Monthly Archives: March 2017

5 Questions about the American Healthcare System

Healthcare reform is a contentious issue in American politics.  While a few presidents—Lyndon Johnson, Bill Clinton, and Barack Obama—have signed laws that changed the American healthcare landscape, the system is still imperfect.  With the new Trump administration, the future of healthcare policy remains unclear.  Some of the changes (i.e. Medicare and the Affordable Care Act) may be in jeopardy.Picture-1000words(442x400)

Below are answers to some important questions about the American healthcare system.  In order to play a part in the continuing conversation about healthcare reform, it’s important to understand the current status of the American healthcare system.

Question: What makes the American healthcare system different than other healthcare systems?
Answer: The American healthcare systems offers a lot of choice for potential insurance coverage, private plans, and public plans including Medicare, Medicaid, Veterans benefits, and the Children’s Health Insurance Program.  Despite all of those choices, America is the only wealthy country without universal coverage.   Additionally, the American healthcare system has higher usage of expensive medical technologies—like MRI machines.

Question: Where does the American healthcare system rank on the list of world healthcare systems?
Answer: The World Health Organization’s 2000 report ranks the American healthcare system as 37th in the world—behind every other wealthy country.

Question: How much does the United States spend on healthcare every year?
Answer: In 2013, the United States spent approximately $9,000 per resident (or 17.1% of the gross domestic product) on healthcare costs.  France spent the second highest amount of money on healthcare, approximately $4,300 per resident and 11.6% of its GDP.  With the lowest healthcare spending levels, the United Kingdom spent 8.8% of its GDP or approximately $3,300 per resident.

Question:  Doesn’t higher spending means that Americans get better healthcare?
Answer:  Not necessarily.  The American healthcare systems provides quality care that is similar to the care provided by other wealthy countries.

Question: If the care is comparable, what are the higher costs for?
Answer:  There isn’t one answer to this question.  There are a range of contributing factors including: widespread use of expensive medical technology, the fee for service model, and higher volumes of patients.

Healthcare policy continues to be a contentious issue in American politics.  Citizens, experts, and politicians have spent decades debating what changes will reform the system.  Yet this is not simply an issue for the politicians.  Stay informed about the discussion surrounding healthcare reform.  These changes will eventually impact the lives (and futures) of many Americans.

Baribault, Maryann and Casey Cloyd. Health Care Systems: Three International Comparisons. EDGE: Ethics of Development in a Global Environment, 26 July 1999, Accessed January 22, 2017.
Comparing International Health Care Systems. PBS News Hour, 26 October 2009, Accessed January 22, 2017.
Murray, Christoper J.L., D Phil, and Julio Frank. Ranking 37th—Measuring the Performance of the U.S, Health Care System. The New England Journal of Medicine, 14 January 2010, Accessed January 22, 2017.
The U.S. Health Care System: An International Perspective. Fact Sheet 2016. DPE. Department for Professional Employees. AFL-CIO,, Accessed January 22, 2017.
U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries.  The Commonwealth Fund, Accessed January 22, 2017.
World Health Organization’s Ranking of the World’s Health Systems. The Patient Factor: Your Voice in the Health Care Equation, Accessed January 22, 2017.

4 Reasons Why You Should Share Financial Goals with Staff

There are two sides to the American healthcare system: financial and patient care. While most staff recognize the existence of both, few are aware of their organizations financial goals.  In almost all offices, there are at least two people—the clinic manager and the medical director—who know the organization’s patient-care and financial goals. Smart healthcare leaders share financial information with their clinic staff.  Failing to share this information is a mistake.FL83630

After all, it’s difficult to expect a clinic team to collectively work to accomplish goals when they aren’t aware of them.  Here are responses to some common objections to sharing financial goals with clinic staff.

Objection: What are financial goals?

Response:  Financial goals are the targets that your clinic is reaching toward. Is it a decrease in the no show rate?  Is it an increase in payments from providers?  The specifics vary between organizations.  Summarizing information on financial goals should be easy.  If it cannot be described in a few sentences, continue simplifying until it can.

Objection:  My staff don’t need to know about the organization’s financial goals.

Response:  Many medical directors assume that their staff are uninterested in the larger goals of the organization. That’s not true. Since staff receive paychecks, they already have a vested interest in the financial success of the organization.

Objection:  It doesn’t benefit the organization to share the financial goals.

Response: When managers don’t share information on goals, they actively prevent their staff from assisting.  Since goals cannot always be easily achieved, smart managers recruit their staff to help reach them. Staff suggestions won’t always work.  Frequently, a staff member offers a solution that the managers hadn’t considered.

Objection:  Our first priority is patient care.

Response: Perfect.  Healthcare organizations should focus on providing high-quality patient care first.  The two goals are not mutually exclusive.  Staff can provide high-quality patient care and also be aware of the financial goals of the organization.

Finances and patient care make up the two sides to the American healthcare system. One cannot exist without the other.  Staff realize this, yet many managers still fail to share financial goal information with staff.  Reaching goals takes concentrated effort.  Smart healthcare leaders will share this information with staff to ensure that there is as much brainpower as possible working to achieve goals. Managers who fail to share the information intentionally limit their chances of success.

Nurses Needed In These 5 Health Care Settings


Employment for these nursing roles is projected to grow much faster than average until the mid-2020s. In addition to inpatient roles, nurses can work in outpatient clinics, schools, community health centers, nursing homes, home health options, palliative care, and correctional centers.

Outpatient clinics allow nurses to work deeply in a specific specialty.  Nurses who already have (or who want to build) in-depth knowledge about medical specialty will be attracted to these roles.

Schools also need nurses to care for ill students. Job requirements will vary.  Some school nurses work full time; some work part time.  They may work in one location or rotate between neighboring schools.  In these environments, nurses will typically work with pediatric or adolescent patients.

Nursing homes offer the opportunity to work with patients who need varying levels of care.  Some patients may be long-term residents who need assistance with all of their activities of daily living.  Others may be short-term residents who are recovering from an injury or illness.  Since many patients are elderly, nurses interested in geriatric care may gravitate toward these roles.

Home health nurses travel to patient’s homes to assist them on a temporary or permanent basis. Some patients may need short-term care while recovering from an injury or acute illness.  Others may need ongoing care to help with chronic conditions or disabilities.  Since they visit patient’s homes, palliative care nurses are also considered home health nurses.

Correctional center nurses are responsible for intake screenings and medical care for inmates.  Within correctional centers, nurses see patients who have acute and chronic medical conditions.  Due to the close proximity of inmates, outbreaks of disease are common.  On a daily basis, nurses may also be responsible for administering medications as needed.  Care coordination between providers is another part of the nursing role, particularly when someone is being released.

Nurses fill a range of roles in any setting.  Inpatient nurses help patients who are currently admitted to the hospital.  Outpatient nurses get to work in-depth within a particular medical specialty.  School nurses typically work with pediatric populations in one or more locations.  Nursing home nurses care for patients who need varying levels of assistance.  Home health nurses visit patients in their homes on a temporary or ongoing basis.  Correctional center nurses care for incarcerated patients and help coordinate their care. Each setting offers a different set of challenges for nurses to conquer as they care for specific patient populations.

Correctional Facility Nursing. Minority Nurse, 7 February 2016, Accessed January 31, 2017.
Giang, Vivian. Jailhouse Doctor Shares What It’s Like To Care For The Most Dangerous People In the World. Business Insider, 20 March 2013, Accessed January 31, 2017.
Registered Nurses. United States Department of Labor. Bureau of Labor Statistics. Occupational Outlook Handbook, 17 December 2015, Accessed January 31, 2017.

What Sets Correctional Medicine Apart?

Staff working in correctional medicine provide health care to almost 2 million Americans who are currently incarcerated in jails, prisons, and detention centers. There are differences between correctional and traditional medicine environments.

Different Environment
Correctional medicine has rules to protect the safety and privacy. For example, staff need to routinely assess what items they leave out in an unattended exam room. As a safety precaution, certain items should never be left unattended. There may also be restrictions on items (like cell phones) that can be brought into the care environment. On a broader scale, staff may be asked to limit their sharing personal experiences with patients. These restrictions are meant to help maintain a safe health care environment. Despite the restrictions, workers in correctional medicine benefit from its unique environment.

Staff in traditional health care settings spend a chunk of time worrying about health insurances, contracts, and billing. Different doctors accept separate insurances. Some patients who lack (or have undesirable) insurances are barred from seeking care at certain offices. In correctional medicine, staff do not worry about billing or insurances. Instead, providers in correctional medicine are bound to provide medically necessary care to their entire patient population.

Better Follow-Up Care and Routine Screenings
In traditional health care environments, patients go home. In correctional medicine environments, patients do not leave. The patients are always nearby, which simplifies follow up care. Additionally, many correctional medical facilities have higher percentages of compliance with recommended screenings than their traditional medicine counterparts. Again, this is because the patient population is always nearby.

Treating Chronic and Acute Conditions
Similar to the larger population, patients have chronic medical conditions that need care. While some medications can be given to the patient. Guards or correctional medicine staff need to distribute other prescriptions. Due to the close living quarters, acute infections (if not caught quickly) can spread throughout the entire population. If an infection spreads, providers often work with epidemiologists to determine cause and next steps. Due to changing needs, most correctional medicine providers are generalists who can quickly respond to a patient’s needs.

Partnership with Other Staff
Security guards help maintain a safe environment. Sometimes guards provide extra support when a provider needs help with an escalated patient. Often, security guards recognize and report unusual appearance or behavior to correctional medicine providers. This early recognition helps providers to begin early treatment—if necessary.


Correctional medicine has different restrictions and freedoms than traditional health care environments. While the work is challenging, it is worth considering for those health care staff who want the opportunity to stop worrying about insurance and treat their patients.

Correctional Facility Nursing. Minority Nurse, 7 February 2016, Accessed February 9, 2017.
Correctional medicine. Wikipedia, 2 June 2016, Accessed February 7, 2017.
Giang, Vivian. Jailhouse Doctor Shares What It’s Like To Care For The Most Dangerous People In the World. Business Insider, 20 March 2013, Accessed January 31, 2017.
Keller, Jeffrey. Correctional Medicine is Different: Our Patients Don’t Go Home!, Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine: The Principles of Fairness., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: All Clinical Encounters are Discussed in the Dorm., Accessed February 7, 2017.
Keller, Jeffrey. Correctional Medicine is Different: We Can’t Fire Our Patients-and They Can’t Fire Us!, Accessed February 7, 2017.

Healthcare Systems Around the World

There are no easy answers in the debate about reforming the American health care system.  Any proposed solution needs provide better patient care and affordability than the current system does.  With a population of 324 million, finding these solutions is difficult.  Over the years, health care reform has come in different pieces of legislation. For President Johnson, it was the creation of the Medicare and Medicaid programs. Under President Clinton’s administration, HIPAA strengthened protections for patients.  In 2010, President Obama signed the Affordable Care Act that took steps to curb rising costs while expanding coverage to twenty million people.  With a new presidential administration, the debate about the future of the American healthcare system continues.  Given that, it is important for all Americans to understand different options for health care delivery systems.

American Health Care System—or the Fee-For-Service Model  

All health care services have fees associated with them.  When possible, those fees are first charged to the patient’s health insurance company.  After the insurance company processes and pays their part of the claim, the patient is responsible for the remaining balance.  If a patient lacks insurance, the entire bill goes to the patient. Every year, almost 2 million people declare bankruptcy due to medical costs.

The American government provides a variety of different insurance systems that provide different coverage levels to distinct groups of people, ranging from veterans to the elderly to children.  Yet, people are still stunned that the United States is the only wealthy country that doesn’t provide universal health coverage.

A National Health Service

In the United Kingdom, the government provides health care like all other public services (i.e. emergency responders and trash collection.)  Taxes pay for the government to operate medical facilities and pay doctors. Privately owned clinics and independent medical providers are allowed, but face restrictions.

National Health Insurance Plans—also called Single Payer System

In Canada, patients seek care from private sector doctors.  Their bills are paid by a government fund that everyone pays into.  Single payer systems have a strong negotiating position, and often pay lower prices for pharmaceuticals and services.

Since any solution needs to work better than the current system, debates about the American health care system will continue long into the future.  As Americans, it is important to remain educated about the options available.  Each health care delivery system faces a unique combination of strengths and weaknesses.  Ultimately, it will be up to the American people to decide how to shape the system as we move into the future.

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