This essay provides description of two issues identified as the American struggles to provide quality and equitable healthcare to all of the citizens. These problems are access to care and lack of education within healthcare. Each issue is described on both macro and micro levels. Different German programs directed on solving these subjects are described below. These programs improve health care providing of Germans for more than 5 years. They are directed on disease prevention, treatment and increasing of patient awareness concerning health care providing. Solving the issues of access to care and lack of education within healthcare is essential for providing qualitative and equitable healthcare to all of the US citizens.
Access to Care as a Macro Level Issue
Low income American citizens face considerable problems in obtaining free access to health care. Some of these issues are absence of insurance coverage, insufficient access to health care and unaffordable prices of medication and treatment. According to the official statistics, about eighty seven per cent of uninsured low income patients stated that they have “difficulties obtaining insurance coverage”, about nineteen per cent “expressed concerns about access to services or health care costs”. It is notable that children from low income families were less likely to see a health care provider during the last year than the children of other Americans.
This situation can be changed by increasing access to care through universal health care program affordable for all citizens of the United Stated despite their ability to pay for health care treatment. Such program is successfully implemented in Germany since 2009. It is called Social Health Insurance (SHI). It is compulsory for German citizens who earn less than $50,000 annually. Social Health Insurance covers about seventy five per cent of German population. The rest of the population the income of which is over $50,000 annually is covered by private health insurance. Social Health Insurance program was developed for enabling low income citizens to obtain numerous medical services: “preventive services, impatient and outpatient hospital care, physical services, mental health care, dental care, prescript option drugs, medical aids, rehabilitation, and sick leave compensation”. According to the terms of this insurance, both employer and employee pay insurance payments which depend on the amount of personal income. For example, an average employee pays 8 per cent of the gross wage and his employer pays 7 per cent of the wage. The average personal contribution is about $600 per month. Moreover, German Federal Employment Services provide help for medical insurance of unemployed citizens.
Increasing access to care for all people despite their ability to pay can be obtained through elimination the income gap among Americans. Income gap in the United Stated of America is sharpening the existing inequality in obtaining health care services. According to the official statistics, “for low-income workers, total pay and benefits rose by forty one per cent from 1999 through 2006; but these workers’ wages increased only by twenty eight per cent, barely outpacing inflation”. Hence, implementation of different initiatives directed on raising wages of low income class will enable people to obtain health care services of higher quality. The minimum wage level should be increased by federal, state and local regulations and statues with the purpose of obliging employers to pay adequate wages to employees for they can cover expenses on medical treatment.
Access to Care as a Micro Level Issue
Nowadays, the existing income gap creates a situation when people with high income can afford themselves to obtain medical treatment in private health care providing institutions where the quality of treatment is considerably higher. At the same time, citizens with low income are obliged to receive medical care in community hospitals with lower quality of treatment. This situation increases the inequality in health care providing. People of different income levels should be provided with access to health care services of the highest quality level.
Germany successfully implements the social security system directed on solving the above mentioned issue. The government takes responsibility of providing high quality of medical treatment to all citizens within a state regardless of their ability to pay. First of all, existing social security system eliminates physician migration into the private sector. Any health care provider, who decided to practice in the private sector, should work for at least 6 years in community hospitals. The next initiative provides the equal medical coverage in different geographical areas through “geographically restriction of the settlement of new doctors according to their specialty”. Hence, person can obtain different medical services even in small towns. There are no any network limitations in Germany. Moreover, this initiative leads to shortening of waiting lists. Numerous studies show that Germans have the highest rate of obtaining the same-day and the next-day appointments. Supporting information is shown on figure 1.
Figure 1. The same-day or the next-day appointment statistics in different countries all over the world.
One more initiative eliminates obtaining money by doctors from patients. Patients have to show their insurance cards in health care providing institution and doctors should only receive payments from the doctors’ association. This initiative is directed on increasing medical transparency and elimination of paper work and medical invoices.
Lack of Education within Healthcare as a Macro Level Issue
Education plays the considerable role in the quality of medical services. Person cannot go to health care providing institution if he/she does not know about his/her illness and the value of proper medical treatment. It is notable that the frequency of consultation of people with higher education with health care providers is about 28 per cent higher than the frequency of consultation of people with primary education. Moreover, higher level of education increases the possibility of timely recognition of disease. This eliminates sharpening of patient’s condition and enables faster convalescence.
Much attention should also be paid to increasing patient awareness of the necessity of observance medical prescriptions. According to the official statistics, only ninety three per cent of patients take medications prescribed by their health care providers. At the same time, buying medication does not means that patients use it according to doctors’ orders and dosage written on the prescription bottle. More than thirty per cent of patients do not take all the prescribed medication as per medical prescriptions. Lack of understanding and failure of seeking medical advices can be addressed by educational campaigns performed by governmental and private organizations. For example, some of these campaigns may address the proper usage of antibiotics.
Germany develops and implements numerous programs directed on increasing public awareness concerning medical treatment. Special Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung) produces different educational counselling materials for youth and adults. One of the initiatives of this center was developed for improvement of home care by providing additional information and trainings for physicians, patients and their relatives, ambulatory care providers and nurses. It is directed on increasing level of “psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy”.
Public education can be included into classroom curriculum in order to increase community awareness about medical treatment form the early years. This strategy enables building of healthy literacy skills independently from personal income and level of education. Health behavior can be formed by information and social support in educational institutions. These institutions can provide information concerning health risks, work of health system and available health care services, ways of development of personal health behavior, interaction with health care providers, and necessity of supporting of social medical initiatives. Children with high literacy have better health outcomes due to higher level of health knowledge and understanding necessity of timely enquire to health care providing institution. Health education included into classroom curriculum decreases possibility of negative impact of health-related issues connected with everyday concerns. Much attention can be paid to local needs and health issues of particular community, for example high rate of HIV infection.
All these strategies are successfully realized by German special Federal Center for Health Education. Nowadays this organization is focusing on rendering educational information directed on disease prevention: promotion of non-smoking, addiction prevention, promotion of organ and blood donation, prevention of HIV infections, vaccinations and personal infection control, sex education, family planning and contraception, nutrition, exercise and stress management.
Lack of Education within Healthcare as a Micro Level Issue
People’s awareness concerning necessity and ways of medical treatment can be increased through implementation of different programs that provide patients and caregivers with an understanding of how to read prescription bottles, understand health care diagnosis and thoroughly observe medical prescriptions of health care providers. Programs described above can lead to improvement the quality of treatment without considerable financing. Financing can be provided by federal and local governments, and national and international health care organizations.
These programs can provide information about health care services and support to youth and adults, low income and high income population, representatives of different races, genders and religions. Some of them can take place in health care providing institutions and community centers. Health care providers together with social workers can explain common people all special aspects and ways of interpretation of medical prescriptions and understanding of doctor’s instructions. All these programs are directed on decreasing of so called ill-information reflected in “various contradictions of pathological medicine – symptoms without lesions, pathology without symptoms, and the unpredictable way in which the experience of symptoms is related to help-seeking”.
Above mentioned programs can also enable health care providers to follow the families, which enter healthcare facilities regularly, to ensure that patients are adhering to medication requirements and improved lifestyle changes. Attempts to improve patient adherence contain the following key factors: grounded analysis of patients’ awareness of their medical treatment and regime, open and efficient communication between patients and health care providers, and “the nurturance of trust in the therapeutic relationship”. Much attention should be paid to mutual collaboration because it provides higher patient satisfaction from obtained medical treatment, decreases possibilities of non-adherence and leads to greater healthcare outcomes.
Current work provides deep understanding and analysis of lack of access to medical care and education within health care system in the United States. Each of these issues has a considerable negative effect on the quality of health care providing. This essay gives different examples of strategies which are directed on solving these issues, like elimination of income gap, increasing of access to care for low income population, providing high quality medical treatment to low income population, realization of programs directed on increasing of medical awareness, minimization of non-adherence, medical education of youth and adults for increasing their awareness of health care providing services. All above mentioned strategies are oriented on patients, caregivers, health care providers and common people. Some of these strategies are successfully realized in Germany.