As the video above shows, health care reform doesn’t come easy. The Clinton Administration was enduring many of the same obstacles that the Obama Administration is now going through. The trajectory of reform is often painfully gradual and fraught with trial and error.
This week’s literature focuses on health-care and non-profits. Chapter 5 of Nonprofit Nation dives into the topic of health care. According to Nonprofit Nation: “health care accounts for one-seventh of the nation’s economy (O’Neill page 92).” Like it or not, the health care services in America plays a tremendous role. The general makeup of health agencies comes from for-profit, nonprofit, and governmental sources. Nonprofit Nation brings to the table some debates about healthcare that I had not considered. One is whether these organizations are moving in the direction from nonprofit to for profit. Another is the efficiency and societal good of nonprofit health care services and how that compares to for-profit health care.
Are healthcare services moving towards for-profits? The answer is not entirely clear. According to Nonprofit Nation: “The authors conclude that there has been little change over the past 15 years in the overall share of hospitals held by nonprofit, for-profit and government owners” (O’Neill page 103). Jenny Gold’s article Mergers of for-profit, nonprofit hospitals: Who does it help, makes a contrarian argument. Jenny’s claim is that as of recently there has been an unprecedented movement towards for-profit hospitals. Apparently, in bad economic times, like now, non-profit hospitals are often times not financially stable. Therefore, large mega-corporations can buy out the non-profit hospitals, like in the DMC/Vanguard Health Systems of Nashville situation. Nonprofit Nation also claims that there have been some shifts in ownership away from nonprofits. Policies like “deinstitutionalization,” privatization of HMOs, IRS rules that require evidence of community benefits, and the shift in home health care towards for profit, have all been shifts away from nonprofits (O’Neill page 103).
The question, then becomes are for-profit hospitals worse, or less efficient than non-profit hospitals? According to Gold’s article, the results are inconclusive. A separate article by Health Affairs lays out some of the differences. The article proposes that for-profit hospitals are more likely to offer services based on service profitability, and are therefore more economically efficient. They are able to do so by locating in areas with relatively well-insured patients. Conversely non-profits are more open to un-insured patients, and are therefore more equitable. I generally regard non-profit hospitals as more preferable, although the literature is widely debated and overall incomplete. Non-profit hospitals seem preferable by providing equitable treatment and community benefits. The tradeoff, however, is that they can go bankrupt in bad economic times like how Gold’s article details.
The policy of deinstitutionalization is one that I do not know much about. According to Psychiatric Services a psychology journal, deinstitutionalization is the release of mentally ill individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. Evidently there have been problems in deinstitutionalization – the greatest problems have been in creating adequate and accessible community resources. There is also a new generation of uninstitutionalized persons who have severe mental illnesses, many of which become homeless or imprisoned. According to the journal the lesson that must be learned is that successful deinstitutionalization “involves more than simply changing the locus of care” there must also be community services specifically tailored to the needs of each individual. I feel like the deinstitutionalization policy was not carried out as delicately as it should have been. The lack of proper community facilities has resulted in a growing number of homelessness that is not properly understood by today’s society.
The debate over healthcare is rigorous and ongoing. Politicians on either side of the aisle are adamant about reform (or status quo). I have noticed the debate can result in screaming matches where neither side really knows what they are talking about. It seems from the article The Value of Nonprofit Health Care that while both sides have pronounced opinions most are not properly educated. “Past public opinion polling indicates that 80 to 90 percent of Americans appear to think that ownership in health care does matter. Unfortunately, almost two-thirds of those polled don’t know if the health care providers or insures they rely upon in their own communities are nonprofit or for-profit.” One policy tool one can use is simply education. The reason why I feel that non-profit hospitals are more adequate is the incentives they have. For example, a girl in class made a claim that often for-profit doctors would act on the incentive cycling through patients faster than necessary. In her example, the doctors were paid on the number of patients served, and would therefore cycle through them faster than necessary. Non-profit doctors would seemingly not have the same incentive. For-profit hospitals it seems are focused on profits and efficiency; non-profits seem to have a larger scope in providing what is essentially a social good. I feel as though education of these incentives can be essential towards producing adequate and equitable health-care reform.
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ReplyDeleteI feel like hospitals function mostly the same whether they are non-profit or for-profit. However, in theory, the non-profit hospitals are more likely to take on areas of healthcare that may not turn as large of a profit and to reinvest what they do earn. But in the end, free marker forces seem to play a role, competing for the most up to date equipment, and the best medical staff; this to attract patients.
ReplyDeleteIt is the other areas of healthcare such as research and insurance coverage that I have more of a problem with if they are for-profit. Does the insurance company care about your well-being or are you just another statistic within their system. They base their decisions off of probability, but this so that they can turn a profit. Where does the extra money go? Administrative costs, profit, hiring lobbyists?
All in all, I say we should regulate the insurance companies, or do away with them. I believe the best option is the european model or call it whatever you want, socialized, government run healthcare. I feel like the free market is not appropriate for health care and that the government would be best to manage our pool of money. Some repeat the lie that is is overly costly but this is largely not true. The social well-being would much outweigh any costs. And measures could be put in place to avoid unnecessary tests for example. Not every area of healthcare should be dealt with by the free market and the government is more likely to care about the well-being of us, the people.
One last thing to note on, I feel like there is so much irony involved with the healthcare bill, in that in its current form it took most of the proposals by conservatives. For example, no public option? In order to get it passed, it involved a great amount of cooperation between parties in which they were completely split. Some deal making was made but in the end "Obama Care" was bipartisan. I feel like the efforts in the house right now to repeal it are mainly a political ploy -- every knows that it would never get past the senate.
The video you included is from a speech given in 1993 which goes to show just how much bureaucracy can slow things down. In the video, President clinton states that "health care is too uncertain and too expensive, too bureaucratic and too wasteful, it has too much fraud and too much greed". He goes on to say that giving every American health security was "our most urgent priority," so I wonder why 17 years have gone by and this still has not happened. As the statistics you included from Nonprofit Nation pointed out, people seem to be very uninformed on the subject of health care, yet they still seem to have very strong opinions on the subject. I agree that education is the missing factor in the equation of change. If more people knew about how the health care system operates, that would lead to more educated decisions and thus results that people are happy with. The pros and cons of nonprofit and for profit hospitals would be a good place to start, especially considering most people do not even know the difference between the two.
ReplyDeleteThe video does show how Clinton try to address healthcare during his administration and it was not successful. I think many politicians try to change healthcare but often fail or have little impact. I think that healthcare is a huge sector that takes time to change like any other issue and it takes huge political will to have politicians willing to address the root of the problem. I kind of think that healthcare are moving towards for profit because before I took this class, I though of hospital as a business and how they take require you to pay for their services. I got the idea that who pays more, they get better healthcare since expensive hospitals have greater services and better supplies. I agree that education can be a good factor in producing a adequate health care reform.
ReplyDeleteI liked your point on the need for sustainability within the nonprofit sector of health care, in the comparison of for-profit and non-profit structure. In my own eyes health care is a right that needs to be implemented equitably across all lines of citizenship within America, and so the draw to a structure that respects this concept of health care as a right clearly attracted me, but it is important to note the authenticity of such a future. If a hospital is constantly under strain to cover costs and stay afloat, quality of care and conditions could easily slip through the cracks, as you pointed out. Still, I see the solution not in a complete switch to a for-profit system but a priority of the government to step up the financial backing of nonprofits in times of crisis. This would still allow a step back from party-line politics within the Congress while still allowing the function of the government to work as a protecting figure over the goodwill of its citizens.
ReplyDeleteI am also very interested in the comaparison between non-profit and for-profit hospitals in terms of cost and quality of care. While my initial thought was that for-profit hospitals would provide a higher quality of care because they are able to acquire the latest technology and negotiate staff salaries, I did some research. In my search I found a lot of hospitals with titles saying that nonprofit hospitals and HMO's provide better care. However, in a study done by the Duke Clinical Research Institute,they "found no evidence that for-profit hospitals selectively treat less sick patients, provide less evidence-based care, limit in-hospital stays, or have patients with worse acute outcomes than nonprofit centers." All in all, the care comes out the same (acccording to this study).
ReplyDeletehttp://www.ncbi.nlm.nih.gov/pubmed/17919566
In response to your paragraph on deinstitutionalization, you are right in pointing out that the current system is inadequate. Since the 1950's, deinstitutionalization has been based on the theory that people with severe mental illness can deal with their disease by being in a free environment amongst everyone else rather than in a reclusive, enclosed facility. This has, however, lead to a series of other problems including a significant rise in homelessness, crime, and various forms of red tape to pick up people, diagnose, and properly treat them.