Summary
According to the Institute of Medicine (IOM), public health is characterized by its mission which is fulfilling society’s interest in assuring conditions in which people can be healthy. The assuring conditions referred to in this paper mean collective promotion and protection of everyone’s interest in well-being. Private medicine, on the other hand, intensely focuses on individuals or small groups of patients in diagnosis and treatment. Although both practices have greater effectiveness together, there have been conflicting issues that can be categorized into philosophical and economic domains (Sultz and Young, 2017), with the economic domain being the core.
Philosophical Conflict
Core values underlying public health are equity, effectiveness, and accessibility. Social justice directly implies the role of public health to be the delivery of high care to all individuals. Accessibility is in line with the thought that humans achieve their most distinctly human accomplishments via cooperative effort and consideration for the weaker persons, economically in this case (Turnock, 2012). Private medicine practice method of personalized approach views public health as an infringement of privacy. For example, the call for reporting of communicable diseases by the patients motivated them not to seek medical care at all. The historical instances of mandatory activities like mass vaccination have also triggered ethical concerns, with private practitioners noting it as a repudiation of patients’ rights.
Economic Conflict
According to Charles Edward Winslow, public health cannot be regarded solely as a branch of medicine but rather a career dedicated to social service involving other professionals such as nurses, statisticians, engineers, and educators. The community service aspect rules out considerations of profit, but not sustainability, in designing a public health program that proposes to reach even the lower socio-economic class. For example, according to Catlin (2011), of 77.2 billion dollars that the National Health Expenditure Account (NHEA) considers public health spending, 85.1% is attributed to state and local governments, while the rest is from the federal government. This heavy financing provides economic incentives for the operation of the national health system and, as noted before, is key to promoting equity and efficiency.
Turning to private medicine, the already mentioned intense focus on individual patient care and patient-doctor relationships is its concern. This is translated to relative health benefits such as better health outcomes and higher satisfaction rates as compared to public health services. However, one must factor in the private practitioners’ economic well-being in service provision, which now, unlike public health, must include profits. When the government funds facilities such as diagnostic laboratories and outpatient hospitals, it at times goes against the economic plans of private practitioners which results in protests. The public health officials then accuse them of self-interest, causing the conflict.
Medical Errors as Cause of Death and Disability
The 1999 report by the IOM concerned with medical errors in the healthcare industry made headlines due to the sensitive issues it covered: deaths and disabilities of patients. Putting the blaming aside, the focus lies on fixing this problem by involving various stakeholders such as government organizations, healthcare organizations, and professional groups. This calls for the intervention of the federal government in the implementation of safety and reporting systems instead of leaving the responsibility to healthcare providers.
This is so first due to the economic ability of the federal government. For example, the proposed user-centered technologies build on human strengths and counters weaknesses by means of visual aid in user interfaces and incorporation of affordances, natural mappings, and constraints in healthcare equipment (Donaldson, 2008). Natural mapping of equipment refers to the correspondence of its control with the desired outcome. This calls for an overall change or upgrade of current medical equipment, which is fund-intensive. The process can be affected better by the well-endowed federal government instead of health care providers who would channel their funds in other similarly important measures.
The second is due to the legislative powers of the federal government in setting reporting systems that have the potential to serve two purposes: accountability and provision of information that lead to improved safety. The national mandatory reporting system recommendation was in a bid to hold health service providers accountable in instances of serious injuries and death. The voluntary reporting systems on the other hand, focus on safety improvement.
This further implies federal legislative protection of the system’s confidentiality. The reporting systems, mandatory in particular, have their disadvantage as hospitals and health care practitioners will be demotivated to report mistakes when they lack protection from arising litigation. To counter this, within its legislative power, the federal government should formulate necessary laws to reduce the fear of punishment. For example, the apology laws can disarm emotional responses that may lead to patients pursuing lawsuits.
Rising Costs, Lack of Universal Access, and Variable Quality of Health Care
In project management, there exist constraints such that change in one constraint necessitates changes in others. The Iron Triangle in health care is a concept introduced by Kissick (1994) where a description of how cost, quality, and access relate in a complex and dynamic fashion is given. Cost is what a person pays in order to get needed health services, the desired situation being payment of the lowest possible amount. According to IOM, quality is the degree to which health services for individuals and patients increase the likelihood of desired health outcomes and are consistent with the current professional knowledge. Access to health care, traditionally meaning a patient being in a hospital or ambulatory care center, has three dimensions: coverage, services, and workforce.
For example, addressing the cost of health care in isolation results in changes in its quality and access. Cost reduction can be achieved by the state government designing incentives to lower the usage of low-value care, reducing prices by means of regulation, and promoting competition. An obvious implication of low costs is an influx of patients meaning healthcare providers will incur more administrative costs in terms of more paperwork, disease management, and time. The reduction in health practitioners and equipment to patient ratio, and stretching of resources will generally lower the quality of services offered, besides limiting the services and workforce dimensions mentioned in health care access. This example shows how addressing one issue, cost, in the Iron Triangle results in significant and inherent trade-offs involving the other two, access and quality.
Critics of the competing priorities argue that cost, access, and quality should not be competing factors in health care but rather complement each other towards attaining an equilibrium or optimal state. Current technological research lies primarily in digital technology and Artificial Intelligence (AI), which is being embraced globally by healthcare providers, with others planning its adoption in the near future. Simultaneous modeling of the three variables will reveal the best strategies to adopt without suffering trade-offs. For example, AI has been used in processing medical images such as Magnetic Resonance Imaging (MRI) scans by comparing against its extensive database then diagnosing potential illnesses, especially in early detection programs.
References
Turnock, B. (2012). Public health, what it is and how it works. Burlington MA: Jones and Bartlett Learning
Catlin, A. (2011). Public health spending in the national health expenditure accounts. Presentation to the IOM committee on public health strategies to improve health. Washington, DC: Venable Conference Center 2011
Donaldson M. (2008).An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US), Chapter 3.
Kissick, W. (1994). Medicine’s Dilemmas. New Haven and New London CT: Yale University Press
Sultz, H., Young, K. (2017). Healthcare USA: Understanding its Organization and Delivery, (9th Ed): Jones and Bartlett.