Read the two cases and answer the questions thatfollow. Use at least one reference for each case (including the textbook or other source) that backs up the statements you make or provides new information. Complete each case separately, labeling them as Discussion Case 1and Discussion Case 2 for ease of reading. These cases should becompleted in the same document. Post your responses to an original thread (namethe assignment in the subject line “your name” – Case) or tothe “Case Assignment” thread provided by your instructor in theweekly Discussion Board. For some of the questions you may need to locatethe information from sources other than the class textbook.
This assignmentis due Sunday by 11:59 p.m. to the Discussion Board and is worth 50 points.
Discussion Case #1 ——————————
Youare a program officer for a major health care foundation that wants torevitalize primary care in the United States. You have been asked to look atthe experiences of other countries to see whether the methods and ideas theyhave used to promote primary care might have application in this country. Hereis some of the information you have found about Spain and Switzerland:
Spain’s1978 Constitution declared health protection and health care to be the right ofevery citizen and required creation of a “universal, general, and free nationalhealth system that guaranteed equal access to preventive, curative, andrehabilitative services.” (Borkan, Eaton, Novillo-Ortiz, Corte, & Jadad,2010, p. 1433)
Comparedto the United States, by 2006, Spain had widened the gap in terms of greaterlife expectancy and lower infant mortality rates, and it had achieved ormaintained lower rates of premature death for most major diseases, at an annualcost of less than $2,700 per person, compared to the U.S. per-capita rate ofalmost $7,300.
Spain’srapid accomplishment relied on eight key principles: (a) greatly strengthenedprimary care; (b) giving citizens a voice in decisions; (c) adopting electronichealth records; (d) creating an accessible network of community pharmacies(with medications free to people older than 65 years of age and some othergroups); (e) regional and local flexibility in implementing national policy;(f) wide adoption of best practices; (g) a system wide approach that“transcend(s) traditional geographic, sector, and institutional boundaries”;and (h) a sustained, bipartisan commitment to achieving the goals of access andquality. (Borkan, Eaton, Novillo-Ortiz, Corte, & Jadad, 2010, p. 1438)
The systemis funded through tax dollars. To ensure that every citizen has servicesnearby, the country’s 17 autonomous regions and communities are further brokendown into health areas, which manage facilities, health services, and benefitsfor people in a prescribed geographic area, and even further, into “basichealth zones” typically organized around a single primary care team andcovering 5,000–25,000 residents.
In1996, Switzerland restructured its health system in order “to turn the existingsystem of private voluntary health insurance into . . . a mandatory privatesocial health insurance system.” (Cheng, 2010, p. 1442) Today, 84 highlyregulated private health insurers, which offer basic benefits packages andsupplemental coverage, compete for enrollees. Swiss citizens are required tohave the basic package, and those who cannot afford it may receive a premiumsubsidy from the government, but the government itself does not offer an insuranceplan. Private insurers are not allowed to earn profits on the basic packagesthey offer, only on supplemental coverage.
Healthcare providers receive the same reimbursement for basic benefits, regardless ofthe income level of their patients or whether they are subsidized. Basicbenefits cover (a) what a doctor prescribes, (b) pharmaceuticals included inthe national formulary, and (c) controversial procedures included on a“positive list” by the national health authority. “Negative lists” containitems excluded from basic benefits.
Inthe future, Switzerland wants to abandon its fee-for-service system forambulatory care and move to “integrated care,” probably paid for on a capitatedbasis. Another step needed is to overcome the shortage of primary carephysicians, who have long working hours and lower pay than specialists. Still,system leaders have managed to convince the citizenry that health promotion anddisease prevention—pillars of primary care—are important parts of a completehealth care system. However, says Thomas Zeltner, Switzerland’s former healthminister, health reform is “a never-ending task.” (Cheng, 2010, p. 1450)
Usingthe aforementioned brief country descriptions and the other material aboutinter-national experiences in this chapter:
1. What are alternative ways to use system wide incentives toencourage delivery of high-quality, prevention-oriented primary care?
2. How might Americans be reoriented to using primary care, ratherthan costlier specialty services?
3. How does the design of the payment system affect individuals’choice of provider?
4. What appear to be the best ideas from other nations’ experiencesthat could be tested in the United States as ways to increase primary care?
5. If Thomas Zeltner is correct that health reform efforts arenever-ending, which of these promising ideas should be the top priority, ortried first?
Discussion Case #2 —————————–
Recentdata show that Americans consume, on average, more than three times therecommended level of sodium per day in their food and beverages. High saltintake contributes to high blood pressure and its complications—stroke, heartattack, congestive heart failure, and kidney failure. In fact, thousands oflives could be saved if sodium consumption could be lowered in people withhypertension (high blood pressure).
1. Contrast how a health care plan might address this problem inits patient population using the medical model versus how a public healthofficial would address this problem using the population health model.
2. How far can and should governments go in attempting to create amore healthful environment? Intrinsic to many population health policies is thespecter of the “nanny state”—in this case, should everyone have to be exposedto lower sodium in their bread, in other common foods, and in restaurants, soas to protect people who have salt-sensitive illnesses? Should manufacturersbear the costs of manufacturing different versions of foods in order to protectthe public’s health? Should they be required to manufacture healthier foodseven if customers prefer the others? Or be liable if they do not?
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