MMI 401 - American Health Care System
This course served as an introduction to elements of the American Health care system including the provider components, the financing of health care, the basic structure of public policy making and public health systems, comparative analysis of the American system to the health care systems of other countries, and the legal and regulatory framework within which the American health care system functions. In addition to the structural components of the system, the course will review some of the current issues within the American health care system including public health, preparedness, quality of health care, pay for performance, and consumerism.
What I Learned:
My journey into Medical Informatics began with this class. I was new to the healthcare industry, and I had little perspectives beyond that of a consumer of healthcare services. This class helped me quickly realize how naive my assumptions was in thinking that the United States was a leader in healthcare, to which the world looked upon as an example. As I progressed through the class, I discovered that in fact, things are quite the contrary.The class helped me understand the fragmented delivery system that persists, opening my eyes to the challenges that exist in the U.S. healthcare system.For example, our nation is among one of the worst in terms of money spent per capita on healthcare, and one of the lowest in terms of utility given back for every dollar spent. Additionally, it was in this class that I internalized what it means to "improve patient outcomes".
Students coming into the program with a previous technical background but no clinical expertise were introduced to the clinical perspective through two introductory clinical thinking classes. Conversely, clinically-grounded students with no technical background were required to take classes in computer networking and databases. These two separate tracks laid the foundation for convergence between the technical and clinical worlds so that students from either could work effectively together to understand the broad landscape of medical informatics. This is significant because I believe that perspectives from both worlds are necessary to ensure that delivery of healthcare services in the U.S. is efficient, of better quality, cost-effective, more accessible, and timely.
The curriculum for the course was well-defined by Professor Schulte and provided a structured approach to learning about healthcare in the United States. The course begins by studying the historical aspects of the U.S. healthcare delivery system. I found this fascinating, since I work on the Payer side, and thus I gained a better understanding of the historical role played by Payers, and how it has contributed to our current state. One of the most impactful readings was from an American Physician by the name of Atul Gawande with his article entitled "The Cost Conundrum: What a Texas Town can teach us about health care". From here, I dove deeper into the healthcare continuum to understand the structural aspects of our delivery system. I learned about the professional roles undertaken by nurses, physicians, clinicians, and how institutional providers interact with one other in the workforce. Furthermore, I explored the financial dimensions of healthcare including public and private funding sources from Federal and State organizations that includes Medicare, Medicaid and all their parts, as well as payers, employers, and individuals. I also learned about the complexity of providing services to uninsured/underinsured and indigent populations. Finally, my understanding of healthcare delivery would not have been complete without exploring deeper the legal barriers to healthcare such as the legislative and regulatory impacts imposed by Federal and State governments.
Building upon these foundational elements, I was able to take my newfound knowledge and write a comparative analysis paper between the U.S. healthcare system and that of another country.Having friends in Europe, I chose to seek an understanding for how their delivery system was setup. Consequently, I wrote an analysis of "Healthcare in the United Kingdom".I learned that socialized healthcare differs greatly from what we have in the United States. For me, this offered a unique perspective on "Public Health" in comparing it from the United States to the United Kingdom. While it is accessible to everyone, it is not timely. Indeed, there is not a wholesale replacement that can be done without trading one set of problems for another. This paper helped me see that a hybrid approach is needed to solve all the problems by understanding the pros and cons of healthcare delivery across the world. In having this broader perspective, I believe we can learn from one another and land on a solution that is better by improving upon the weaknesses and strengths of other approaches. Each student presented their individual research papers, and collectively we gained a broader perspective to healthcare delivery across the globe.
Another written research assignment was done on a current topic within healthcare. I chose to pursue "Caps on Malpractice".Like the country research, each student presented, and as a class, we gained a broader perspective of current issues in healthcare.
We then were formed into groups for a term project.Student groups were allowed to choose from a list of approved topics, I chose to work with John Goss and Scott Marriott, and the topic we researched was "Personal Health Records (PHRs)". This type of student teaming was one of the best aspects of the MMI program at Northwestern, especially given the caliber of students with whom you get to interact, notwithstanding the synchronous format which allows for shared learning through an interactive means.
In conclusion, this class laid the critical foundation for the rest of the program. While it is required for students entering the program from a technical track, I believe it would be of equal benefit to the clinically focused student, too. Throughout the remaining classes in the MMI program, I found myself often coming back to articles and the textbook from this class as it helped establish the imperative behind the Medical Informatics and how the latter can help to address the enumerable challenges facing the U.S. healthcare system.
Assigned Reading Materials
American Health Care Association Reimbursement and Research Department.(2011, June). Trends in Nursing Facility Characteristics. Retrieved from ahca: http://www.ahcancal.org/research_data/trends_statistics/Documents/trends_nursing_facilities_characteristics_Jun2011.pdf
Atwood, D. (2008). Impact of Medical Apology Statutes and Polices. Journal of Nursing Law, 12(1), pp. 43-53.
Collins, S. R., Kris, J. L., Doty, M. M., & Rustgi, S. D. (2008, August 20). Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families. Retrieved from The Common Wealth Fund: http://www.commonwealthfund.org/Publications/Fund-Reports/2008/Aug/Losing-Ground--How-the-Loss-of-Adequate-Health-Insurance-Is-Burdening-Working-Families--8212-Finding.aspx
Davis, K. (2007, January 10). Learning from High Performance Health Systems Around the Globe. Retrieved from The Common Wealth Fund: http://www.commonwealthfund.org/usr_doc/996_Davis_learning_from_high_perform_hlt_sys_around_globe_Senate_HELP_testimony_01-10-2007.pdf?section=4039
Day, T. (n.d.). About Nursing Homes: Acute Care Rehabilitation. Retrieved from National Care Planning Council: http://www.longtermcarelink.net/eldercare/nursing_home.htm
DeBakey, M. E. (2005, August 18). The role of government in health care: a societal issue. The American Journal of Surgery, pp. 145-157. Retrieved from http://www.heartacademy.org/2006/debakey.pdf
Deloitte Center for Health Solutions. (2008). The Medical Home: Disruptive Innovation for a New Primary Care Model. Retrieved from http://www.dhcs.ca.gov/provgovpart/Documents/Deloitte%20-%20Financial%20Model%20for%20Medical%20Home.pdf
Dwyer, J. (2007, October). What's Wrong with the Global Migration of Health Care Professionals?: Individual Rights and International Justice. The Hastings Center Report, pp. 36-43.
Gawande, A. (2009, June 1). The Cost Conundrum: What a Texas town can teach us about health care. The New Yorker. Retrieved from The New Yorker: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Gawande, A., Berwick, D., Fisher, E., & McClellan, M. (2009, August 12). 10 Steps to Better Health. Retrieved from New York Times: http://www.nytimes.com/2009/08/13/opinion/13gawande.html?pagewanted=all
Gostin, L. O., Boufford, J. I., & Martinez, R. M. (2004). The Future Of The Public’s Health: Vision, Values, And Strategies. Health Affairs, 23(4), p. http://content.healthaffairs.org/content/23/4/96.full.pdf+html. Retrieved from http://content.healthaffairs.org/content/23/4/96.full.pdf+html
Oberlander, J., Marmor, T., & Jacobs, L. (2001, 29 May). Rationing medical care: rhetoric and reality in the Oregon Health Plan. Retrieved from CMAJ: http://www.cmaj.ca/content/164/11/1583.full.pdf+html
Schoen, C., Collins, S., Kriss, J., & Doty, M. (2008, June 10). How Many Are Underinsured. Retrieved from Common Wealth Fund: http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2008/Jun/How%20Many%20Are%20Underinsured%20%20Trends%20Among%20U%20S%20%20Adults%20%202003%20and%202007/Schoen_howmanyareunderinsured_1144_itl%20pdf.pdf
Thomson Healthcare. (2007, October). Physician Demand (HealthLeaders Fact File). Retrieved from Health Leaders Media: Physician Demand