HEALTH CARE SYSTEMS-Medicine and Health

Constrains experienced in introduction of universal coverage of healthcare systems in developing countries


The emergence of novel diseases in the contemporary society which has been attributed to the development of poor eating habits, activity level and poverty has augmented in the contemporary society.  This has called for the emergence of newer and better methods to cope with these diseases in terms of maintenance, treatment and prevention. This is what has brought about the emergence of urgency care which entails ambulatory healthcare provided to patients under pre planned basis. According to Walker, Tolentine and Teach (2007: 247-253) this care has long been in existence since time immemorial when people used to visit traditional health consultants for advise. However this policy gained recognition in the 1970s when significant expansion and growth of the healthcare industry expanded bringing about the emergence of managed care organization. Since then intensified campaigns particularly in developed countries have been done and new technologies to support this sector have been pumped in either from the federal governance or non governmental organizations. According to Blank and Burau (2007: 54-66) reformers viewed it as a program to enhance equity in the provision of healthcare other than healthcare exclusion based on aspects such as your origin, race, colour and financial background. Universal healthcare in the contemporary society is provided for using Medicaid, Medicare and also other insurance forms as observed by Saltman, Bankauskaite and Vrangbaek (2009). Different health care systems categorized in to four models; the Bismarck, Beveridge, the health insurance which is national wide and also the out of pocket model as according to Tritter, Koivusalo and Olila (2009). The Beveridge and the Bismarck models are the most commonly used in healthcare today. In the policy of the Beveridge healthcare is provided to all individuals by the federal government through funds collected on taxation. These healthcares are solely owned by the government but incorporate both government and private employees. These policies though helpful particularly for the families that are not well up financially has been observed to have low costs per capita since funding  is exclusively done by the government hence substandard services are often provided. This is a common policy of health among the Great Britain countries and in some Scandinavian countries among other Europeans countries. In the Bismarck model common among the Americans healthcare is provided through the insurance system where certain amount of money is deducted in your total income and is used to cater for your health once you get ill. In this case these insurance systems cover virtually everyone and they are not profit making though operated by private healthcare practitioners. Although these universal health care policies have tried to expand their services globally they have faced many problems particularly in management of finances and diseases particularly with the increment of aged persons who equally must be catered for though not earning any income (Belcon, Ahmed, Younis & Bongyu: 2009, 40-74). They also have a problem in structuring since they incorporate both government and private employees who have divergent views about making profits hence a lot of impunity due to the vulnerability of receiving kickbacks, making fictitious diagnosis and also offering wrong consultancy advices. Further they have questionable quality assurance for the services they offer evidenced by majority of complain from clients due to poor health outcomes (Bjorn & Gunnar: 2004, 1-105). These healthcare programs have not however been successfully implemented in the developing countries due to these effects of these problems. This essay focuses a great deal on these problems and their contribution to the failure of universal health systems succeeding in developing countries as they have in developed countries as this will give a basis to future resolutions to these problems.

Financial constrains experienced by universal healthcare coverage systems in developing countries

            In developing countries problems of healthcare are prevalent particularly due poor technology and policies to prevent and control diseases minding that majority of the inhabitants of these countries are illiterate and less concerned of their health status not until such incidences reach the asymptomatic stage. Constrains of the management of these healthcare systems in third world countries has been a major problem preventing the feasibility of these policies. This is because of poor political stability causing the financial gross income of these countries to be exceeding low to key in funding for the implementation of these aspects in healthcare. This has consequently lead to increased workload of healthcare with most hospitals being flooded with patients who can not even cater for their sustenance. The government which are characterised with high impunity have neglected these projects through inputting fewer funds yet they impose high taxation. Such projects on implementation are characterized with poor per capita as result of too much reliance on the government considering that most individuals do not have source of income. According to Casto and Layman (2006: 1-21) the reimbursement of these funds is characterized by their vandalism even before doing the supposed purpose to serve patients hence mismanagement. The problem of financial management has been intensified by the fact that the private wing of these healthcare systems tends to be more financial oriented other than voluntary hence they accept the switching of customer consultations, corruptions through bribes to do for customers favour hence financial management features a lot of egoism and can easily succeed. The benefit of people not eligible for these insurance plans and go unnoticed has also been prevalent hence the diversion of funds to persons who do not qualify for them being a big blow for the quality of these services due to  lack of eminent management. Considering the baby boom generation characterized with increased births and increased demand for healthcare services which is prevalent in developing countries then this means the financial ability for this project to be feasible must be constrained. The increase in number of aging persons who are not funding the insurance programs or not paying the taxes yet they have the highest cases reported with long term illnesses hence require much health attention is overwhelming the model of both Bismarck and Beveridge hence making these policies of healthcare less successful (Belcon, Ahmed, Younis & Bongyu: 2009, 40-74). A big problem in revenue cycling has also been witnessed where doctors have been shown to show alterations of financial archives so that they can fabricate fictitious projects and then key the money for their own selfish gains knowing that these policies are supposed to be non profit making causing a big financial blow to the company. These aspects have been seen to result to the fallout of established companies while no castigations are issued to such practitioners hence the advocacy for increased mismanagement and vandalism of these resources. A practical example has been witnessed in Eastern and Central European countries due to a difference in needs of countries based on the health system funding systems. According to Drechsler and Jutting (2007: 497-535) insurance system have failed to cause any significant change in health care and some have even failed. A clear indication of this predicament has been seen in Switzerland where such health insurance systems have even failed completely.  Advocacy on sustainable management of such schemes finances is highly advocated for particularly in many countries they have been seen to bring significant change in through proper and efficient management of the funding system for sustenance.

Structure of healthcare system constraints

The healthcare system structure consist of practitioners who are have a key role in ensuring providing healthcare services are provide they may be either private or employed by the government. It also consists of consumers who are either patients who have enrolled to insurance schemes and have monthly deductions from their earning as according to Bismarck or those exclusively funded by the government as in the case of Beveridge Tritter, Koivusalo and Olila:2009). The system also consist of tax and revenue collectors both private and public wings which are found to be rival groups in developing countries. These have made the structural functioning of these health schemes lack organization and a proficient way to carry out their services. This has been clearly evidenced by the lack of fairness and quality due to lack of putting them as precedence as stated by the Audit of Structures and Functions in the Health system (2003: 45-70).

The incorporation of both the private and the public sector has brought about working differences; this is because these two structures have not been able to deliver value to ongoing health investments particularly in developing countries with a vision to bring development to the world. Their recruitment systems have been characterised with impunity and nepotism hence lack transparent delivery of services. Appointment of staff that is not qualified has also been witnessed with frequent complains of misdiagnosis, wrong advise during consultation and ultimately wrong outcomes of medication. This is because a lack of streamlining the leadership of these schemes considering the private wing is out to make profits. A lack of sincere performance appraisals hence no proper detection mechanism of these anomalies has also been witnessed since the persons doing the monitoring of these employees are equally corrupt and in most cases accomplices of these practitioners. A problem of less or blurred accountability in these systems has  continually augmented with the leadership of these systems being reluctant to listen to the grievances of their customers thus such clients resent the services given by these organizations since they are not quality yet they are not doing something positive about it. This is what has consulted to many of these clients particularly those who are affluent and influential to seek for medical services from private consultants. The scope of auditing and financial accountability have in these healthcare systems have been found wanting since the archiving of medical records have been seen inefficient since they do not in most cases correspond to the services offered to the patients. This has been used as a tactic by these practitioners to gaining profits by fabricating fictitious consultations to patients which never existed.

The structure has also not detected patients who are not eligible for these programs and yet keep seeking and receiving treatment without event paying for the services hence the sustenance of these programs has become quite a burden to the economic growth of these developing countries. The lack of decentralized government systems for these programs have resulted to power being to the affluent while the voicing of the majority miniature authorities are never listened to. Incorporating the private wing in these g3overnment systems has only made them to be more complex and less manageable hence these countries ca1n not cope up with this pressure considering they have less gross earnings since they depend on agriculture and that their technology are not up to standard to deal with such predicaments (Audit of Structures and Functions in the Health System: 2003, 45-70). A noted concern on the needed for consolidated systems which a national focus to deliver health, pave way for primary care to flourish and bring development and ensure accountability must be formulated. Developing structures to facilitate configuration systems and also doing quality appraisals by external consultants must be intensified if these structures will be properly implemented for effectiveness (Audit of Structures and Functions in the Health system: 2003, 45-70).

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