Introduction
Study Background
The U.S. healthcare system is going through a larger-than-life change that has the prospect of transforming healthcare organizations and delivery systems. As of not long ago, repayment models had presented the insignificant motivation for healthcare specialists to enhance quality and lessen the cost, which had brought about framework fracture, replication, and medicinal anomaly (Goldsmith, 2011, p. 1). At the moment, the U.S. government is advocating for change in a solid effort to create groundbreaking arrangements that tackle the exceptional challenges that beset the framework of the therapeutic service. Among the numerous initiatives is one that will assume a key role in advancing high-quality service at a minimal cost (Schoen, 2016, p. 1).
The principal objective of these reform programs is to offer affordable quality services to the citizens. Even though there is a common notion by most Americans that the quality of healthcare offered in the country is exceptionally high, several studies have shown that this is not often the case (Institute of Medicine, 2001, p. 5).
The recent occurrence at the Duke Medical Center where the surgeons failed to confirm the blood type of an organ transplant patient provides an example that, even at the nation’s topmost medical institutions, the quality of healthcare may fall short of expectation (Goldsmith, 2011, p. 3; Teleki, Damberg, & Revile, 2003, p. 1). Such quality-associated shortcomings are particularly disturbing given the fact that the U.S. government spends nearly 18 percent of the GDP on the healthcare sector (Jain & Mohan, 2015, p. 3).
Problem Statement
The healthcare services offered through employees’ compensation schemes are not exempted from the similar quality challenges facing the healthcare system in general (Teleki et al., 2003, p. 1). Without a doubt, given the intricacies of the majority of employees’ healthcare compensation schemes, there is a reason to accept as true that the quality of healthcare offered to employees through compensation schemes may be particularly wanting. As a result, this paper aims at exploring challenges in evaluating and enhancing quality care with a specific focus on employees’ compensation schemes. The paper concludes by providing some recommendations for enhancing quality care for individuals in the scheme.
Methodology
The study is based on desk research, which is an array of existing data accessible in the secondary sources (Outhwaite & Turner, 2007, p. 75). The study is also based on contextual analysis. The contextual analysis incorporates a point by point investigation of a subject, as well as its associated elements (Outhwaite & Turner, 2007, p. 82).
Challenges to evaluating and enhancing quality care
General Challenges
To enhance the quality of healthcare, it is imperative to evaluate it (Griffiths, Jones, Maben, & Murrells, 2008, p. 2). Evaluating the quality of healthcare is a difficult task since there are numerous impediments on the way. For instance, to evaluate healthcare quality, it is important to weigh different standpoints of numerous stakeholders in the healthcare system. It is not easy to find practicable ways of addressing every stakeholder’s concern without making any compromise (Griffiths et al., 2008, p. 3).
Another challenge to assessing the quality of healthcare is the intricacy of creating accountability. The performance principles expected of healthcare practitioners and organizations must be reasonable, that is to say, achievable and well-defined. Holding medical practitioners might be particularly hard to do in a free-for-service setting where people are accustomed to being autonomous and there are critical procedural, administrative, and legal deterrents (Griffiths et al., 2008, p. 5).
A third challenge for evaluating the quality of healthcare is building up unequivocal and straightforward scientific benchmarks that make allowance for estimation. Wherever conceivable, quality measures ought to be founded on the most present, proof-based medical studies. Where studies are not accessible, the proficient agreement ought to be looked for. This procedure is labor-intensive, tedious, and costly (Schoen, 2016, p. 17).
Challenges specific to the U.S. employees’ compensation scheme
Notwithstanding the difficulties of measuring and enhancing quality that exists in the overall healthcare system, employees’ compensation schemes confront extra and exceptional constraints. In the first place, at the most fundamental level, there is no clear, universally accepted description of quality for employees’ compensation health care programs or consensus on the most critical subjects. As a result, it is hard to develop a procedure for estimation or enhancement (Griffiths et al., 2008, p. 6). There are also no broadly operational, institutionalized quality measures for either medical consideration or client consummation in employees’ compensation scheme. Therefore, the capacity to evaluate the quality of healthcare has been fairly constricted by the limitations of scientific data (Schoen, 2016, p. 32).
Third, quality estimation suffers in employee’s compensation schemes in the U.S. owing to the system fragmentation. At the moment, every state has its compensation scheme and, therefore, there is no national benchmark. Last but not least, there additional data challenges that face the program. For example, the data is very restricted; hence, it is very difficult to connect employee compensation data to overall healthcare information (Schoen, 2016, p. 22).
Enhancing quality in employees’ healthcare compensation scheme
The Patient Protection and Affordable Care Act of 2010-generally known as Obama care- generates distinctive prospects for healthcare providers and policymakers to restructure the present healthcare framework to uphold better value to healthcare users. Requisites of the change law are prompting associations to turn into dynamic change representatives by providing an array of motivational programs that should meet particular quality and execution measures (Goldsmith, 2011, p. 5). One of such requisites is the establishment of Accountable Care Organizations (ACOs), which are groups of healthcare service providers that agree to take responsibility for the healthcare service delivery quality and cost to a particular populace of patients tend to by clinicians operating under these groups (Schoen, 2016, p.9).
The Act through the ACOs has removed constraints on healthcare coverage. Also, the ACOs provide a guideline on how to achieve particular performance and quality measurement. The guideline offers a mechanism for tracking and evaluating quality measures. It also emphasizes the development of a solid infrastructure in terms of advanced information systems, new models of care management, and patient education. Improved infrastructure enhances data availability and accessibility (Lake, Stewart & Ginsburg, 2011).
Conclusion and recommendation
Several significant efforts have been made by the U.S. government to improve the quality of care for individuals in various healthcare schemes. The enactment of the Patient Protection and Affordable Care Act of 2010, which is generally known as Obama care, was a major milestone towards improving the quality of healthcare in the country. It has ensured that every American has access to quality care through the employee benefits or the Medicaid system.
Through the Accountable Care Organizations, healthcare practitioners will be able to pinpoint difficult areas and their magnitude to formulate intervention programs, measure progress, and develop strategies for further advancement. Therefore, full implementation of the Act is critical in averting most of the challenges facing employees’ healthcare compensation scheme. Moreover, the government should ensure increased collaborations among different stakeholders in the healthcare sector by enacting new laws. Such laws will enhance information flow and subsequent development of new models of evaluating and enhancing quality.
References
Goldsmith, T. (2011). Accountable Care Organizations: The Key to Transforming Healthcare? Boston, MA: Suffolk University.
Griffiths, P., Jones, S., Maben, J., & Murrells, T. (2008). State of the art metrics for nursing: a rapid appraisal. London: National Nursing Research Unit.
Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press.
Jain, V., & Mohan, S. (2015). The Affordable Care Act and Its Impact on Workers Compensation. Teaneck, New Jersey: Cognizant, Inc.
Lake, T., Stewart, K., & Ginsburg, P. (2011). Lessons from the Field: Making Accountable Care Organizations Real. Washington, DC: National Institute for Healthcare Reform.
Outhwaite, W., & Turner, S. (2007). The SAGE handbook of social science methodology. London: SAGE.
Schoen, C. (2016). The Affordable Care Act and the U.S. Economy: A Five-Year Perspective. New York: The Commonwealth Fund.
Teleki, S., Damberg, C., & Revile, R. (2003). Quality of Health Care: What Is It, Why Is It Important, and How Can It Be Improved in California Compensation Programs? Santa Monica, CA: RAND Corporation.