Health Care Law vs Patient Outcomes

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    The way I understand our current Third Party Payer system the major decisions are made by a company looking to cut costs and make a profit. Drs are encouraged not to order 'unnessasary tests' (as if they would waste their time or effort on any test that is truely unnessasary) and Nurses are encouraged to not bring 'unnessasary' equipment into the patients room, streaching our care between 8-10 patients in the acute care setting and in LTC the ratios are extreemly frigtening.

    But at the same time countries with a Single Party Payer system run into their own chalanges; Wait lists, higher taxes, and some treatments are not covered, not to mention it can be a buerocratic nightmaire. While I have never worked in a country with a Single Party Payer system, I am sure Health Care Providers are met with just as many chalanges.

    As Nurses our priority isnt cost, profit, or politics; it is and always will be our patients. So my question is; Which system shows better Patient Outcomes, and why? Has there been a study done compairing them that I am not aware of? I want to better understand what is best for this country, and more importantly my patients.
    echoRNC711, barbyann, and lindarn like this.
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  4. 3
    This article outlines a study done on preventable deaths in the US and 18 other industrialized countries with data from the World Health Organization. The study was done for 1997-1998 and updated again in 2002-2003. I believe the final data from the update was published in 2008. The US ranked last and showed less improvement than the other countries from 1997-2003.

    Measuring The Health Of Nations: Updating An Earlier Analysis

    The 18 other countries in the study were: France, Japan, Australia, Spain, Italy, Canada, Norway, Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, UK, Ireland, Portugal.

    "The rate of amenable mortality is a valuable indicator of health care performance, say the authors—one that can point to potential weaknesses in a nation's health system that require attention. "[T]he findings presented here are consistent with other cross-national analyses, demonstrating the relative underperformance of the U.S. health care system in several key indicators compared with other industrialized countries."
    tewdles, TheCommuter, and NRSKarenRN like this.
  5. 4
    Quote from cassiemassey
    But at the same time countries with a Single Party Payer system run into their own chalanges; Wait lists, higher taxes, and some treatments are not covered, not to mention it can be a buerocratic nightmaire. While I have never worked in a country with a Single Party Payer system, I am sure Health Care Providers are met with just as many chalanges.
    *** I have both worked in a single payer health system and been a patient. I observed as my gransmother in law went from a spry and independant lady living alone, to haveing a in home provider/help and visiting nurse, to CRBF to hospital with broken hip, to nursing home, back to CBRF and finaly to nursing home for good and eventualy hospice care over a 7 year period.
    She recieved superb and timely health care. I had nothing at all to complain about. My personal experiences as a patient were the same. Best of all I paid less in taxes as a percentage of my income when I work in the country with single payer.
    dawnma, JMBnurse, elkpark, and 1 other like this.
  6. 2
    The problem with what is being proposed at this time with the change in health care is that it is not a one party payment, it is going to be mandated that everyone have health insurance, meaning that those who do not have health insurance provided by their employer have to purchase it, and most people cannot afford to do that and if they don't, they will be penalized on their income taxes several thousands of dollars. I do not know about you, but I cannot afford that, I am working for a home care agency that just opened and we do not nor can we afford health insurance for our employees (which is me) and I cannot afford health insurance, and I cannot afford to be penalized on my income taxes.
    RNinIN and VivaLasViejas like this.
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    I have no experience with single payer systems. However I would advocate neither the current situation, nor a single payer system. I personally think the solution lies in a free market system with an emphasis on coordination of care and management of chronic conditions, instead of our reliance on acute care and the primary care physician. Our current system is more like bringing a screwdriver and a crane to a construction site and expecting to build something (credit Atul Gawande).

    I would like to clarify that the current reforms set to roll out have been (perhaps innocently) misrepresented by the previous poster. The initial penalty for not purchasing insurance is capped at 1% of your income. Unless one is making over $100,000 that amount is not in the "thousands." And I would gently suggest an income of that amount should support the purchase of some kind of health insurance. And, like all things tax, the number of dependents in a household affect that figure as well. Further, there are govt subsidies that will cover people who make too much to receive medicaid (I believe that's at 400% of the poverty level), but not enough to afford insurance. The gov't subsidies decrease as one's income increases.

    My sources are the Kaiser Family Foundation and Healthcare.gov.
    dawnma, Fuzzy, wooh, and 3 others like this.
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    Quote from katiedid53
    The problem with what is being proposed at this time with the change in health care is that it is not a one party payment, it is going to be mandated that everyone have health insurance, meaning that those who do not have health insurance provided by their employer have to purchase it, and most people cannot afford to do that and if they don't, they will be penalized on their income taxes several thousands of dollars. I do not know about you, but I cannot afford that, I am working for a home care agency that just opened and we do not nor can we afford health insurance for our employees (which is me) and I cannot afford health insurance, and I cannot afford to be penalized on my income taxes.
    Actually, that's not entirely true. There is a penalty/fee/tax/whatever (starting in 2014), but that's only $95 per year, although it can go up to $695 (or 2.5 percent of taxable income) in 2016. So no worries on paying thousands of dollars in penalties.

    As far as not being able to afford insurance, some people will be exempt on "hardship grounds", meaning those who are very poor and can't file taxes (income around $9,500 for individuals and $19,000 for married couples), and people who have access to health care through a job but would have to spend more than 8 percent of family income to take it up (after employer contributions and federal subsidies are taken into account).

    Source: 5 myths of the individual mandate - Joanne Kenen - POLITICO.com

    You can also check out healthcare.gov for more info, and search for insurance options there as well. Sorry to derail the topic a bit, I just wanted to try and clear up any misunderstandings.
    grownuprosie, karenesn, JMBnurse, and 1 other like this.
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    Quote from musingmom
    I have no experience with single payer systems. However I would advocate neither the current situation, nor a single payer system. I personally think the solution lies in a free market system with an emphasis on coordination of care and management of chronic conditions, instead of our reliance on acute care and the primary care physician. Our current system is more like bringing a screwdriver and a crane to a construction site and expecting to build something (credit Atul Gawande).

    I would like to clarify that the current reforms set to roll out have been (perhaps innocently) misrepresented by the previous poster. The initial penalty for not purchasing insurance is capped at 1% of your income. Unless one is making over $100,000 that amount is not in the "thousands." And I would gently suggest an income of that amount should support the purchase of some kind of health insurance. And, like all things tax, the number of dependents in a household affect that figure as well. Further, there are govt subsidies that will cover people who make too much to receive medicaid (I believe that's at 400% of the poverty level), but not enough to afford insurance. The gov't subsidies decrease as one's income increases.

    My sources are the Kaiser Family Foundation and Healthcare.gov.
    I always suspect, in these conversations, that the individuals proposing "free market" systems and that people who have a problem with paying for insurance just don't want to be responsible probably don't have any experience as an individual customer in our current free market system. You don't really get how bad the system is until you've tried to buy insurance on your own in our wonderful "free market." The last time I was unemployed for a significant amount of time, I went shopping for health insurance as an individual. At the time, I was in my early 50s and in excellent health except for one minor health issue which is stable on no medication/treatment and has been for a long time. The best offer I could find was $500/month premium with a $5,000 deductible -- that's $11,000 out of my pocket (each year) before the insurance would pay a single penny. Now, if I had been working full-time and making a decent salary, I might have been able to afford that (but, in that case, I would have insurance through my work, at a more affordable group rate).

    Our system needs serious changes, much more than the ACA (which is basically just minor tweaking of our current dysfunctional system) will provide. I am another of the many advocates of a single-payer system in the US.
    dawnma, Fuzzy, wooh, and 4 others like this.
  10. 1
    I agree with the fact that we need change. The way I see it even this current 'change' is, hopefully, designed to be a smooth bridge to a single payer system. Those who cannot or will not pay the fees of a private system can 'buy' insurance through the governement offered plan (medicare or tricare Im not sure exactly which they will offer they will most likely blend the two). Eventually the private systems will loose their customers from the lower and middle class and only cover upper class customers where they can recieve more 'catered' care. which is fine and dandy with me if they want a designer plan, I'll take the generic as long as it covers everything we truely need and give me a way to focus on my patient instead of their money. Its good to hear, PMFB-RN, that the single payer system is successfull when done properly. And JMBnurse I am very interested to read this article, maybe I'll post it on the bulitin board at work aswell.
    If this country is destined for a mostly single payer system, we can't just write a law, wake up one day and have it work. It would be too much of a shock to both the healthcare and financial system in this country. which is why I wanted to know if that direction is where we should head. Its a process and just like a patients recovery, its going to take a long time, and carefull planning to get our system where it needs to be.
    JMBnurse likes this.
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    Ranking and rates from 'measuring the health of a nation ariticle, thx JMBnurse!
    JMBnurse likes this.
  12. 6
    I think something akin to socialized medicine would be preferable, but for reasons passing all understanding, but presumably pure ignorance, Americans insist they don't want it. Therefore, modifications to the current snafu such as the ACA seems to be the best we can do. I do think everyone should carry insurance if they are working. There is no excuse not to, so I support that part of the bill.

    I am a very healthy individual. I am not overweight, I don't drink, don't smoke, exercise 7 days a week, and I take no prescription medication under normal circumstances. Last spring I ran into a minor health issue that has had a minor complication this fall. So far I have incurred over $30,000 in medical bills, and I am getting an EGD on Tuesday, with a few biopsies which will add approximately another $8,000 before all is said and done. Ordinarily, I take no medications, but my pharmacy bill for the months of September and October has been over $1,500. And this is not a catastrophic illness. This could happen to anyone. A middle class person without insurance would have been bankrupted by this ordinary illness and it's minor complication that can happen to any healthy person at anytime. So yes, unless you cannot work, you should be required to carry health insurance. Unless of course this country wises up and agrees to something more sensible than this ridiculous 3rd party payer system!
    dudette10, dawnma, VanLpn, and 3 others like this.


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