Healthcare in America

The Health of the Population Versus the Health of the Individual

The United States is generally viewed as having the best health care in the world—when best is defined as having the most advanced technology and highly skilled specialists. However, when the United States is compared on basic health status factors against other countries in the world, it comes up deficient. Infant mortality status is a measure of how many children die before their first birthday. On this measure, the United States ranks 42nd in the world behind countries such as Cuba, Portugal, Finland, the Czech Republic and many others (Central Intelligence Agency, 85).

When measured on the average life span of its citizens, the United States was reported in 2006 at 78.0 years, the same as Cuba and Chile and behind countries such as Switzerland (82), Spain (81), Sweden (81), Canada (81), Singapore (80), and the United Kingdom (79). These data suggest that the U.S. population, while enjoying access to the most highly sophisticated medical services available, is not as healthy as other developed and underdeveloped countries (Birk, 36).

The “New” Consumer

The evolving role of consumers in taking more responsibility for their health and the consequent rise of consumerism in health care have created the need for a shift in the way in which health care executives think about their customers. Compelled to reach deeper and deeper into their pockets to cover the cost of care, customers are more knowledgeable and bring higher expectations to their medical care experience. Effective leadership entails a move away from physician-centric operations to consumer-centric practices, from passive models of customer service to active models, one that measures success from the patient's perspective—which typically is focused on the health care experience (Buell, 52).

Much of consumerism is being driven by the high cost of health care. Payment programs and employee benefit plans require more and more consumer financial participation in the cost of care through increased deductibles and copays. Increasing numbers of major employers are establishing consumer-directed health care programs, which are designed to provide each employee with a given annual amount of money that is placed into a health care account. The corollary health benefit insurance plan then places high deductibles on the employee—a deductible that approximates the amount of funding the employer places in the employee health savings account. In this arrangement, the employee has the choice of how to spend these dollars, and any that are not spent stay in the employee's account for future use. The objective of this strategy is to encourage the employees and their families to make judicious use of medical services and to seek out those that are less expensive.

This has implications for the hospital—in a slow economy more patients are unable to pay for medical costs and the hospital is at higher risk of bad debts when the patient cannot pay for services. If, on the other hand, consumers do not get medical care, they go to emergency rooms in acute phases of illness—a very costly alternative ...