The health care system is yet to satisfy the standards of the American public when it comes to quality of service and accessibility. There is a continuous escalation of rates and decrease in quality, which primarily affects those relying on their health care policies. There are numerous issues that must be addressed and the system itself needs reforms. It does not need an individualistic approach when it comes to accountability. The system itself needs the appropriate changes. This paper would elaborate on the different quality issues that concern the American Health Care System and how to address them.
Evaluation of Healthcare
The Institute of Medicine reports that the health care system is a `nightmare to navigate` (IOM, 2001, p. 4). Do you agree? What interventions would you recommend?
According to the provisions identified by the United Nations, every human being is entitled to his right to ensure that his health is well attended for. This right entails that several other rights are necessary in order to assure that this is well addressed. Since every human being has a right to life, therefore has a right to health, there should be a prerequisite to provide healthcare to every citizen. Protecting this right is to give importance to achieving normal human functioning, necessary to promote a prosperous world with humans in their optimum condition (Gulliford et al., 2003, p. 2).
The United States has a Health Care System that has a reputation for having relatively expensive rates that are generally attributed to its high level of quality. Despite the fact that the system is esteemed for its excellence, it cannot be denied that it is still plagued by imperfections that are quite crucial for the citizens concerned, citizens who are supposed to benefit from the healthcare that they pay for. Reports gathered reveal evidences that reflect a system that is below par excellence as medical malpractices do persist and minimal care is provided to patients (Porter and Teisberg, 2006, p.1).
Most Americans have their individual experiences regarding the system. It is difficult to conceive that most of the success stories in the health care system happened in spite of it rather than because of it. From being the national pride, Healthcare in America has become one of the primary concerns of its citizens. The costs that patients shoulder have escalated through the years amounting to almost $2 Trillion as of 2006. With increasing rates, more Americans lose access to insurances, which leads to alarming crises of insufficient primary and preventive care.
Despite the fact that costs continuously increase, health care quality still continues to suffer and deteriorate. Due to the conjunction of the implications caused by high costs, unsatisfactory quality and limited access to health care has elevated levels of anxiety among citizens dependent on the system. Their frustrations bring them to endless complaints against the health care system that they do not deserve. Despite that it is a system that guarantees service and quality care, patients, employers, physicians, and other professionals are still dissatisfied with how the system is handled. Despite decades of proposed and implemented reforms, improvements are still to be obtained (Porter and Teisberg, 2006, p. 2).
Indeed, the healthcare system is difficult to navigate. Its complexity causes conundrum to those who wish to understand its organization. It is a labyrinth of patchwork health care industry composed of doctors’ offices, group practices, clinics, hospitals, integrated delivery systems, and public health departments that are sustained by funding from patients, employers, government and insurance companies (Health Care Improvement Partners, 2007, p. 40). Due to the myriad of dimensions of the system, one cannot help but become overwhelmed by the complexity that envelops it. The problems involved in the system can be classified into three different areas of concerns: First is the cost and access to health insurance, second is the standard of coverage, and the third is the extent of coverage that an employer and an individual should shoulder expenses (Porter and Teisberg, 2006, p. 3).
I certainly agree with the reports released by the IOM that it is difficult to navigate the health care system. The health care system in the United States is considered by most as structurally broken. This is the fundamental problem plaguing Americans and despite efforts to implement reforms and changes, the problems are still not addressed. This flaw in the structure is due to the loss of competition. There is failure of competition in the system and this is quite evident as there are inexplicable differences in cost and quality for the same type of care across providers and across geographic areas. The Institute of Medicine found that there are numerous cases of over treatment, undertreatment and medical errors in American medical facilities (Porter and Teisberg, 2006, p. 51).
My recommendations to alleviate and address these problems include the following: Impose government restrictions on the rates given by healthcare institutions on patients; to promote competition among health care professionals for higher accountability on medical practice and reduced rates for patients; allow for greater accessibility for patients who cannot afford the present health care by giving incentives among employers to provide their employees the proper benefits;
Increase efficiency by reducing wastage of equipment, supplies, ideas and energy; and ensuring equitability of providing care that is not relative according to gender, ethnicity, social status, and geographic location; there should be customisation depending on individual patient’s needs; and patients should be given utmost control as they are the ones to suffer severe consequences when malpractices happen; there should be an increased transparency between patients and physicians as patients must make decisions based on the best available information that is not subjective from one physician to another; and prevention must be the priority than reaction to medical conditions that a person is already inflicted with; and most of all, there should be an improved communication system among clinicians and medical institutions in order to ensure appropriate transfer of information and coordination of providing health care (Institute of Medicine, 2001, p. 61-68).
These proposals are essential in achieving a system that promotes optimum care for patients, making their welfare a priority and not a commodity. Health care is both a responsibility and a right of every human being on earth.
Focus on 2007: Select a current event relevant to Evaluation of Healthcare System and discuss your thoughts on its implications and ramifications. Or, as an alternative, discuss an aspect of the IOM report, Crossing the Quality Chasm.
In order to keep a more organized healthcare system, there should be an efficient way in managing medical files. This is part of improving healthcare provided for patients in such a way that it would aid the navigation of even just a fraction of the system. Hospitals and other healthcare institutions have historically used a paper-based system of record keeping. But the modern day systems have already adopted electronic devices in expediting information transfer and data organization. Using such a systems allows hospitals to become more efficient, which therefore results to higher profits and reduced medical errors (HIMSS, 2007, p.7). Therefore, it is essential in improving the healthcare system, the use of information technology in order to aid patient record handling and management.
According to the IOM Report of 2001, Information Technology (IT) is very significant in the improvement of health care quality. The potential development of automated systems can result to reduction of errors in the prescription of drugs and its dose administration. Based on studies, health care will have an increased effectiveness as these automated systems can increase the level of compliance with clinical practice guidelines. Although these automated systems are very promising, computer technology aiding diagnosis and treatment management are yet to become more effective in order to elevate the level of quality. IT also allows for a more patient oriented system that enables them to gain access to clinical knowledge through the assistance of comprehensive and reliable web and online sites.
Professionals can customize health education and disease management messages for individual cases and clinical decisions can also be supported by information gained from individual patient’s characteristics, genetic makeup, and specific conditions. Such an improvement on the system can be highly beneficial for both patients and clinicians, as there would be an elevated service quality and increased client satisfaction. IT can also result to improved efficiency as it can reduce the administration of redundant laboratory testing. And finally, IT can also enhance the level of equity by providing more options for patient-clinician interactions. All these advantages mentioned can only be possible if people regardless of their ethnic origin, socio-economic status, location and other factors have access to technological infrastructure necessary (Institute of Medicine, 2001, p. 164).
According to reports made by the Department of Health and Human Services, there is currently a difficulty for organizations to acquire access to information technology as they lack enough capital to fund this improvement. Despite the fact that there are trillions of dollars spent on health care in America, only an approximately 10% of the hospitals have adopted the use of electronic database system and only a few have recognized the need for the access to the internet. Because of this situation present in the health care industry, the government has provided budget and incentives in order to encourage medical institutions to use technologically advanced instruments (General Accounting Office, 2003, p. 12). Government intervention is very important in implementing the necessary changes in the system. Without the political will, it would be very difficult to penetrate the medical facilities and initiate them to adhere to the advances of technology.
IT holds the promises of expansion in the aspect of coverage of beneficiaries. It cannot be denied that there are honest errors committed by professionals, as this is a limitation of them being humans. Because of this, despite the fact that America has an envied health care and medical research, the system is still subjected to imperfections that can result to serious situations. Therefore there is a need of a system that would minimize subjectivity and increase the level of precision when it comes to diagnosis and treatment management. With the onset of scientific and medical discoveries, there is a novel biological world that requires information management and analysis.
Medicine has become highly genetic in approach and this entails datasets of ranging from DNA and protein sequences to high-resolution images of cellular components, tissues, organs, and organisms. It is thus important to use information technology in conducting research in these biomedical studies. Both for the purpose of data management and analysis and of modelling biological processing, information technology is developed and gave rise to the field of bio informatics. If those involved in the system could enhance computer-modelling technologies through the application of high end computing to complex problems, researchers would be enabled to develop ways to locate abnormalities with higher levels of accuracy. Classic methods of experimentation are proven to be costly, unethical, dangerous and even impossible (President’s Information Technology Advisory Committee, 2001, p. 15).
Recommend a method to determine the validity and the credibility of health care resources found on the Internet.
It has been pointed that Information Technology is very essential. Record keeping is just one way that IT affects the healthcare system. In a world where the Internet is one of the fastest growing sources of information dissemination, it is inevitable that there are an increasing number of patients and health care consumers who resort to the World Wide Web for knowledge and understanding regarding their situation. This allows them to have more participation in their treatment management and health care administration. Therefore there is a need to screen the available sites in the Internet for their credibility and validity in order to ensure that the information delivered to patients are true and factual. The situation is, patients are having difficulties on their online searches. Therefore if reviews and appraisals are conducted on these materials, a novel model of health care characterization can arise. Content, usage, authorship, and publication characteristics can provide patients with an organized framework suitable for the assessment of a variety of needs, purposes, and characteristics (Civan and Pratt, 2006, p. 88a).
There is currently an abundance of information concerning health that web surfers can enjoy. Some may have their own merits, but it is quite inevitable to experience Internet sites that are not reliable. Because of the nature of the Internet where anyone can upload anything, people can suffer from misinformation. It is now possible that anyone equipped with a computer, a modem, and an Internet connection will be able to publish on the Web. These publications no longer pass the scrutiny of peer-reviews and editorials that were established for quality assurance. Basically the web has the potential to be a sea of works that were authored, edited, and published by anyone who can even claim anonymity. It is not a distant possibility that the contents of the works were fraudulent, unsubstantiated, and non-verified. And with the overwhelming quantity of information, it becomes difficult to screen which information is relevant and meaningful and not. The volume of health information can be intimidating that it can even promote apathy among those who are supposed to learn of their contents (Wolfe, 1998).
Whatever the given reason for accessing the Internet, one must be vigilant on the quality of resources that one receives. Increase in the quantity of information does not always entail the best results as this does not automatically mean that there is an improved learning, judgment or skills. Currently, the discretion is still on the reader. It is up to the individual on how he would discriminate which information is reliable and which is not. But due to the sensitive nature of clinical decisions, it is difficult to simply rely on a layman’s judgment.
Individuals therefore would have to develop the skills to comprehend the lesson, to determine the appropriate information applicable to one’s situation, application of knowledge for practice improvement, evaluation of results, and adopt the changes based on results. On the part of medical practitioners, most have a varied access to online materials available in the net. Yet these materials are still subjected to errors and must be assessed with caution. It is therefore essential that the journal articles and other materials are peer-reviewed and have been filtered for their credibility, validating the information contained within (Mazurat, 2001).
Currently, there are efforts in the biomedical field in validating the online sites accessible to the public: Groups of the Accredited Standards Committee Medical Devices are developing their standards on use of educational software; the National Learning Infrastructure Initiative acts as an instructional software development catalyst for quality improvement and reduced cost of online sources; Meta sites are currently being developed to review, catalogue, and rate primary sites for content and quality; and many other sites that combat false information and misconstrued facts (Mazurat, 2001).
What are currently accomplished are the quality evaluation criteria for published information. However, experts are yet to accomplish the task of criteria testing, validation and dissemination for public use. So far, experience is still the best asset in the quality assessment of materials (Mazurat, 2001). There are several recommendations that can be given in order to address this problem in addition to the current efforts done by several sectors. First is the establishment of an organization that specializes in screening all scientific and medical research studies to be published in the Internet. A seal that ensures that the contents are reviewed by this credible and reputable organization would provide readers the appropriate assurance that the material they are consuming has met quality standards.
Another is the collaboration with the governments of different countries, where they would endorse the sites that they have carefully scrutinized. Hospitals and medical institutions should also release pamphlets and conduct seminars on their patients. And last, is for the proper sanctions be imposed on perpetrators of posting falsified information on the web. Although the Internet can reach virtually every country on earth, individual countries should formulate their laws that take the Internet influence into consideration.
Focus on 2008: Select a current event relevant to this course and discuss your thoughts on its implications and ramifications. Or, as an alternative, discuss an aspect of the IOM report, crossing the Quality Chasm.
Despite the advances in information accessibility and file and record management that are available for healthcare systems to use, America still faces a relatively flawed system. The Internet has become very much useful in increasing patient knowledge on their diseases and hospitals have become more efficient in giving disease management to patients due to sophisticated forms of software and programs that they use. Both are very visible and present in the American society and many citizens have utilized these resources to their advantage. Yet the problem still lies, America has a system of healthcare that is not of superior level.
Politicians and insurance companies in America have long been confident in proclaiming the American health care system as a superior one in the world. However, as time passes, the flaws in the system are becoming more evident which causes difficulties among Americans to simply accept the situation. The US is currently plagued by the fact that not every citizen is entitled to health care benefits as an estimated 42.6 million people lack health insurance. This population do recognize that the health care system is not serving its purpose for everyone, that there is the serious problem of increasing costs and decreasing accessibility.
This is a crisis that many politicians and policymakers have long attempted to address. However, their efforts did not yield appreciable results as the problems are only alleviated by providing short-term, patchwork solution, and time pressured policy designs rather than considering the system in its entirety. It is therefore necessary that long-term changes be implemented on the system in order to ensure optimum results. If we could investigate other health care systems in other developed countries and compare them with the existing one in America, then it is possible to formulate alternatives based on policies that have been tested on other locations (Bureau of Labor Education, 2001, p. 1).
According to research studies, the United States has relatively high expenditures concerning health care. This is based on health expenditures per capita/person and on total expenditures as a percentage of gross domestic product or the GDP. According to 1998 records, about every American spends $4,178.00 on their health care, which is more than 100% higher than the OECD median of $1,783.00. When the health expenditures were percentaged with GDP, a value of 13.6% was taken making America far more expensive than its closest competitors with only 10.6% (Germany). This situation is possibly a result of a combination of reasons, contributed by the continually elevating costs of prescription drugs, administrative costs, and technology used in medicine.
This is a situation brought about by the multiple payer system in the US where an approximated 19.3-24.1% in health care costs are due to administrative expenses. There is also a growing trend of medical institutions shifting from non-profit oriented setups to a for-profit system. Comparing the non-profit and for-profit hospitals, a 34% increased in administrative costs was imposed by the latter while only 24.5% was given by the former (Bureau of Labor Education, 2001, p. 2).
As of 1999, 15.5% of Americans do not have access to insurance policies. This affects the increase in health care costs in terms of early prevention. Some diseases would have been managed early on with less expensive means, but due to lack of insurance, others do not resort to medical assistance until reaching critical conditions. There is also the case of the baby boomers, as the population of the US is aging, costs in health care due to more medical cases also rise (Bureau of Labor Education, 2001, p. 3).
William Farr M.D. wrote to Florence Nightingale in 1864, “What are figures worth if they do no good to men’s [and women’s] bodies or souls” (Iezzoni, 2003, p.410)? What did he mean? How do you relate this statement to modern day risk-adjustment methods?
The methods employed for risk adjustment are relatively novel and have only recently gained acceptance in the adjustment of capitation of healthcare payments in the US. These models produce outputs based on data retrieved from computerised patient records or from the billing records of insurance companies. Due to this, data gathering is relatively inadequate leading to complications such as a coding system of diagnostic data characterized by inaccuracy. These data are only dealing with the average estimates, which create biases, as they do not efficiently consider other cases such as procedures with more expensive costs or patients with unexpected care attention needs. This includes organ transplantation, HIV positive patients given with costly antiretroviral drugs (Majeed et al., 2001, p. 608).
According to Iezzoni (2003, p. 402), the development of risk adjustment is highly encouraged as it is significant for particular functions. This includes assessment of results of certain kinds of interventions, such as ICU care and CABG surgery. The employment of risk-adjustment methods, even if they contain certain flaws, are highly accepted and are considered very effective for medical institutions and for the health care system as a whole. Such methods are very important in the promotion of a productive dialogue between doctors and their clinical team and staff. This leads to an improved system as the information gains credibility, doctors become more confident in suggesting way on how to make better changes.
In America, risk adjustment methods are employed in order to compute for the adjustments of capitation and the different types of payments to healthcare providers and professionals, which include family practices and other physician-hospital consortia. In relatively large size of populations, it is possibly enough to take in consideration the age, sex, and ecological measures. On the other hand, small populations that are managed by family practices and small physician-hospital consortium, risk adjustment is proven essential as it ensures that patients diagnosed with more complicated medical problems are provided with the proper funding for their treatment.
The use of risk adjustments has also motivated physicians and other health professionals to provide diagnostic data that are complete and accurate. Risk adjustment is also important in adjusting case mix in the comparison of practice patterns among professionals. It minimizes errors in variations for differences that underlie population case mix which results to a more just and accurate measurement of performance among those evaluated. Risk adjustment is also useful in assessing the health of the population. Classic methods include survey of mortality and other vital data that are not accurate determinants of a population’s health. Because the models were designed to reflect all the cases attended by the physicians, a broader spectrum on the diseases and illnesses in the population are presented (Majeed et al., 2001, p. 607).
An example of these risk adjustments is the APR-DRG (All-Payer Severity-Adjusted DRGs) that has no technical constraints. Although other proposed models are also promising, every risk adjustment system has its own set of advantages and disadvantages. But studies have shown that this particular risk adjustment method is a better alternative. It is the most widely accepted and adapted model, having its quality and validity tested and compared with other systems (Office for Oregon Health Policy and Research, 2005).
Florence Nightingale and William Farr both sought for the proper mathematical computation of statistical data in the medical industry during the Victorian Era. William Farr enforced the idea that what good will mathematical figures do if they do not reflect the actual situation of the health sector. If the numbers were not representative of the realities of the problems plaguing the system, then it would not help the citizens who should benefit from primary medical assistance (Iezzoni, 1996).
The year prior the writing of this letter, Florence Nightingale took notice of the dramatic difference between the London City hospitals and provincials ones. The city medical facilities were largely more dangerous as presented in statistics computed and published in William Farr’s Registrar-General report. Here, it was said that there was an alarming rate of mortality reaching 90% in London while rural hospitals only have 13%. The method of computation employed was by dividing the total annual number of patients admitted and died and the number of inpatients per day. But when another method was used, where the total number of inpatients divided the number of deaths per year annually, a drastic drop to 10% was computed.
This lead to numerous debates in the London medical press on the proper way of calculating mortality rates. Several criticisms on Farr’s method were raised such as claims that there is a failure of adjustment for differences in illness severity between urban and rural hospitals. This could be misleading as most of the patients admitted in urban hospitals are more complicated than those attended by rural facilities. This reflects the need during those times to formulate the proper way of statistically determining the quality of medical care (Iezzoni, 1996).
William Farr told Florence Nightingale in a letter, “What are figures worth if they do no good to men’s bodies or souls?” (Iezzoni, 2003, 410). This means that even if they continue debating on how to compute the figures properly, the bottom line is that they have to improve the system. If experts focus on how to compute these figures properly and not concentrate on how they can elevate patient care, reduce mortality rates, and lower hospital stays. Only when such numbers are utilized will they make a function. They have no worth until they are used properly. These numbers would reflect the deficiencies, inefficiencies, and mistakes that the hospitals commit. The objective is to use the statistics in order to serve the patients better.
These quality concerns that have dated back even before the Victorian Period clearly call for an improved system that mathematically determine that actual data without biases and with minimal errors. Achieving ways in properly computing for the appropriate figures needed would lead to a system that would better determine its areas for improvement and its errors in facilitating the health of their subjects.
Focus on 2008: Select a current event relevant to this course and discuss your thoughts on its implications and ramifications. Or, as an alternative, discuss an aspect of the IOM report, Crossing the Quality Chasm.
The healthcare system has adopted risk-adjustment methods in order to aid physicians in their professional work. Information is highly available through media such as print materials and electronic ones. Even hospital records are easy to navigate and have been improved for the benefit of patient care and disease management. Yet it is quite dismal that according to the IOM, errors in the medical field are not simply individual in nature and is not a result of a single person’s negligence.
This is a system wide failure that plagues those who are expecting to be assisted properly with the necessary medical attention. It would be more effective if we view this issue in a holistic sense as opposed to blaming individuals. It is common for humans to make mistakes, and we must always consider the fact that the professionals in this field are humans themselves. Based on recent research studies, malpractice and error rates can possibly be reduced through system improvements, this leads to higher quality standards that would salvage more lives and even alleviate the ordeal of the patients (Agency for Health Care Research and Quality, 2000).
Most of the recorded medical errors are preventable and only reflect risks that are associated with them undergoing the proper treatment. Some patients are administered with drugs that they are allergic to, therefore causing anaphylactic shock and possibly cause them to die. Some complain of errors in drug administration concerning the proper dosage or prescription, some due to surgeries, and some even have cases of being amputated with the wrong limb. If the system responds to these inadequacies, then reforms would definitely save countless lives (Agency for Health Care Research and Quality, 2000).
Ever since the Institute of Medicine has released its report in 1999 on the medical error and malpractice present in the United States, this subject has become a highly controversial issue focused by numerous constituencies throughout the country. Prior the 20th century, medical errors are given minimal attention and failures to meet optimal results were attributed to either fate or God. But as people sought for higher standards and given expectations for more acceptable outcomes, it has been recognized that medical malpractice should be very much considered.
The 1980’s brought numerous articles concerning this subject, but the pinnacle of awareness of medical error came during the 1990’s. Late 1999, the IOM defined the different factors that contribute to the medical error that their report accounted for. By extrapolating the available literature and data, it was found that medical errors resulted to the mortality of 44,000 to 80,000 people. This also revealed that medical malpractice cost payers between $17 billion and $29 billion yearly that are due to direct health care costs and also indirect healthcare costs (including disability and lost wages). The report also stated that most cases are very much preventable and in order to improve the situation, there should at least be 50% reduction in medical error for the following half decade.
It includes the following proposals: First is that the Federal government should create and fund a body that would aim for the reduction of medical error and increase of patient safety in all of America. Second, the system should develop a system of reporting for the errors committed by medical professionals. This would enhance the monitoring of medical errors in both federal and state operated medical institutions. Third is that Congress should legislate a peer review protection of data that concern the elevation of quality of medical attention given. Fourth is that there should be safety standards implemented for the benefit of both the patient and the licensed professional. And last, there should be the imposition of error reduction programs in all levels affected, including healthcare provider, hospital systems, individual hospitals, and the physicians and other medical practitioners (Sirota, 2005, p. 1228).
It cannot be denied that such practices do happen and they are threats to millions of lives. A single honest mistake can lead to a fatal result. But such occurrences can be improved if only the government would properly address this by setting standards that are not insurance-dictated and are more patient oriented. By limiting amending the conditions set by insurance companies, such policies that clearly hinder patients from obtaining optimum care, and then perhaps American citizens would be able to witness a revolution in the health care system. And perhaps the public should also be given ample information regarding medical errors and malpractice. It is for the protection of both the physicians and the patients. This would reduce lawsuits and other unnecessary impediments due to misinformation and ignorance (Agency for Health Care Research and Quality, 2000; Quality Interagency Coordination Task Force, 2001).
The IOM report has provided a redefinition to the term error. From “the term error encompasses all those occasions in which a sequence of mental or physical activities fails to achieve its intended outcome or achieves and unintended outcome,” (Sirota, 2005, p. 1229) the IOM slightly modified it into “a failure of a planned action to be completed as intended (an execution error) or use of the wrong plan to achieve an aim (a planning failure) (Sirota, 2005, p. 1229). But these statements only arrive at a single conclusion, that error is a judgment passed on the perspective of an observer which can either be false or not. Such an opinion can be affected by biases as a result of the information that the observer has acquired. Most of the times, there is an underestimation on the part of the observers on the level of difficulty that the situations entail and consequently put blame on the wrong person, if blame should be even be given (Sirota, 2005, p. 1229).
There are certain policy strategies that the government of the United States is currently employing. The objectives of such health policies include the improvement of clinical effectiveness that is a highly process-oriented strategy. In 1989, the Agency for Healthcare Research and Quality was established in order to concentrate on results of medical care instead of the process of care. They have provided practice guidelines, at the patient level, and performance monitoring, at the institutional and system levels. Such practice guides are statements that are developed in order to aid medical practitioners and their patients in arriving to a decision in giving the appropriate treatment for individual cases. These aim for the reduction of inappropriate care, minimization of geographic variations, and elevation of efficiency levels (Aday, 2004, p.99).
The effectiveness of such clinical guidelines is still in the process of gradual development. When some of the guidelines were evaluated, it was found that they have relatively low impact, based on the recommendations submitted by the Consensus Development Program. Doctors themselves were aware of such an issue. The improvement only lie at the level of assessment of the process, but there are minimal changes in the improvement of the outcome of medical attention given to patients (Aday, 2004, p. 108).
There are numerous aspects in the American Health Care System that are in need of attention and be given the appropriate action. But recognition would initiate reforms, and studies are currently being conducted in order to improve the system. Compared to other countries, America is still to prove its health care system to be enough to accommodate all the needs that its citizens deserve.
Aday, L. U., Begley, C. E., Lairson, D. R., & Balkrishman, R. (2004). Evaluating the healthcare
system (3rd ed.). Chicago: Health Administration Press.
Civan, A. and Pratt, W. (2006). Supporting Consumers by Characterizing the Quality of Online Health Information: A Multidimensional Framework. System Sciences, 5, 88a-88a.
Porter, M.E. and Teisberg, E.O. (2006). Redefining Health Care. Massachussetts: Harvard Business
Gulliford, M. and Morgan M. (2003). Access to Health Care. New York: Routledge.
Iezzoni, L. I. (Ed.). (2003). Risk adjustment for measuring health care outcome. Chicago: Health
Iezzoni, L.I. (1996). 100 Apples Divided by 15 Red Herrings: A Cautionary Tale from the Mid-19th Century on Comparing Hospital Mortality Rates. Retrieved 17 December 2007 from http://www.annals.org/cgi/content/full/124/12/1079
Majeed, A., Bindman, A.B., and Weiner, J.P. (2001). Use of Risk Adjustment in Setting Budgets and Measuring Performance in Primary Care II: Advantages, Disadvantages, and Practicalities. Retrieved 17 December 2007 from http://www.bmj.com/cgi/content/full/323/7313/607.
Mazurat, Randy (2001). Online Educational Resources – Will More Information Make us Wiser?. Journal of Canadian Dental Association, 63, 32.
Office for Oregon Health Policy and Research (2005). Oregon Hospital Quality Indicator Project. Retrieved on 17 December 2007 from www.oregon.gov/OHPPR/HQ/docs/IQI2004_RiskAdjustment_APR_DRG.pdf
Sirota, R. L. (2005, October). Error and error reduction in pathology. Archives of Pathology &
Laboratory Medicine, 129(10), 1228-1233.
Wolfe, Gayle (1998). A Scholarly Project. Michigan State University. Retrieved on 17 December 2007 from http://www.msu.edu/~wolfegay/Schol%20Proj.htm.
Bureau of Labor Education (2001). The US Health Care System: The Best in the World, or Just the
Most Expensive? Retrieved 17 December 2007 from dll.umaine.edu/ble/U.S. %20HCweb.pdf.
Community of Health Care Improvement Partners (2007). Health Care System Complexity: “A
Navigation Conundrum”. Retrieved on December 17, 2007 from
General Accounting Office (2003). Information Technology: Benefits Realized for Selected Health
Care Functions. Retrieved 17 December 2007 from www.gao.gov/cgi-bin/getrpt?
Health and Human Services (2006). Health IT Environment. Retrieved 17 December 2007 from http://www.hhs.gov/fedhealtharch/images/healthITenvir.png
Healthcare Information and Management Systems Society (HIMSS) (2007). Enterprise Integration: Defining the Landscape. Retrieved 10 January 2008 from www.himss.org/content/files/Ent_Integr_whitepaper_030807.pdf.
Institute of Medicine ( 2001, March). Crossing the Quality Chasm: A New Health System for the 21st
Century. Retrieved 17 December 2007 from books.nap.edu/html/quality_chasm/reportbrief.pdf.
President’s Information Technology Advisory committee. Transforming Healthcare through
Information Technology. Retrieved 17 December 2007 from www.nitrd.gov/pubs/pitac/pitac- hc-9feb01.pdf .
Quality Interagency Task Force (2000). Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact. Retrieved on 17 December 2007 from http://www.quic.gov/report/mederr7.htm