities that were left vacant due to military restructuring and Tricare development.

About Naval Hospital Pensacola

Naval Hospital Pensacola, a 60 bed facility, is the second oldest Naval hospital. The services provided by Naval Hospital Pensacola are primarily primary care, but the facility also has five operating suites and also provides urology, orthopedics, obstetrics and gynecology, among other services and operates with a budget of $64.5-million (Ludvigsen & Carroll, 2003). Naval Hospital Pensacola’s pharmacy is said to be the fourth busiest in the Navy, according to Ludvigsen and Carroll (2003).

Marketing Naval Hospital Pensacola

Purpose

In order to analyze the potential for additional capacity, Naval Hospital Pensacola formed a committee whose recommendation was that an additional 5,000 enrollee capacity was possible. The hospital, at the time of the plan formulation, served approximately 19,000 enrollees. The Managed Care Department of Naval Hospital Pensacola then developed this marketing plan to answer the recommendations of the capacity committee. Additionally, “the hospital implemented a policy which requires TRICARE Prime enrollees moving within [Naval Hospital Pensacola’s] catchment area of 40 miles, to use [Naval Hospital Pensacola]” (Ludvigsen & Carroll, 2003, p. 1). This policy ensured that certain Tricare recipients must utilize services provided by the naval hospital and dissuaded them from using civilian services that other Tricare recipients were allowed to use. This policy, according to Ludvigsen and Carroll (2003), provided additional access to approximately 10,000 Tricare Prime recipients residing within the 40-mile catchment area of Naval Hospital Pensacola.

SWOT Analysis

The marketing plan (Ludvigsen & Carroll, 2003) provided internal and external analyses that showed staffing was adequate for the proposed growth and, unlike the civilian sector, the funding would be made available based on use as Naval Hospital Pensacola is a military treatment facility whose budget relies on enrollment and not on cost-savings. “Because [Naval Hospital Pensacola] derives its funds via Federal appropriations, [Naval Hospital Pensacola’s] administration does not experience the financial pressures that civilian counterparts face, and can focus on quality issues” (Ludvigsen & Carroll, 2003, p. 7). Additionally, Naval Hospital Pensacola relies on the concept of one-stop shopping for enrollee health care needs as a marketing strength.

However, the SWOT analysis detailed within Ludvigsen and Carroll’s (2003) marketing plan admits that the naval hospital suffers access of care issues as a main vulnerability. This, coupled with a broken promise image, allows three other area hospitals to fulfill this marketing void. “Effectively competing requires improving quality of care, creating access, improving facilities, providing amenities, and promoting these accomplishments” (p. 9). Examples of Federal legislation are provided to show the marketing disadvantages of military treatment facilities.

Objectives

The primary objective of the marketing plan (Ludvigsen & Carrol, 2003) is to increase enrollment by 5,000 Tricare Prime recipients, mainly within the internal medicine, family practice, and pediatric clinics. In order to be viewed as successful, the minimum additional enrollment must be 2,000 over the next two years, again targeting 5,000 additional enrollees.

Methods

The marketing plan (Ludvigsen & Carroll, 2003) of Naval Hospital Pensacola utilizes a combination of three models in order to focus the hospital efforts. The first model is the traditional marketing mix model detailed by four components: product, placement, pricing, and promotion. The second model, based on the hospital’s own consumer marketing studies, include four components, “the Four C’s” (p. 21): competence, convenience, communication, and compassion. The final model, based on the Institute of Medicine’s (2001) health care improvement aims and objectives, includes safety, efficacy, patient-centricity, timeliness, efficiency, and equity.

Using a matrix to match the qualities of each of the three models, criteria were developed to further synthesize the goals of the hospital, its marketing theory, and the expectations of the targeted health care consumers. Representation of this combined modeling, however, starts to confound the reader by unnecessary references to concepts of quantum physics. The model is concisely represented by three dimensional representation with patient-focus in the middle of a pyramid formed between product, access, efficiency, and promotion.

Discussion

Being a military treatment facility and being highly governed by Federal legislation, Naval Hospital Pensacola is not a typical health care organization. In order to market improved or underutilized services, the hospital requires a novel approach, which is outlined within the marketing plan of Ludvigsen and Carroll (2003).

Naval Hospital Pensacola does well to focus, first, on the strengths and weaknesses identified by internal and external analyses, then, developing a plan that exploits the strengths to develop a means of overcoming the identified weaknesses. By focusing on industry-accepted aims and objectives, Naval Hospital Pensacola demonstrates improvement in measurable areas to attract additional enrollment. It is important to note, however, that, being a military treatment facility, the hospital enjoys a rare advantage of being able to pass rules mandating enrollment of certain beneficiaries within the prescribed catchment area.

The plan is an effective means of overcoming certain identified obstacles. It is realistic, allowing for fail-soft situations (or, minimal standard improvement), and comprehensive plan that addresses a true marketing need for both the hospital and the target health care consumer.

References

Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press.

Ludvigsen, S. M. & Carroll, W. D. (2003). Naval Hospital Pensacola marketing plan. Retrieved from http://www.tricare.mil/familycare/downloads/marketing_plan.pdf

Pay-for-Performance

Challenges in Developing  Standards

The U.S. health care industry is contemplating the implementation of pay-for-performance reimbursement schemes in order to increase quality and safety in the delivery of health care. Pay-for-performance is a business model that combines reduced compensation for those who fail to meet standards and bonus payments for those that meet or exceed the stated expectations, but the results of such programs, thus far, is mixed (Baker, 2003; Campbell, Reeves, Kontopantelis, Sibbald, & Roland, 2009; Lee & Ferris, 2009; Young et al., 2005). The introduction of pay-for-performance models is primarily to provide relief from other, more extreme, reimbursement models, such as fee-for-service (which rewards overuse) and capitation (which rewards underuse), and with rising health care costs, a diminishing economy, and the increasing number of Americans lacking adequate health insurance, its introduction to the U.S. health care system could not be more timelier (Lee & Ferris, 2009).

The impetus of contemporary pay-for-performance schemes is derived from a report from the Institute of Medicine (2001). This report argued that current reimbursement schemes fail to reward quality in health care and may possibly create a barrier to innovation (Baker, 2003; Young et al., 2005). There are many international supporters of health care pay-for-performance, especially in England where the National Health Service employs pay-for-performance to keep costs under control while attempting to provide for quality and safety in the delivery of primary health care (Baker, 2003; Campbell et al., 2009; Young et al., 2005). However, the adoption of pay-for-performance seems to face many challenges.

One challenge to pay-for-performance implementation concerns the effectiveness in the overall continuity of care. Campbell et al. (2009) conducted an analysis of the effect of pay-for-performance in England and found that, although implementation of pay-for-performance in 2004 resulted in short-term gains in the quality of care, the improvements receded to pre-2004 levels. Beyond the pay-for-performance standards, though, the quality of care in areas not associated with incentives declined. Cameron (2011) reports on a recent study of the effectiveness of pay-for-performance on hypertension – the study shows no improvement in any measure including the incidence of stroke, heart attack, renal failure, heart failure, or combined mortality among the group (Lee & Ferris, 2009). McDonald and Roland (2009) describe these effects on other aspects of care as unintended consequences detrimental to health care quality and safety as a whole.

Another significant challenge to pay-for-performance implementation is ensuring that certain patient populations continue to be able to access appropriate care (McDonald & Roland, 2009). Under some pay-for-performance schemes, practices with a sicker patient demographic (i.e. geriatrics, oncology, neonatology, etc.) will suffer economically despite providing a higher level of care than their counterparts in family medicine or other more generalized practices. Specific concerns address a physicians ability to choose not to treat patients due to their non-compliance with medical orders (McDonald & Roland, 2009). Equity and access cannot suffer under a just reimbursement model, just as physicians with a sicker demographic should not suffer.

Identifying a reliable standard of measure in health care quality proves difficult. Earlier methods, such as those developed by Campbell, Braspenning, Hutchinson, and Marshall (2002), initially appeared sound, but ineffective methods and unintended consequences were soon identified (Cameron, 2011; Lee & Ferris, 2009; McDonald & Roland, 2009). More recent work by Steyerberg et al. (2010) shows that new approaches are on the horizon and that pay-for-performance may still remain a viable scheme, providing the measures and standards are, in fact, legitimate and accurately identify improved quality without detracting from other aspects of heath care. Steyerberg et al. identifies novel approaches to prediction models that may help to standardize measures in pay-for-performance schemes to be more realistic and reliable without causing many of the unintended consequences of earlier plans.

As we become more technologically advanced and find ways, albeit expensive, to cure and treat diseases that until now were intractable, we must address the ethics surrounding the provision of this care as a system of management. By combining the whole of health care into the ethics discussion, we opt to leave no one wanting for care, but we now have to address the problem of paying for the expensive care that we have all but demanded. Pay-for-performance, though not perfect, shows much promise in keeping health care costs manageable. However, we must strive to identify those patients and practitioners that lose out under this system of reimbursement and strive to identify just and ethical means of repairing the scheme. Though, we should first answer the question: is health care a right or a privilege?

References

Baker, G. (2003). Pay for performance incentive programs in healthcare: market dynamics and business process. Retrieved from http://www.leapfroggroup.org/media/file/Leapfrog-Pay_for_Performance_Briefing.pdf

Cameron, D. (2011, January 27). Pay-for-Performance does not improve patient health. Harvard Medical School News. Retrieved from http://hms.harvard.edu/public/news/2011/ 012611_serumaga_soumerai/index.html

Campbell, S. M., Braspenning, J., Hutchinson, A., & Marshall, M. (2002). Research methods used in developing and applying quality indicators in primary care. Quality and Safety in Health Care, 11(4), 358–364. doi:10.1136/qhc.11.4.358

Campbell, S. M., Reeves, D., Kontopantelis, E., Sibbald, B., & Roland, M. (2009). Effects of pay for performance on the quality of primary care in England. New England Journal of Medicine, 361(4), 368-378. doi:10.1056/NEJMsa0807651

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Retrieved from http://www.iom.edu/reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx

Lee, T. H. & Ferris, T. G. (2009). Pay for performance: a work in progress. Circulation, 119(23), 2965-2966. doi:10.1161/CIRCULATIONAHA.109.869958

McDonald, R. & Roland, M. (2009). Pay for performance in primary care in England and California: comparison of unintended consequences. Annals of Family Medicine, 7(2), 121–127. doi:10.1370/afm.946

Steyerberg, E. W., Vickers, A. J., Cook, N. R., Gerds, T., Gonen, M., Obuchowski, N., … Kattane, M. W. (2010). Assessing the performance of prediction models: A framework for traditional and novel measures. Epidemiology, 21(1), 128–138. doi:10.1097/EDE.0b013e3181c30fb2

Young, G. J., White, B., Burgess, J. F., Berlowitz, D., Meterko, M., Guldin, M. R., & Bokhour, B. G. (2005). Conceptual issues in the design and implementation of pay-for-quality programs. American Journal of Medical Quality, 20(3), 144-50. doi:10.1177/1062860605275222

Electronic medical records:

The Push and the Pull

Increasing safety and efficiency in medicine can only lead to an increase in health care quality, right? Some might not agree, especially when it comes to the implementation of electronic medical records (EMRs). There is a federal effort to ensure all medical records are in digital format by 2014, and supporters of EMR technology laud their effectiveness at minimizing medical errors, keeping records safe, facilitating information portability, and increasing cost-efficiency overall (The HWN Team, 2009; Preidt, 2009). Unfortunately, many are skeptical of the cost, security, and utility of such systems (Brown, 2008; The HWN Team, 2009; Preidt, 2009; Terry, 2009). These concerns (and others) are dramatically slowing the pace of EMR adoption, especially in smaller private practices where cost is a significant issue (Ford, Menachemi, Peterson, & Huerta, 2009).

Does EMR adoption actually increase safety? As Edmund, Ramaiah, and Gulla (2009) point out, a working computer terminal is required in order to read the EMR. If the computer system fails, there is no longer access to the medical record. This could be detrimental in a number of cases, especially when considering emergency medicine. Edmund, Ramaiah, and Gulla also describe how difficult it can be to maintain such a system. With this in mind, it is plain that as the system ages there will be more frequent outages and, therefore, more opportunity for untoward effects. Further, recent research shows how EMRs enforce pay-for-performance schemes that many U.S. physicians resent. McDonald and Roland (2009) demonstrate that physicians in California would rather disenroll patients who are noncompliant when reimbursed under pay-for-performance models enforced by the EMR software. Declining to treat patients who express their personal responsibility and choice in their own medical treatment cannot improve the effectiveness of safety in the care that they receive.

There needs to be a middle ground. Baldwin (2009) offers some great real world examples of how some hospitals and practices use hybrid systems to ensure effectiveness and quality while enjoying the benefits of digital records. According to Baldwin, there are many concerns to account for when considering a move from an all paper charting system to an all digital system. Many times, these concerns cannot be allayed and concessions between the two systems must be made. Brown (2008) suggests providing a solid education to the front-line staff regarding EMR implementation, and hence, obtaining their ‘buy in’ to the process to create a smoother transition to implementation. However, this does not address the safety concerns. Baldwin’s advice to analyze which processes should be computerized allows a solid business approach to EMR implementation, allowing some processes to remain paper-based if it makes sense to do so.

References

Baldwin, G. (2009). Straddling two worlds. Health Data Management, 17(8), 17-22.

Brown, H. (2008, April). View from the frontline: Does IT make patient care worse? He@lth Information on the Internet, 62(1), 9.

Edmund, L. C. S., Ramaiah, C. K., & Gulla, S. P. (2009, November). Electronic medical records management systems: an overview. Journal of Library & Information Technology, 29(6), 3-12.

Ford, E. W., Menachemi, N., Peterson, L. T., & Huerta, T. R. (2009). Resistance is futile: But it is slowing the pace of EHR adoption nonetheless. Journal of the American Medical Informatics Association, 16, 274-281. doi:10.1197/jamia.M3042

The HWN Team. (2009, March). Electronic medical records: the pros and cons. Health Worldnet. Retrieved from http://healthworldnet.com/HeadsOrTails/electronic-medical-records-the-pros-and-cons/?C=6238

McDonald, R. & Roland, M. (2009, March). Pay for performance in primary care in England and California: Comparison of unintended consequences. Annals of Family Medicine, 7(2), 121-127. doi:10.1370/afm.946

Preidt, R. (2009, December 16). Pros and cons of electronic medical records weighed. Business Week. Retrieved from http://www.businessweek.com/lifestyle/content/healthday/634091.html

Terry, N. P. (2009). Personal health records: Directing more costs and risks to consumers? Drexel Law Review, 1(2), 216-260.

Community Health Centers

Community health centers increase availability of (i.e. access to) health care and is shown by some to improve health outcomes (Taylor, 2009). Improving access to health care is achieved by placing these community health centers geographically proximate to underserved and at-risk populations. Taylor (2009) boasts improvements in health outcomes due to the number and placement of community health centers, but she provides no compelling evidence to say that any improved outcome is not directly caused by the improved access. Forrest and Whelan (2000) discuss a need to improve access to physician offices more than community health centers to improve follow-up care which continues to lack in the community health center model, though the point may be moot if the community health centers can improve the delivery of service to allow for proper follow-up. Forrest and Whelan do, however, acknowledge the value of community health centers in providing increased access to health care to underserved and vulnerable populations.

Dieleman et al. (2004) offers collaboration of health care providers in the primary care setting as a means of improving efficiency and thereby improving health outcomes. The testing instrument used during this study indicates an overall improvement of the attitudes towards role recognition, provider satisfaction, patient satisfaction, and patient health status, as well as the quality of patient care provided. In my experience with many community-based health clinics, they tend to be less than spectacular as far as quality of care, cleanliness, and patient-provider attitudes. By adding other providers into the patient-provider relationship, it would allow others to comment within the team where improvements can be made in relation to each patient-provider relationship and in a more general sense.

A collaborative holistic approach to patient care, whether in primary care, emergency care, or in critical care, will foster a sense of partnership within the team, including the patient and family, that will allow the team to truly care for the patient, will allow the patient to be invested in his or her care, and will promote a complete view of the whole patient both when sick and when well. Collaboration will, hopefully, allow improved efficiency in the provision of care while maintaining a trustworthy and committed relationship with the patient. Forging these relationships will, hopefully, help to overcome any challenges faced within our continually changing health care landscape.

References

Dieleman, S. L., Farris, K. B., Feeny, D., Johnson, J. A., Tsuyuki, R. T., & Brilliant, S. (2004). Primary health care teams: team members’
perceptions of the collaborative process. Journal of Interprofessional Care, 18(1), 75-78. doi:10.1080/13561820410001639370

Forrest, C. B. & Whelan, E. (2000). Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians’ offices. Journal of the American Medical Association, 284(16), 2077-2083. doi:10.1001/jama.284.16.2077

Taylor, T. (2009, October). The role of community-based public health programs in ensuring access to care under universal coverage [Issue brief]. American Public Health Association. Retrieved from http://sylvan.live.ecollege.com/ec/courses/53027/CRS-WUPSYC6205-4570539/CommunityBasedReformupdtd.pdf

Quality in Interdisciplinary Critical Care Medicine

To improve the overall quality of care provided in critical care medicine, Curtis et al. (2006) promote a framework, as well as some key concepts, for measuring performance improvement outcomes within the critical care or intensive care setting. Curtis et al. introduce the reader to Donabedian’s (as cited in Curtis et al., 2006) model of improving the quality of healthcare, which focuses on “structure, process, and outcome” (p. 212). With quality improvement the focus of this article, Curtis et al. approaches the dynamics of interdisciplinary teams in the context of the multitudes of ICU variations available throughout the United States. Additionally, Curtis et al. recognize that high-quality care is dependant on both clinical and non-clinical processes, citing organizational management as a key requirement that has significant impact on overall patient care.

“Successful quality improvement programs require interdisciplinary teamwork that is incremental and continuous” (Curtis et al, 2006, p. 216).

In reading Curtis et al. (2006), I find that approaching patient care with a team approach addresses all of the available topics and more. Improving patient satisfaction requires improving performance which, in turn, creates efficiency and can improve reimbursement (especially under pay-for-performance models). On the other hand, addressing a requirement to increase reimbursement under a pay-for-performance model can ultimately lead to increases in patient satisfaction by improving inefficient processes. Overall, one of the largest benefits of operating within a team environment is the access to a larger knowledge-base, increasing the application of knowledge for all team members.

References

Curtis, J. R., Cook, D. J., Wall, R. J., Angus, D. C., Bion, J., Kacmarek, R., … & Puntillo, K.(2006). Intensive care unit quality improvement: A “how-to” guide for the interdisciplinary team. Critical Care Medicine, 34(1), 211-218. doi:10.1097/01.CCM.0000190617.76104.AC

Health Care Reform

In beginning this endeavor, I found it initially difficult to find anything related to health care legislation that I would be inclined to support or oppose in a letter to my Congressman. I tend to rely on the elections in order to convey my political positions. After studying some of the recent legislation, I found that the only premise that interested me was the adoption of The Patient Protection and Affordable Care Act of 2010 and the related Health Care and Education Reconciliation Act of 2010. Unfortunately, attempting to find credible dialogue on the internet regarding these laws is both impractical and near impossible. The special interest groups are leaning to their respective extremes. With commentary not proving trustworthy for factual insight, I relied on the Congressional Budget Office and the full text of the laws to cement my position. Using the aforementioned information in conjunction with Senator Lieberman’s contact information from the U. S. Senate website (http://www.senate.gov), I formulated a letter to him outlining my economic concerns (see Appendix).

I understand the grandeur of the idea of universal health care. I applaud the debates of how best to offer affordable or free health care to ever citizen of the United States. Unfortunately, as a nation, we are not fit in our financial means to proffer such an expensive entitlement. As Goodson (2010) reports, many of the initiatives outlined within the law are not guaranteed to be successful. This at an increased cost of $390 billion over the first 10 years (Elmendorf, 2010).

To ensure that my points were valid, I researched the approval ratings of these laws. According to WashingtonWatch.com (2010), approximately 80% of respondants do not favor the passing of these laws. More scientifically, however, a consistent range of 54 – 58% of Americans favor repeal of the laws, while 63% of senior citizens agree (Rasmussen Reports, 2010).

References

Elmendorf, D. W. (2010, March 20). Manager’s amendment to reconciliation proposal [Letter to the Honorable Nancy Pelosi]. U. S. Congress, Washington, D. C. Retrieved from the Congressional Budget Office website: http://www.cbo.gov/ftpdocs/113xx/doc11379/ Manager%27sAmendmenttoReconciliationProposal.pdf

Goodson, J. D. (2010). Patient Protection and Affordable Care Act: Promise and peril for primary care. Annals of Internal Medicine. Advance online publication. Retrieved from http://www.annals.org/content/early/2010/04/15/0003-4819-152-11-201006010-00249.full

Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152 (2010).

Patient Protection and Affordable Care Act of 2010, Pub. L. No. 111-148 (2010).

Rasmussen Reports. (2010, May 17). Health care law: 56% Still Want to Repeal Health Care Law, Political Class Disagrees. Retrieved on May 22, 2010, from http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/march_2010/health_care_law

WashingtonWatch.com. (2010). P.L. 111-148, The Patient Protection and Affordable Care Act. Retrieved on May, 22, 2010 from http://www.washingtonwatch.com/bills/show/111_PL_111-148.html

Appendix

Michael F. Schadone
[REDACTED]
Woodstock, CT 06282

The Honorable Joseph I. Lieberman
706 Hart Office Building
United States Senate
Washington, DC 20510

May 22, 2010

Re: The Patient Protection and Affordable Care Act of 2010

 Dear Senator:

 My name is Michael Schadone and I am a nationally registered critical care paramedic working in Northeast Connecticut. I am writing you today because I do not support the recent legislation referred to as The Patient Protection and Affordable Care Act of 2010. I urge you and your colleagues in Congress to repeal this law. I believe that our efforts aimed at improving the economy will, in itself, dramatically reduce the disparities in access to health care.

Under the auspices of a progressive government, our country has seen many times of woe. Bigger government and higher rates of spending have driven our economy into the ground. It was only the idea of smaller government and trust in the American entrepreneur that ever caused unemployment rates to drop to less than five percent. More people gainfully employed means more people with access to affordable health care. Is this not our goal? In Europe, economic systems are collapsing. Many of the countries with universal health care have tax rates approaching 70 percent (including ‘value-added tax’). It is commonly held that suppressing the spending power of the citizenry will surely lead to a collapse of the free market, the basis of our economy. I certainly do not want the United States of America to resemble Greece, Portugal, Spain, or Cuba. We are the Great Experiment, and so far, it is working. I fear, though, not for much longer.

I favor universal health care just as I favor universal education and other entitlements but not at the expense of our country. Improvements to the economy will put us in a position to gain strength and enable us to afford such a sweeping paradigm shift in health care. More importantly, a better economy will allow us to do it properly. I urge you to focus on the economy and repeal this dangerous law.

 Sincerely,

Michael F. Schadone

Reducing our Health Care Expenditures

With the recent signing into law of the Patient Protection and Affordable Care Act (2010), more affectionately known as ‘Obama Care’, much of the health care discussion has turned from deciding what we should do to how we should do it. Many us acknowledge that the current state of our health care needs reformation; the only problem seems to be choosing the best approach. As a licensed out-of-hospital provider, I am in a unique position to observe patients entering our health care system, being treated by our health care system, and exiting (for good or bad) our health care system. I can see that our health care needs are not being met, and I can see both how patients approach their care and how practitioners approach their patients — inefficiently and ineffectively. We need to resolve these issues.

Canada is a fairly close approximation to the United States in locale, geography, economy, and political ideology (Doran, ca. 2000; “GNI per capita”, 2010). It might make sense for us to look towards Canada to see if they have adopted a plan that we could either emulate, or, in the very least, research for a sense of best practices. Kovner, Knickman, and Jonas (2008) describe Canada as having a national health insurance (NHI) system of health care, in that the system is provisioned by a mix of both public and private contributions. Two benefits of Canada’s health care system include a high life expectancy (77.4 for males at birth) and a low cost ($3,165 per capita, or 9.9% of GDP; Kovner et al., 2008, Table 6.2, p. 165). In comparison, Kovner et al. shows that the life expectancy for males in the United States is 74.8 under a system that costs $6,102 per capita (or, 15.3% of GDP). These numbers are significant because we need to understand what we can expect from our investments, and I feel that the average life expectancy is a great benchmark of a health care system as a whole. One worry that I would have, though, is if we were to adopt the same pharmaceutical cost controls, research and development in the industry may suffer, as well as any other technology burdened by cost-cutting measures. I have to assume that the free market would effectively drive these areas, however.

In order to adopt such sweeping changes of our health care system, both liberals and conservatives would have to negotiate their ideals. I am a fairly conservative citizen who believes in smaller government and spending constraints. If reducing our health care expenditures by realigning the modes and methods of health care delivery was realistic, I could be in favor of such a reform. Political agendas aside, Canada’s health care system is certainly one that we should further consider.

References

Doran, H. (ca. 2000). Politics and political parties in Canada. Internet sources for journalists and broadcasters. Retrieved on April 22, 2010, from http://www.synapse.net/radio/can-pol.htm

“GNI per capita, Atlas method (current US$)”. (2010). Data catalog. The World Bank Group. Retrieved on April 22, 2010, from http://data.worldbank.org/indicator/NY.GNP.PCAP.CD

Kovner, A. R., Knickman, J. R., & Jonas, S. (Eds.). (2008). Jonas & Kovner’s health care delivery in the United States (9th ed.). New York, NY: Springer.

Patient Protection and Affordable Care Act of 2010, H.R. 3590, 111th Cong. (2010).