As a community member, the more community education that can be affectively administered is beneficial for all persons in the community. If more people can be treated at a cost effective price then ultimately more money will be freed up to use on patients who need more one on one care.
The proposed reform is looking to cut all areas of health care and health services. Proper nutrition and shelter are essential to maintaining good health. What the government seems to not be accounting for is the increase in health care costs when they take away essential health services. It is impossible to successfully eliminate many health services and yet lower the budget on health care. Although there are many persons who abuse the current system that is in place, simply eliminating programs that are actually vital to a large population within a community is not the proper way to fix the budget deficit.
As a potential health care provider, some of the provisions and statements seen in the community educator's proposal are both beneficial and hurtful to practicing health care professionals. The reform will personally affect my line of work because physical therapy is already a practice that is extremely limited in the length of care that is able to be provided. Most patients are only allotted less than ten sessions a year which is no where near enough visits to effectively rehab some patients, like someone who recently underwent a serious surgery. However, there are patients that attend physical therapy sessions for instruction on proper body mechanics and tension relief techniques which have many more visits approved than what is actually necessary. Many of these patients could greatly benefit from attending community taught courses, such as proper lifting mechanisms, in order to prevent injury so that the demand for physical therapy is decreased. Decreasing the workload for the therapist will allow more time and resources to be used on patients requiring more intense care. It is also more cost effective to instruct more than one patient at a time.
Community health educators could be the stepping stone to eliminating some of the abuse seen in the system as well as reducing costs that are excessive for performed services.
Friday, April 16, 2010
Tuesday, April 13, 2010
A Healthcare Worker's Percpective
I have been employed in the health and human service industry for the past fifteen years. Many of those years were spent in the non-profit sector. I watch as the number of people needing services increases but the number of people to provide the services stays the same or in some circumstances decreases.
These providers rely primarily for financial support from the government to sustain their services. When funding is cut it directly affects the quantity and quality of services we can provide. Providers have to be creative in finding ways to continue offering quality services.
I am currently a social worker in a small rural county. We are presently experiencing some major cuts in our funding that has led significant budget cuts to our human service department. Myself and co-workers are taking on larger caseloads and other job responsibilities in place of rehiring a full-time position that is vacant. While not replacing this full-time position will help, it is only a small fraction of the total budget we will need to make adjustments to.
What I find frustrating is that when these budget cuts are passed down to us, we are expected to accommodate them quickly. This can lead to hasty decisions being made without thinking about the long term affects. There is the potential for people to "fall through the cracks" when there are gaps in services. Many of these people are children who rely on these services to provide them with food, shelter and clothing. Their access to these necessities should not be compromised. We all need to advocate for a change to protect those who are already vulnerable.
I have been employed in the health and human service industry for the past fifteen years. Many of those years were spent in the non-profit sector. I watch as the number of people needing services increases but the number of people to provide the services stays the same or in some circumstances decreases.
These providers rely primarily for financial support from the government to sustain their services. When funding is cut it directly affects the quantity and quality of services we can provide. Providers have to be creative in finding ways to continue offering quality services.
I am currently a social worker in a small rural county. We are presently experiencing some major cuts in our funding that has led significant budget cuts to our human service department. Myself and co-workers are taking on larger caseloads and other job responsibilities in place of rehiring a full-time position that is vacant. While not replacing this full-time position will help, it is only a small fraction of the total budget we will need to make adjustments to.
What I find frustrating is that when these budget cuts are passed down to us, we are expected to accommodate them quickly. This can lead to hasty decisions being made without thinking about the long term affects. There is the potential for people to "fall through the cracks" when there are gaps in services. Many of these people are children who rely on these services to provide them with food, shelter and clothing. Their access to these necessities should not be compromised. We all need to advocate for a change to protect those who are already vulnerable.
Friday, April 9, 2010
Healthcare workforce: A patient’s perspective
Over the last ten years I have had long experiences with the health care system and have been significantly involved with the workforce in that industry. I have had 14 surgeries, from carpal tunnel surgeries to four spinal fusions and the removal of a cancerous kidney. I have spent weeks in hospitals, hours in clinics and doctor’s offices and read volumes of outdated magazines in waiting rooms. I have been in the care of primary care physicians, specialists, surgeons, physician’s assistants, nurse practitioners, nurses, various technicians as well as clerical and administrative personnel. My experiences have been generally positive and I am optimistic about the care we receive as patients. At the same time I foresee difficulty looming in the health care industry.
The national health care debate has focused our awareness on the dichotomy between the increasing demand for healthcare personnel as the population ages and the lagging supply of these vital workers. In addition there is a disconnect between the number of practitioners and where they contribute to the system. In effect we have too few necessary riders on the bus and more tragically we have those who are aboard in the wrong seats.
The attraction of the medical profession, particularly for physicians, has eroded recently, especially among men. There are competing professions that offer significant comparative financial reward without the grueling years of schooling and the huge accumulation of debt from student loans. Those who do opt for the degree of MD are attracted to the specialties rather than the practice of primary care due to the compensation system that places the highest financial rewards in these more elite fields. Obviously the incentive system is flawed and the result is that the shortage of personnel to serve the greatest number of patients that have conditions that can be best be addressed by early intervention as well as provide services to the most needy such as the populations in rural areas and the most needy sections of major cities.
Further, there are too few nurses. There are many out there who would very much like to join this profession but there are barriers that loom to retard that. Due to economic pressures there is less hiring and even layoffs. Fewer nurses are forced to work longer hours and increase productivity by having more patients assigned. In addition we cannot produce the nursing component of the workforce due to the lack of ability to train new candidates that arises from the shortage of nursing instructors. Huge waiting lists exist across the country for seats in nursing schools.
Some of this is exacerbated by the need for the clerical and administrative demands of the modern health care industry. I was advised that in a rather small hospital there were 473 job categories that did not include doctors, nurses or technicians. These are the necessary employees that manage billing, insurance, government forms and reports and customer relations. While these roles are necessary they also demand a vital portion of the resources of the institution that could be dedicated to the actual and direct service to the patient.
The solutions seem to be obvious but the devil as always is in the detail. The incentive system for recruitment at the beginning level needs to entice more candidates to the practice of general medicine. Many of the problems can be diagnosed and remediated at this level. The addition of PA and NP at this level would be a great value.
We will have to increase the schools for training nurses and other technicians and that presents a manpower dilemma and large expenditures of money. We will have to retain the nurses we have and be prepared to fill the ranks for the people who are reaching the end of their tenure due to changing demographics.
We will have to realign the resources that do now exist by increasing the productivity of clerical staff by the use of more technology and reduced burdens of documentation that is currently constipating the system. The monies and resources saved here can be used to support the other more vital functions.
There is much to be done and the solutions as always are the use of our people and the expansion and improvement of our workforce.
(Jim Flora; Christina's Grandpa)
Wednesday, March 17, 2010
Workforce Reform #2
State and Federal government would be involved with this reform. In Minnesota, the Governor has proposed cutting $350 million from health and human services. Limiting the number of budget cuts a specific section within the health care workforce can experience in a given year. For example, not allowing a state government to continually cute funding in the area of health and human services, thus human services is forced to cut many positions as well as beneficial programs. The individuals and families affected by the cuts of these beneficial programs including, health care, cash assistance, and food assistance are already struggling in this economy. If they lose these basic needs they are more at risk for illness/death and abuse to self and others. If the allied professionals such as social workers are being forced to carry heavier caseloads due to positions being cut or positions remaining vacant, then it is the vulnerable individuals and families who will suffer. They may be neglected or get lost in the system. It should be a priority to enforce those who have the ability to work or pursue an education to do so. But to do this we need more allied health professionals rather than less.
Programs would not be cut altogether in the health and human services division but rather forced to make budget cuts. Each different area of health care would be an equal playing field, in that they would all feel the effects of these budget cuts, but no programs would be completely eliminated. Individuals who are able to work should be expected to work or get an education for future employment, so that they can support themselves.
This reform would insure that a service that is especially helpful for an under served population does not continually face losses. Instead, budget cuts would be equally felt throughout many different areas of health care, but each would not suffer as severe cuts as they would if they were the only one facing the cuts. Those who genuinely need the services would continue getting them and those abusing the system would be cut from getting those services.
Those receiving services and already vulnerable would not lose the needed services mentioned previously. This reform would increase the quality of health care in the US by providing education and health and wellness/promotion programs that would occur on a community level. This would increase the quality of care because the health educators and chamber would be able to better focus their efforts on the community and the individuals in that community by working with smaller groups/populations.
Health and Human Services is the backbone for many communities. When services/employees are cut it has a direct impact on the basic needs humans rely on and should have access to such as food, clothing, shelter, and health care. The government is depriving these individuals of those basic needs in a time when we are expected to help those who are without. By having a fund that supports health educators and promoting the health of the US by having community based programs, its intentions are to cut health care costs down the road that are associated with secondary and tertiary care.
Sources:
Center on Budget and Policy Priorities. (2010). An Update on State Budget Cuts: Governors Proposing New Round of Cuts for 20011; At Least 45 Have Already Imposed Cuts that Hurt Vulnerable Residents. Retrieved March 11, 2010 from http://www.cbpp.org/cms/?fa=view&id=1214
Minnesota Budget Project. (2010). Governor's Supplemental Budget Proposes Widespread Cuts in Health and Human Services. Retrieved March 11, 2010 from http://minnesotabudgetbites.org/2010/03/09/governors-supplemental-budget-proposes-widespread-cuts-in-health-and-human-services/
Palfreman, J. (Writer, Producer, and Director) & Reid, T.R. (Writer). (2008, April 15). FRONTLINE: Sick Around the World. Boston: WGBH educational foundation.
Shi, L., & Singh, D.A. (2008). Delivering Health Care in America: A Systems Approach (Fourth ed.). Sudbury: Jones and Bartlett.
U.S. Department of Health and Human Services, Health Resources and Services Administration. (2006). The United States Health Workforce Profile. Retrieved March 11, 2010 from http://bhpr.hrsa.gov/healthcareworkforce/reports/#multiple
Programs would not be cut altogether in the health and human services division but rather forced to make budget cuts. Each different area of health care would be an equal playing field, in that they would all feel the effects of these budget cuts, but no programs would be completely eliminated. Individuals who are able to work should be expected to work or get an education for future employment, so that they can support themselves.
This reform would insure that a service that is especially helpful for an under served population does not continually face losses. Instead, budget cuts would be equally felt throughout many different areas of health care, but each would not suffer as severe cuts as they would if they were the only one facing the cuts. Those who genuinely need the services would continue getting them and those abusing the system would be cut from getting those services.
Those receiving services and already vulnerable would not lose the needed services mentioned previously. This reform would increase the quality of health care in the US by providing education and health and wellness/promotion programs that would occur on a community level. This would increase the quality of care because the health educators and chamber would be able to better focus their efforts on the community and the individuals in that community by working with smaller groups/populations.
Health and Human Services is the backbone for many communities. When services/employees are cut it has a direct impact on the basic needs humans rely on and should have access to such as food, clothing, shelter, and health care. The government is depriving these individuals of those basic needs in a time when we are expected to help those who are without. By having a fund that supports health educators and promoting the health of the US by having community based programs, its intentions are to cut health care costs down the road that are associated with secondary and tertiary care.
Sources:
Center on Budget and Policy Priorities. (2010). An Update on State Budget Cuts: Governors Proposing New Round of Cuts for 20011; At Least 45 Have Already Imposed Cuts that Hurt Vulnerable Residents. Retrieved March 11, 2010 from http://www.cbpp.org/cms/?fa=view&id=1214
Minnesota Budget Project. (2010). Governor's Supplemental Budget Proposes Widespread Cuts in Health and Human Services. Retrieved March 11, 2010 from http://minnesotabudgetbites.org/2010/03/09/governors-supplemental-budget-proposes-widespread-cuts-in-health-and-human-services/
Palfreman, J. (Writer, Producer, and Director) & Reid, T.R. (Writer). (2008, April 15). FRONTLINE: Sick Around the World. Boston: WGBH educational foundation.
Shi, L., & Singh, D.A. (2008). Delivering Health Care in America: A Systems Approach (Fourth ed.). Sudbury: Jones and Bartlett.
U.S. Department of Health and Human Services, Health Resources and Services Administration. (2006). The United States Health Workforce Profile. Retrieved March 11, 2010 from http://bhpr.hrsa.gov/healthcareworkforce/reports/#multiple
Monday, March 1, 2010
Workforce, Reform Proposal #1
The US government and/or a private organization should mandate how physicians are trained. According to Russell Robertson M.D., the chair of the Council on Graduate Medical Education (COGME), there is a lack of interest, support and funding for our nations primary care physician residency programs.
Similarly to Great Britain or Canada, we should have either the government or a group of private "provincial ministries of health care" (negotiations between the medical schools, provincial governments, and physician associations) finance all residency slots and controls the number of positions by specialty (Shi and Singh p 129). According to Robertson, about 65 percent of all physicians in the U.S. are sub-specialists and 35 percent are primary care physicians. It is necessary to create incentives to entice medical students to pursue careers in primary care. In Great Britain, the primary care physicians known as “gatekeepers” are paid bonuses for keeping their patients healthy and not needing specialty care. Our reform would also offer the same financial opportunities to those going into NPP positions, such as NPs; PAs; etc. due to the fact that they can improve primary care access to those individuals in rural settings, provide high quality and cost effective care, and show greater interest in patients (Shi and Singh p 144).
There would be a more balanced and controlled distribution of specialists and generalists as well as NPPs. We need to start transforming the current system, and start pushing for primary health care and a wellness perspective. The promotion of preventive care with primary care physicians and NPPs will reduce the number of patients seeking care from specialists. Increasing the funding for NPPs education by having a portion of taxes designated to help compensate those students pursuing a degree in a NPP field. This would allow for the medically underserved communities to receive high quality, low cost primary healthcare in order to prevent diseases that in the long run will cost more money over time.
At first this would be a costly change, however, over time costs would level off because of increased access and therefore more people would utilize primary care instead of putting off medical problems until they become something bigger, and NPPs deliver high quality care with cost effectiveness in mind.
Arvantes. J. (2009, September 23). Primary Care Physician Shortages Can Be Traced Largely to Pipeline Issues, Says FP. Retrieved February 25, 2010 from http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20090923medpac-pcps.html
Center for American Progress. (2010). Closing the Health Care Gap. RetrievedFebruary 15, 2010 from http://www.americanprogress.org/issues/2010/01/health_workforce.html
U.S. Department of Health and Human Services, Health Resources and Services Administration. (2006). The United States Health Workforce Profile. Retrieved February 15, 2010 from http://bhpr.hrsa.gov/healthworkforce/reports/#multiple
Friday, February 19, 2010
Overview and History-Workforce
"Today, one of the most pressing issues facing our health care system is the shortage of health care workers. From lab technicians,to nurses, to pharmacy technologists, to rural and urban physicians, the demand for our health care workers is increasing just as more and more of our workers reach retirement age and leave the workforce. We cannot afford to have our hospitals short-staffed or our health care professionals to be working triple shifts. We must address this shortage and ensure that all of our citizens have access to quality health care."
Jim Doyle,GovernorState of Wisconsin
At the heart of the United States' health care system, lies a fundamental component, crucial to the success of the system as a whole: the Workforce. Without this element, there would be no one to provide the services necessary for citizens to access health care in the first place; there would be a missing component to the "three-legged stool" encompassing the access to care, quality of care and cost of care. In current discussions on health care reform, we must carefully consider the huge role the health workforce plays in the grand scheme of things and its affect on the system as a whole in order to make proper changes.
The health care workforce-- or those who provide health care and administrative duties for the general population-- includes, but is not limited to: physicians, nurses, dentists, pharmacists, optometrists, psychologists, podiatrists, chiropractors, non-physician practitioners, health services administrators and allied health professionals. Currently, there are over 10 million people in the U.S. health care workforce. In fact, it consists of greater than three percent of the total labor force in the nation. This contributes to about 16% of the nations Gross Domestic Product. It is projected that this number will only continue to grow due to a growing population of immigrants as well as in increase in the aging population. (Shi & Signh p. 3, 120)....
Our country's focus on disease treatment rather than preventive care has led to the lopsided training of physicians. Our medical schools emphasize hospital-based training, which has produced more specialists and fewer generalists/primary care physicians. These physician specialists are not prepared to focus on the promotion of wellness and prevention.
Despite there being such a huge number of people already in the US health care workforce, our country is actually experiencing a shortage in healthcare workers; it is estimated that by the year 2020 our country will be experiencing a shortage of 200,000 physicians and 1 million nurses. In our larger metropolitan areas, these shortages may not be felt as strongly, but in rural and underserved areas they will definitely feel the shortage.
With the current goal to expand our national health care plan to cover the uninsured, we would need to expand our current levels of primary care physicians by 25% at a time when we are experiencing a shortage them. Currently, our shortage in nurses across the country could be as high as 400,000 leaving as many as 116,000 RN positions in hospitals and over 100,000 nursing positions in nursing homes vacant.
One aspect of our evolving health care workforce to take into account is the fact that by 2011 some of the first 78 million Babyboomers will be hitting the age of retirement--this could spell out disastrous effects on our health care workforce--many will either retire from health related fields and/or begin to need increased amounts of care due to increases in chronic conditions. It is without a doubt that planning for these types of shortages would have been a very difficult task for our country to have foreseen due to regional maldistribution of health professionals, overspecialization of physicians, and the current and expected demographics of the health workforce and the population they serve.
Center for American Progress: Closing the Health Care Gap
http://www.americanprogress.org/issues/2010/01/health_workforce.html
Sources:
American Hospital Association. (2009). Workforce. Retrieved February 15, 2009 from
http://www.aha.org/aha_app/issues/Workforce/index.jsp
Center for American Progress. (2010). Closing the Health Care Gap. Retrieved
February 15, 2010 from http://www.americanprogress.org/issues/2010/01/health_workforce.html
Health Care Workforce Development. (2009). Healthcare in the News. Retrieved
February 18, 2010 from http://www.dwd.state.wi.us/healthcar/e
Shi, L., & Singh, D. A. (2008). Delivering Health Care in America: A Systems
Approach (Fourth ed. ). Sudbury: Jones and Bartlett .
U.S. Department of Health and Human Services, Health Resources and Services
Administration. (2006). The United States Health Workforce Profile. Retrieved
February 15, 2010 from http://bhpr.hrsa.gov/healthworkforce/reports/#multiple
Jim Doyle,GovernorState of Wisconsin
At the heart of the United States' health care system, lies a fundamental component, crucial to the success of the system as a whole: the Workforce. Without this element, there would be no one to provide the services necessary for citizens to access health care in the first place; there would be a missing component to the "three-legged stool" encompassing the access to care, quality of care and cost of care. In current discussions on health care reform, we must carefully consider the huge role the health workforce plays in the grand scheme of things and its affect on the system as a whole in order to make proper changes.
The health care workforce-- or those who provide health care and administrative duties for the general population-- includes, but is not limited to: physicians, nurses, dentists, pharmacists, optometrists, psychologists, podiatrists, chiropractors, non-physician practitioners, health services administrators and allied health professionals. Currently, there are over 10 million people in the U.S. health care workforce. In fact, it consists of greater than three percent of the total labor force in the nation. This contributes to about 16% of the nations Gross Domestic Product. It is projected that this number will only continue to grow due to a growing population of immigrants as well as in increase in the aging population. (Shi & Signh p. 3, 120)....
Our country's focus on disease treatment rather than preventive care has led to the lopsided training of physicians. Our medical schools emphasize hospital-based training, which has produced more specialists and fewer generalists/primary care physicians. These physician specialists are not prepared to focus on the promotion of wellness and prevention.
Despite there being such a huge number of people already in the US health care workforce, our country is actually experiencing a shortage in healthcare workers; it is estimated that by the year 2020 our country will be experiencing a shortage of 200,000 physicians and 1 million nurses. In our larger metropolitan areas, these shortages may not be felt as strongly, but in rural and underserved areas they will definitely feel the shortage.
With the current goal to expand our national health care plan to cover the uninsured, we would need to expand our current levels of primary care physicians by 25% at a time when we are experiencing a shortage them. Currently, our shortage in nurses across the country could be as high as 400,000 leaving as many as 116,000 RN positions in hospitals and over 100,000 nursing positions in nursing homes vacant.
One aspect of our evolving health care workforce to take into account is the fact that by 2011 some of the first 78 million Babyboomers will be hitting the age of retirement--this could spell out disastrous effects on our health care workforce--many will either retire from health related fields and/or begin to need increased amounts of care due to increases in chronic conditions. It is without a doubt that planning for these types of shortages would have been a very difficult task for our country to have foreseen due to regional maldistribution of health professionals, overspecialization of physicians, and the current and expected demographics of the health workforce and the population they serve.
Center for American Progress: Closing the Health Care Gap
http://www.americanprogress.org/issues/2010/01/health_workforce.html
Sources:
American Hospital Association. (2009). Workforce. Retrieved February 15, 2009 from
http://www.aha.org/aha_app/issues/Workforce/index.jsp
Center for American Progress. (2010). Closing the Health Care Gap. Retrieved
February 15, 2010 from http://www.americanprogress.org/issues/2010/01/health_workforce.html
Health Care Workforce Development. (2009). Healthcare in the News. Retrieved
February 18, 2010 from http://www.dwd.state.wi.us/healthcar/e
Shi, L., & Singh, D. A. (2008). Delivering Health Care in America: A Systems
Approach (Fourth ed. ). Sudbury: Jones and Bartlett .
U.S. Department of Health and Human Services, Health Resources and Services
Administration. (2006). The United States Health Workforce Profile. Retrieved
February 15, 2010 from http://bhpr.hrsa.gov/healthworkforce/reports/#multiple
Sunday, February 14, 2010
Political Stance
"Hospital care, at its core, is about people caring for people. Yet combined pressures--a shrinking workforce, an aging population, financial concerns, increased demand and other stresses--have translated into a severe personnel deficit."
--American Hospital Association
As a group, we vary in our political standpoints, so therefore, we have decided to remain open-minded but with a bipartisan view point. We aren't aligning with any particular political party to base our decisions upon at this time.
However, we do believe:
--American Hospital Association
As a group, we vary in our political standpoints, so therefore, we have decided to remain open-minded but with a bipartisan view point. We aren't aligning with any particular political party to base our decisions upon at this time.
However, we do believe:
- The pharmaceutical companies have too much control and money invested in our health care system
- Everyone should have access to health care, especially in rural and inner-city settings
- Too much money is spent on administrative costs due to a multiple-payer fragmented market system
If the government can offer a subsidized lunch program in our school systems, then why can't they offer a subsidized health care program/system that meets the needs of all Americans?
We value:
The fact that health care is a basic human right
- Health care should be accessible, cost effective, and high quality for everyone
- An emphasis on primary care and prevention instead of the traditional medical model (overspecialization)
Out team's values and beliefs influence the workforce in that the shift from the traditional medical model towards primary care and prevention, the cost of health care as a whole will be greatly reduced. Due to large disparities within the quality of health care in metropolitan versus rural areas, with the induction of a health plan that includes universal access, out quality of health care as a nation should become more standardized. Our idea of encompassing every one's human right to health care into a universal plan would provide citizens with two options for coverage. There would be the general public insurance provider that is controlled via the government and then if citizens choose to opt out, they can pick up their own choice of private insurance options at their own discretion and payment options.
Currently, the health care workforce (especially physicians) within our national health plan, are being controlled like puppets while the large and powerful pharmaceutical companies are controlling the stings like puppeteers. Our health plan would make sure that health care providers are not able to establish contracts with the pharmaceutical companies. Again, we need to focus on primary prevention, and not let the pharmaceutical companies dominate our health care system. By focusing on primary prevention, it's possible that we would not need such a large quantity of prescription drugs on the market today.
Subscribe to:
Comments (Atom)