Health care sector provides health care services, such as disease prevention and treatment to the public. It involves various players, such as nurses, physicians, pharmacists, and clinicians working together to ensure that the public receives high quality health care (de Andrade et al., 2015). On the contrary, the public sector in the country is overseen by the government. In the US, various services, such as security, defence and taxation, fall under the public sector. However, both private and public sectors provide other services, including health care. The government specifically controls and funds health care sector, and helps in the implementation of various reforms.
Governments across the globe participate in health care sector in various ways. Health insurance is one of the functions of many governments worldwide. They ensure that a portion or the entire population is insured. In the US, the government offers health insurance to a portion of its people through Medicare and Medicaid (de Andrade et al., 2015). It provides subsidies to the insurance programs, by not taxing the amounts allocated towards health insurance of employees in private organizations. Moreover, the government discourages unhealthy behaviours, such as drinking alcohol and smoking, by placing a high tax on such products.
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The public sector health care is among the greatest areas in the US. The US spends approximately 14% of its revenue on the public health care sector (Flood, Minkler, Lavery, Estrada, &Falbe, 2015). The American government takes charge over about 50% of funding in this sector (Flood et al., 2015). The health care and public sector has numerous stakeholders; physicians, insurance companies, patients, and the government among others. Health care insurers give money to health care providers to cover for services offered to patients. In addition, the insurers come up with policies, which indicate when and where patients will seek medical services. Patients seek medical services from health care providers and either personally pay for the services or through health care insurers. Health care providers identify health problems of their patients and provide treatment to them. They also identify public health problems and device various strategies to mitigate the issues.
The US government participates in health care sector through Medicare and Medicaid. Medicare insures people who are above 65 years, and earns about $200 million each year (Flood et al., 2015); it covers around 14% of the US citizens (de Andrade et al., 2015). People under Medicare’s free-for-service program have the choice to select the medical provider when seeking treatment, but it does not cover drug prescription for outpatients and expenses of long-term care for chronic ailments. The managed care program allows the insurer to pay a fixed amount of money for the patients’ treatment.
Medicaid, on the contrary, is a public insurance organization, which covers the poor, the children, the disabled, the blind, and the middle-aged women. People covered by Medicaid are in a position of getting insurance if their earnings are insignificant or if the amount they use for health care makes them receive scarce earnings. The individuals who have enrolled in both Medicare and Medicaid, ensure that services not covered by Medicare, such as long-term health care and drug prescription, are covered by Medicaid (Flood et al., 2015).
In addition to the two public health care insurers, the government has health programs that offer health care services for Native Americans, veterans, and families of army officers who are vigorously occupied with their duties. Even so, a huge number of citizens have their health insurance covered by their employers, since the government subsidies the taxes required for the amounts contributed towards health insurance by the companies. Even with the efforts of government and employers to insure people’s health, many citizens (about 12% of people living in the United States) are not insured (Flood et al., 2015).
Activities people engage in affect their health both in a good and in a bad way. Some decisions, such as drinking alcohol and smoking cigarettes, negatively affect people’s health. At the same time, industrial activities, such as the condemnation of the environment, negatively affect health conditions of the local residents. On the contrary, activities, such as exercising and eating balanced diets, improve health of people (Giles et al., 2015). Getting involved in activities that negatively affect health does not only affect the people who practice or promote them, but also those who surround them. For instance, smoking affects the smoker, the unborn, and the people who surround or live with the smoker, i.e. second hand smokers. Similarly, polluted environment affects the people who contaminate it and the people who leave in the close proximity.
In addition to insurance and policymaking, the government funds public health care sector through grants to maintain and develop health care facilities (Flood et al., 2015). For instance, the government initiated the Hill-Burton program to help build health care buildings in 1950s. It also funds various health care organizations to perform research with an aim of improving the quality of medical assistance. Nonetheless, health care funding cannot yield benefits if innovation and technology is not taken into account.
In order to provide quality and efficient health care to the public, the public health care sector has encouraged innovation and implementation of information technology (Eldredge, Markham, Kok, Ruiter, & Parcel, 2016). Many public health care organizations have implemented information technologies that enhance delivery of efficient health services to clients, although the use of such technologies has not been very widespread (de Andrade et al., 2015). The health care sector continues to implement technologies including Electronic Health Records (EHRs), the Elekta Synergy Cone Beam CT system, Robots, and electronic Clinical Health Record among others to serve clients effectively and efficiently. The implementation of such technologies helps physicians share patients’ information across a secure network. For instance, a physician in another hospital can access a patient’s records stored in a database of a particular hospital. However, the issues of integrity and privacy, security of patients’ information, and confidentiality have not been keenly addressed in the public health sector; the government of America has continued to resolve the issue of privacy of records of patients through the Health Insurance Portability and Accountability Act (HIPAA). HIPAA stipulates how health care providers can utilize and disclose information regarding patients. The main aim of HIPAA is to ensure that the information about patients is protected, while enabling it to be transferred from one place to another with an aim of providing effective and efficient health care to the public.
With regard to medical innovation, the government spearheads innovation of healthcare services and products, especially, when there is a need to control health care fears (Giles et al., 2015). For instance, the government can compel health care stakeholders (physicians, groups that advocate patients’ welfare, patients, healthcare organizations, and other health care experts) to do research and discover new strategies, which can solve such diseases as Ebola or HIV, especially when they become a threat to the public health. In certain instances, the government leaves the innovation to health care technology organizations to test, develop, and market the tools that mitigate health care issues. Since the internal departments of research and development of public health facilities do not have the time, resources, and technology required for innovations, they normally rely on creativity and talents of their internal employees to come up with products and services that meet the needs of patients (Eldredge et al., 2016). In case the products and services are not perfect, technology organizations can adjust them to ensure that they help improve the wellbeing of human.
The public health care sector faces various vulnerabilities, which hinder effective and efficient provision of medical care to patients. The vulnerabilities include social determinants of health and health inequalities, governance and corruption, as well as information system security and privacy.
Social Determinants of Health and Health Inequalities
Social determinants of health include factors that determine the health of individuals and their environment, the way they have been raised, and their daily activities. On the contrary, health inequality refers to disparity in the determinants of health among varying sets of individuals or inhabitants. The inequalities in the resources available within the society determine whether the society is healthy or not (Dodson, Good, & Osborne, 2015). Employment, safety in the community, level of education, level of income, and social and family support are some of the social determinants of health. If the government pays close attention to improving the social determinants of health by providing employment to citizens, ensuring that every child receives basic education, improving the level of income of households, and providing security and amenities that enhance physical education in societies, the society will remain healthy and the government can ease the burden of treating and managing diseases. When the social and economic situations in a society are inadequate, there is high likelihood of the society developing unhealthy behaviours, which can affect their health, and less likelihood of the society practicing in healthy behaviours. On the contrary, in the places where social indexes are appropriate, there is a high likelihood that population will practice healthy lifestyles (Eldredge et al., 2016). For instance, the burden of educating children from poor families, the inability to afford proper accommodation, and low level of income do not just affect the health of involved individuals, but also have an influence on the larger community and country, since the burden of treatment and health care falls on the rich. In this regard, improving the economic and social status of citizens can advance the health status of the sick and lower health burden of a country (Giles et al., 2015). Therefore, the government has to ensure that the environment where people live is safe, that children receive quality and affordable education, and families are employed. Furthermore, the increased level of income will improve the critical infrastructure resilience brought about by social determinants of health.
Governance and Corruption
Governance in health care refers to managing the health care facilities to achieve specific goals (Giles et al., 2015). Corruption, on the other hand, is abuse of power for personal gains. Various factors lead to immense corruption within the public health care sector. The health care sector requires over $3 trillion annually around the world (Dodson, Good, & Osborne, 2015). In addition, the demand for health care services is not easy to predict, since every health problem comes with its own challenges. There are also weak regulations with regard to procurement and use of funds in the health care industry, and inadequate salaries. Corruption takes place in different dimensions in the health care sector. In the pharmaceutical sector, diversion, resale, and theft of drugs account for most corruption cases in the US. For example, theft of drugs can occur without altering the catalogue records; patients who have not contacted pharmacies or hospitals can also receive drugs. Furthermore, medical practitioners can also dispense drugs to patients who pay for them but keep the money collected for their own use; and they can record drugs as dispensed but fail to dispense them to intended patients. Other corruption instances include false promotion of drugs or medical services with an aim of gaining clients or money, paying bribe to medical practitioners to provide false prescriptions, offering bribe to physicians or surgeons to provide medications.
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Corruption in public health care sector can also take place during regulation (Flood et al., 2015). Regulators of the sector can be found practicing corruption, especially when their promise to protect the lives of patients conflicts with the need of private and some public health care facilities to maximize returns. While the regulators have been entrusted with the mandate to ensure that the training of health professionals, manufacture of drugs, and treatment of patients follow specified laws and policies, some controllers use their power to extort money from their clients and allow them operate without strictly following the defined laws and policies (Eldredge et al., 2016). In return, the public receives low quality health care that adversely affects the health outcomes. The government’s effort to provide effective, efficient, and high quality health care in addition to offering universal access to medical services to the public are also negatively affected.
To improve critical infrastructure resilience to corruption, the government should encourage the implementation of policies that would help identify corruption cases and prevent them in the future. Moreover, it should also review the salaries of health care workers to ensure that they are not underpaid. The judiciary’s independence should also be encouraged to ensure that no powerful or influential personalities interfere with the working process of the judges. The media should also be supported and protected in case they reveal acts of corruption especially with the help of their investigative journalism department.
Information Security Vulnerability
The public health care sector of the United States is vulnerable to cyber-attacks, which intend to access the health records of patients. The sector integrates different technologies forming heterogeneous infrastructure, which is prone to hardware and software weaknesses, especially at the places where organizations cross (Dodson, Good, & Osborne, 2015). In addition, vendors of the systems do not always provide support patches once they have been purchased. System administrators also fail to update the systems regularly. Information systems of government and healthcare have been the target for cyber-attacks, since they contain a lot of varying financial data and personal identifiable information (PII). For example, electronic health record system stores health and financial information of patients in addition to PII. The public health care sector gets information from the public, stores it, and secures it from any attacks. With the implementation of Health Information Technology and Economics Clinical Health (HOTECH) Act, many public health care facilities have continued to adopt EHRs. Nonetheless, the need to access the data by multiple agencies and stakeholders, the central nature of data storage, and the need to transfer the information from one place to another makes the system vulnerable to many cyber security attacks. The intention of cyber attackers varies from the desire to steal information, cripple the health care sector, and obtain health information of important people in the society to fraudulently obtaining health care finances.
While the public health care sector is a highly regulated area, it is independent and flexible (Eldredge et al., 2016). Therefore, it is in a position to develop and implement a multilayer information security system in their organizational customs. In this regard, the sector can allocate enough resources and ensure that it strictly follows the HIPAA guidelines and conditions. The sector should also invest in seeking the services of highly qualified system security experts who are able to periodically audit their information systems, identify vulnerabilities, and device ways of preventing the systems from cyber-attacks.
The public health care sector strives to solve the problem of social determinants of health. De Andrade et al. (2015) indicate that while the government tries to tackle the issue of economic and social determinants of health, many individuals in the community thwart the efforts since many people are reluctant to get out of their comfort zones and embrace the new models of life. For instance, some communities still believe that educating the boy child is more important that educating a girl child thus prevent the efforts of the government to provide equal opportunity for all children to access basic education. Since education is one of the key social determinants of health, a community that does not embrace education can be prone to health problems, unlike the one that embraces education. De Andrade et al. (2015) highlight the role various health care practitioners play in ensuring that the government resolves the health care vulnerability of social and economic determinants of health. While community health extension workers, social workers and other health practitioners engaged in the field practice face adverse response from the target communities, they can engage the communities and change their mind set in order to positively welcome activities aimed at making the community members healthy.
Similarly, Dodson, Good, and Osborne (2015) acknowledge that the social status of individuals makes them either embrace healthy lifestyles or not. The authors agree that people living in developing countries face health challenges and propose that such nations have to be empowered to strengthen their health systems. They also outline the importance of health promotion as a mean of encouraging individuals and communities to be more responsible for their personal health and wellness. Similarly to de Andrade et al. (2015), Dodson, Good, and Osborne (2015) assert that health promotion initiatives need to be participative; they have to involve all parties who are concerned, including the community members, during their planning, implementation, and evaluation processes.
While highlighting the vulnerabilities of health care sector, Eldredge et al. (2016) indicate that proper planning and development of health promotion and educational programs enhance the chances of tackling the vulnerabilities. The planning process should improve proper governance of the health care sector. According to Dodson, Good, and Osborne (2015), effective governance eliminates corruption. The philosophy behind engagement in health promotion is the desire to bring the utmost good to the utmost number of people; thus to benefit the greatest number of people, there is a need to fight or avoid corruption, which denies the public from accessing quality and affordable health care. Eldredge et al. (2016) define health promotion as the process that enables people to enhance their control over their health, and, therefore, improving it. In this regard, encouraging people to take control over their lives ensures that they try to improve their social determinants of health and work to stay healthy. Eldredge et al. (2016) indicates various key elements to promote health including creating indicators that enhance health delivery, appreciating health services, developing environments that enhance wellbeing, urging societies to take actions, and promoting talents of society members.
Flood et al. (2015) analyse a major challenge faced by the public health care sector that is resource insufficiency. Resource insufficiency results in all health challenges or vulnerabilities being discussed in this paper, including corruption, social determinants of health, and cyber-attack. Enough resources are required in order to pay for medical practitioners, develop initiatives to counter cybercrime, effectively implement the HIPAA act, and promote health in various communities. Flood et al. (2015) explain that resources enable inter-sectoral collaboration, which has become the key to success for health promotion initiatives. Proper allocation and management of resources enhances creation of partnerships that invest more resources in promoting healthy activities in the society. Involving various sectors, such as the anticorruption bodies, the media, investigation bodies, information technology experts, and healthcare professionals can enhance effective delivery and promotion of health initiatives (Flood et al., 2015). Giles et al. (2015) concur with Flood et al. (2015) regarding the necessity of collaboration to enhance health delivery by encouraging various sectors to unite and work together to ensure that people practice healthy behaviours. The international workshops are able to bring together various international bodies such as the World Health Organization, Transparency International, and the World Bank among others to join efforts and solve various challenges that the public health care sector faces. The living standards of the people living in poverty can be improved through creation of new job opportunities, the increased number of children enrolled in schools, people knowledgeable and practicing healthy living habits, and the understanding that the corruption cases in the health care have to be reported and appropriate actions have to be taken.
Golden, McLeroy, Green, Earp, & Lieberman (2015) analyse the changes that good governance of the health care sector can bring especially with regard to the prevention of disease manifestation. The leaders of health care sector also identifies the amount of money needed to implement projects in the sector; for example, the management should talk with other sectors to help fund the health care and public sector, what reflects the argument made by Flood et al. (2015) and Giles et al. (2015) that collaboration of various stakeholders and sectors enhances gain of resources and delivery of effective and efficient health care. The collaboration should thus not only aim at raising resources, but also seeking the services and involvement of various specialists, such as information technology experts to help solve the issues faced by the public health care sector, including cyber-crime. Hawe (2015) adds that the use of complexity systems thinking, which involve working together with different sectors, helps develop health intervention strategies. Hawe (2015) adds that the use of complexity systems thinking, which involves working together of different sectors, help develop health intervention strategies. To back health sponsorship means that a lot of things need to be done prior to implementing any strategy. Such sponsorship involves using various tactics which consist of coming up with policies, changing organizations, improving community actions, creating laws, teaching, and communicating.
In support of working together in various sectors, Johnston and Finegood (2015) advocate for working together in the private and public sectors since it is key to providing effective, efficient, and high quality health care. The management of public health care sector determines the accumulation of resources required for implementation of health programs, which, according to Flood et al. (2015) and Giles et al. (2015), have the role of convincing other organizations to participate as sponsors or partners of health promotion programs. Source of funding is essential, since finances determine the reach of health promotion initiatives. Laverack and Manoncourt (2015) argue that emerging and contagious diseases such as Ebola need various sectors to work together to be effectively contained. The collaboration also helps to prevent the spread of such diseases. Even so, Tang, St?hl, Bettcher, and De Leeuw (2014) indicate that while developing health promotion strategies, there is a need to help a great number of people. Initiatives of promoting health should thus integrate assessment and harmonization between diverse healthcare providers.
Unless corruption in public health care sector is not eliminated, the efforts to provide quality medical care to all citizens will not be realized. The government and medical practitioners should raise enough money to fund the public health care sector. The money should be used to hire enough qualified health workers and pay decent salaries. When workers are not overburdened with work and receive adequate pay, the chances of them soliciting for bribe become low. The money should also be channelled towards projects that enhance the reduction of corruption. For instance, the public health care sector can support the efforts of anticorruption bodies and investigative journalists by encouraging them to publish corruption cases that have taken place in the sector. In addition, the money should be used to fund court cases that intend to prosecute individuals or organizations that have been involved in corruption to ensure that they are liable for their actions. The research and development department in the public health care sector should be provided with adequate finances to enable them develop new innovations that aim at improving the health of people in the society.
Since technology is inevitable part of today’s world, the sector should use information technology to ensure that public receives quality health care (Flood et al., 2015). Since the transfer of information from one location to another makes it vulnerable to cyber-attacks, the sector has to implement fully the HIPAA act. In this regard, health care providers will follow the law as they utilize and disclose information regarding patients. The law will also ensure that the information of patients is protected, while enabling it to be transferred securely from one place to another. In addition, the sector should hire or seek services of highly qualified and experienced information technology experts to help it identify vulnerable points in their systems and fix them accordingly. The experts will also help the sector to identify applications, which are highly secure, and thus prevent cyber attackers from accessing them. The experts will design and implement information security plan that will be able to forecast possible future security threats and find ways of mitigating them.
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Social determinants of health are also important aspects to consider while dealing with the issue of health care (de Andrade et al., 2015). First, the government should ensure that every child receives high quality basic education. When the level of education is high, there is a high likelihood that people are aware of the need to live healthy lives. They will thus practice lifestyles that encourage healthy living, such as cutting grass and using mosquito nets to prevent malaria, exercising to stay fit and healthy, and seeking the services of health care professionals in case they become sick. Second, the government should ensure that the living standard of the poor is raised by proving employment and ensuring that those who are employed are paid well. When people are employed, they are able to pay for their treatment (Flood et al., 2015). In addition, people get enrolled in various health insurance schemes by their employers. Third, the government should ensure that families are insured by Medicare or Medicaid in order to avoid financial difficulties when they get sick. They will be able to seek treatment without the burden of paying for health care services since the insurance companies they are enrolled in will pay for the needed medical services. Third, the government should continue with the policy of not taxing funds channelled towards health insurance to enable such companies to get enough money to pay for health services offered to their employees. Last, the government should continue collaborating with various stakeholders to raise enough funds to enable effective operations of the sector. The stakeholders will also help with doing research regarding emerging issues in health care and provide recommendations on how to solve these issues (de Andrade et al., 2015). For example, organizations such as World Health Organization and Centers for Disease Control and Prevention can provide statistics regarding poverty level, level of education, types of diseases that mostly affect people, and child mortality rate, etc., what can help the government to come up with initiatives to improve or solve health issues.
The public health care sector is very crucial in ensuring that the country raises healthy individuals who can help drive the economy. The government should thus collaborate with the private sector to ensure that it offers quality and affordable healthcare to the public. The private hospitals should not overcharge citizens who need to receive medical services in their facilities. While private facilities often aim at making profits, as any business does, it is prudent to take the health of individuals into account, before considering the possible revenues. They should also work with the government to ensure that the environment people live in promotes good health. Initiating ways of collaboration between the public and private sectors will enhance working together and creating new ways of combating the difficulties facing the health care and public sectors.