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Health Care in the United States, Essay Example

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Words: 1013

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In the United States, there has long been discussion about the quality and nature of the delivery of healthcare. The debates have included who may receive such services, whether or not healthcare is a privilege or an entitlement, whether and how to make patient care affordable to all segments of the population, and the ways in which the government should, or should not, be involved in the provision of such services. Indeed, many people feel that the healthcare in this country is the best in the world; others believe tha (The Free Dictionary)t our health delivery system is broken. This paper shall examine different aspects of the healthcare system in our country, discussing whether it has been successful in providing essential services to American citizens.

The delivery of healthcare services is considered to be a system; according to the Free Diction- ary (Farlex, 2010), a system is defined as “a group of interacting, interrelated, or interdependent elements forming a complex whole.” This is an apt description of our healthcare structure, as it is compiled of patients, medical and mental health providers, hospitals, clinics, laboratories, insurance companies, and many other parties that are reliant on each other and that, when combined, make up the entity known as our healthcare system.

Those who believe that our healthcare system is the best in the world often point to the fact that leaders as well as private citizens from countries throughout the world frequently come to the United States to have surgeries and other treatments that they require for survival. A more cynical view of this phenomenon is that if people have the money, they are able to purchase quality care in the U.S., a “survival of the fittest” situation. Those who lack the resources to travel to the U.S. for medical treatment are simply out of luck, and often will die without the needed care.

In fact, reports by the World Health Organization and other groups consistently indicate that while the United States spends more than any other country on healthcare costs, Americans receive lower quality, less efficient and less fairness from the system. These conclusions come as a result of studying quality of care, access to care, equity and the ability to lead long, productive lives. (World Health Organization,2001.) What cannot be disputed is that the cost of healthcare is constantly rising, a fact which was the precipitant to the large movement to reform healthcare in our country in 2010. More than 10 years ago, the goal of managed care was to drive down the costs of healthcare, but those promises did not materialize (Garsten, 2010.) A large segment of the population is either uninsured or underinsured, and it is speculated that over the next decade, these problems will only increase while other difficulties will arise (Garson, 2010.)

When examining the healthcare system, there are three aspects of care that call for evaluation: the impact of delivering care on the patient, the benefits and harms of that treatment, and the functioning of the healthcare system, as described in an article by Adrian Levy. Levy argues that each of these outcomes should be assessed and should include both the successes and the limitations of each aspect. The idea is that there should be operational measurements of patients’ interactions with the healthcare system that would include patients’ experiences in hospitals, using measurements of their functional abilities and their qualities of life following discharge. The results of patients’ interactions with the healthcare system should be utilized to develop and improve the delivery of healthcare treatment, as well as to develop policy changes that would affect the entire field of healthcare in the United States.

One view of the state of American healthcare is that the system is fragmented; there have been many failed attempts by several presidents to introduce the idea of universal healthcare. Instead, American citizens are saddled with a system in which government pays either directly or indirectly for over 50% of the healthcare in our country, but the actual delivery of insurance and of care is undertaken by an assortment of private insurers, for-profit hospitals, and other parties who raise costs without increasing quality of service (Wells, Krugman, 2006.) If the United States were to switch to a single-payer system such as that provided in Canada, the government would directly provide insurance which would most likely be less expensive and provide better results than our current system.

It is clear that throwing money at a problem does not necessarily resolve it; the fact that the United States spends more than twice as much on healthcare provision as any other country in the world only makes it more ironic that when it comes to evaluating the service, Americans fall appallingly flat. In my opinion, if the new healthcare reform bill had included a public option which would have taken the profit margin out of the equation, the nation and its citizens would have been in a much better position to receive quality healthcare. The fact that people die every day from preventable illnesses and conditions simply because they do not have affordable insurance is a national disgrace. In addition, many of the people who have been the most adamantly against government “intrusion” into their healthcare are actually on Medicaid or Medicare, federally-funded programs. Their lack of understanding of what the debate actually involves is striking, and they are rallying against what is in their own best interests. These are people that equate Federal involvement in healthcare as socialism. Unless and until our healthcare system is able to provide what is needed to all of its citizens, all claims that we have the best healthcare system in the world are, sadly, utterly hollow.

Adrian R Levy (2005, December). Categorizing outcomes of Health Care delivery. Clinical and investigative medicine, pp. 347-351.

Arthur Garson (2000). The U.S. Healthcare System 2010: Problems Principles and Potential Solutions. Retrieved July 3, 2010, from Circulation: The Journal of the American Heart Association: http://circ.ahajournals.org/cgi/reprint/101/16/2015

The Free Dictionary. (n.d.). Farlex. Retrieved July 3, 2010. http://www.thefreedictionary.com/system

World Health Organization. (2003, July). WHO World Health Report 2000. Retrieved July 3, 2010, from State of World Health: http://faculty.washington.edu/ely/Report2000.htm

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Home — Essay Samples — Nursing & Health — Health Care Policy — Challenges and Solutions in the Health Care System

Challenges and Solutions in The Health Care System

Categories: Health Care Policy

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Published: Feb 7, 2024

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Introduction, problems in the current health care system, causes of the problems in the health care system, proposed solutions to the problems in the health care system, advantages and disadvantages of the proposed solutions, implementation of the proposed solutions.

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124 Healthcare Essay Topic Ideas & Examples

Inside This Article

Healthcare is a diverse and complex field that encompasses a wide range of topics, issues, and challenges. Whether you are studying healthcare as a student, working in the healthcare industry, or simply interested in learning more about this important area, there are countless essay topics that you can explore. To help you get started, here are 124 healthcare essay topic ideas and examples that you can use for inspiration:

The impact of healthcare disparities on patient outcomes
Strategies for improving access to healthcare in underserved communities
The role of technology in transforming healthcare delivery
The ethics of healthcare rationing
The importance of diversity and inclusion in healthcare organizations
The rise of telemedicine and its implications for patient care
The impact of the opioid epidemic on healthcare systems
The role of nurses in promoting patient safety
The challenges of providing mental health care in a primary care setting
The future of healthcare: personalized medicine and precision healthcare
The role of healthcare providers in addressing social determinants of health
The impact of climate change on public health
The role of public health campaigns in promoting healthy behaviors
The challenges of healthcare delivery in rural areas
The impact of healthcare reform on the uninsured population
The role of healthcare informatics in improving patient outcomes
The importance of cultural competency in healthcare delivery
The ethical implications of genetic testing and personalized medicine
The impact of healthcare costs on patient access to care
The role of healthcare administrators in shaping the future of healthcare delivery
The challenges of implementing electronic health records in healthcare settings
The impact of healthcare privatization on patient care
The role of healthcare providers in promoting patient autonomy
The challenges of providing end-of-life care in a healthcare setting
The impact of healthcare disparities on maternal and child health outcomes
The role of healthcare providers in addressing the opioid crisis
The challenges of providing healthcare to undocumented immigrants
The impact of the COVID-19 pandemic on healthcare systems
The role of healthcare providers in promoting vaccination uptake
The challenges of healthcare delivery in conflict zones
The impact of healthcare disparities on LGBTQ+ populations
The role of healthcare providers in promoting healthy aging
The challenges of providing healthcare to homeless populations
The impact of healthcare disparities on rural communities
The role of healthcare providers in addressing food insecurity
The challenges of providing healthcare to refugees and asylum seekers
The impact of healthcare disparities on people with disabilities
The role of healthcare providers in promoting mental health awareness
The challenges of providing healthcare to incarcerated populations
The impact of healthcare disparities on immigrant populations
The role of healthcare providers in promoting sexual health education
The challenges of providing healthcare to indigenous populations
The impact of healthcare disparities on veterans' health outcomes
The role of healthcare providers in promoting healthy lifestyles
The challenges of providing healthcare to low-income populations
The impact of healthcare disparities on minority populations
The role of healthcare providers in promoting preventive care
The challenges of providing healthcare to elderly populations
The impact of healthcare disparities on women's health outcomes
The role of healthcare providers in promoting maternal health
The challenges of providing healthcare to children and adolescents
The impact of healthcare disparities on mental health outcomes
The role of healthcare providers in promoting substance abuse treatment
The challenges of providing healthcare to homeless youth
The impact of healthcare disparities on LGBTQ+ youth
The role of healthcare providers in promoting healthy relationships
The challenges of providing healthcare to LGBTQ+ youth
The impact of healthcare disparities on transgender populations
The role of healthcare providers in promoting gender-affirming care
The challenges of providing healthcare to LGBTQ+ elders
The impact of healthcare disparities on people of color
The role of healthcare providers in promoting racial equity
The challenges of providing healthcare to immigrant populations
The impact of healthcare disparities on refugee populations
The role of healthcare providers in promoting cultural competency
The challenges of providing healthcare to non-English speaking populations
The role of healthcare providers in promoting disability rights
The challenges of providing healthcare to people with mental illnesses
The impact of healthcare disparities on people experiencing homelessness
The role of healthcare providers in promoting housing stability
The challenges of providing healthcare to people living in poverty
The impact of healthcare disparities on incarcerated populations
The role of healthcare providers in promoting criminal justice reform
The challenges of providing healthcare to veterans
The impact of healthcare

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Health Care Comes Home: The Human Factors (2011)

Chapter: 7 conclusions and recommendations.

7 Conclusions and Recommendations

Health care is moving into the home increasingly often and involving a mixture of people, a variety of tasks, and a broad diversity of devices and technologies; it is also occurring in a range of residential environments. The factors driving this migration include the rising costs of providing health care; the growing numbers of older adults; the increasing prevalence of chronic disease; improved survival rates of various diseases, injuries, and other conditions (including those of fragile newborns); large numbers of veterans returning from war with serious injuries; and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as its quality and cost.

The committee was charged with examining this major trend in health care delivery and resulting challenges from only one of many perspectives: the study of human factors. From the outset it was clear that the dramatic and evolving change in health care practice and policies presents a broad array of opportunities and problems. Consequently the committee endeavored to maintain focus specifically on how using the human factors approach can provide solutions that support maximizing the safety and quality of health care delivered in the home while empowering both care recipients and caregivers in the effort.

The conclusions and recommendations presented below reflect the most critical steps that the committee thinks should be taken to improve the state of health care in the home, based on the literature reviewed in this report examined through a human factors lens. They are organized into four areas: (1) health care technologies, including medical devices and health information technologies involved in health care in the home; (2)

caregivers and care recipients; (3) residential environments for health care; and (4) knowledge gaps that require additional research and development. Although many issues related to home health care could not be addressed, applications of human factors principles, knowledge, and research methods in these areas could make home health care safer and more effective and also contribute to reducing costs. The committee chose not to prioritize the recommendations, as they focus on various aspects of health care in the home and are of comparable importance to the different constituencies affected.

HEALTH CARE TECHNOLOGIES

Health care technologies include medical devices that are used in the home as well as information technologies related to home-based health care. The four recommendations in this area concern (1) regulating technologies for health care consumers, (2) developing guidance on the structure and usability of health information technologies, (3) developing guidance and standards for medical device labeling, and (4) improving adverse event reporting systems for medical devices. The adoption of these recommendations would improve the usability and effectiveness of technology systems and devices, support users in understanding and learning to use them, and improve feedback to government and industry that could be used to further improve technology for home care.

Ensuring the safety of emerging technologies is a challenge, in part because it is not always clear which federal agency has regulatory authority and what regulations must be met. Currently, the U.S. Food and Drug Administration (FDA) has responsibility for devices, and the Office of the National Coordinator for Health Information Technology (ONC) has similar authority with respect to health information technology. However, the dividing line between medical devices and health information technology is blurring, and many new systems and applications are being developed that are a combination of the two, although regulatory oversight has remained divided. Because regulatory responsibility for them is unclear, these products may fall into the gap.

The committee did not find a preponderance of evidence that knowledge is lacking for the design of safe and effective devices and technologies for use in the home. Rather than discovering an inadequate evidence base, we were troubled by the insufficient attention directed at the development of devices that account, necessarily and properly, for users who are inadequately trained or not trained at all. Yet these new users often must

rely on equipment without ready knowledge about limitations, maintenance requirements, and problems with adaptation to their particular home settings.

The increased prominence of the use of technology in the health care arena poses predictable challenges for many lay users, especially people with low health literacy, cognitive impairment, or limited technology experience. For example, remote health care management may be more effective when it is supported by technology, and various electronic health care (“e-health”) applications have been developed for this purpose. With the spectrum of caregivers ranging from individuals caring for themselves or other family members to highly experienced professional caregivers, computer-based care management systems could offer varying levels of guidance, reminding, and alerting, depending on the sophistication of the operator and the criticality of the message. However, if these technologies or applications are difficult to understand or use, they may be ignored or misused, with potentially deleterious effects on care recipient health and safety. Applying existing accessibility and usability guidelines and employing user-centered design and validation methods in the development of health technology products designed for use in the home would help ensure that they are safe and effective for their targeted user populations. In this effort, it is important to recognize how the line between medical devices and health information technologies has become blurred while regulatory oversight has remained distinct, and it is not always clear into which domain a product falls.

Recommendation 1. The U.S. Food and Drug Administration and the Office of the National Coordinator for Health Information Technology should collaborate to regulate, certify, and monitor health care applications and systems that integrate medical devices and health information technologies. As part of the certification process, the agencies should require evidence that manufacturers have followed existing accessibility and usability guidelines and have applied user-centered design and validation methods during development of the product.

Guidance and Standards

Developers of information technologies related to home-based health care, as yet, have inadequate or incomplete guidance regarding product content, structure, accessibility, and usability to inform innovation or evolution of personal health records or of care recipient access to information in electronic health records.

The ONC, in the initial announcement of its health information technology certification program, stated that requirements would be forthcom-

ing with respect both to personal health records and to care recipient access to information in electronic health records (e.g., patient portals). Despite the importance of these requirements, there is still no guidance on the content of information that should be provided to patients or minimum standards for accessibility, functionality, and usability of that information in electronic or nonelectronic formats.

Consequently, some portals have been constructed based on the continuity of care record. However, recent research has shown that records and portals based on this model are neither understandable nor interpretable by laypersons, even by those with a college education. The lack of guidance in this area makes it difficult for developers of personal health records and patient portals to design systems that fully address the needs of consumers.

Recommendation 2. The Office of the National Coordinator for Health Information Technology, in collaboration with the National Institute of Standards and Technology and the Agency for Healthcare Research and Quality, should establish design guidelines and standards, based on existing accessibility and usability guidelines, for content, accessibility, functionality, and usability of consumer health information technologies related to home-based health care.

The committee found a serious lack of adequate standards and guidance for the labeling of medical devices. Furthermore, we found that the approval processes of the FDA for changing these materials are burdensome and inflexible.

Just as many medical devices currently in use by laypersons in the home were originally designed and approved for use only by professionals in formal health care facilities, the instructions for use and training materials were not designed for lay users, either. The committee recognizes that lack of instructional materials for lay users adds to the level of risk involved when devices are used by populations for whom they were not intended.

Ironically, the FDA’s current premarket review and approval processes inadvertently discourage manufacturers from selectively revising or developing supplemental instructional and training materials, when they become aware that instructional and training materials need to be developed or revised for lay users of devices already approved and marketed. Changing the instructions for use (which were approved with the device) requires manufacturers to submit the device along with revised instructions to the FDA for another 510(k) premarket notification review. Since manufacturers can find these reviews complicated, time-consuming, and expensive, this requirement serves as a disincentive to appropriate revisions of instructional or training materials.

Furthermore, little guidance is currently available on design of user

training methods and materials for medical devices. Even the recently released human factors standard on medical device design (Association for the Advancement of Medical Instrumentation, 2009), while reasonably comprehensive, does not cover the topic of training or training materials. Both FDA guidance and existing standards that do specifically address the design of labeling and ensuing instructions for use fail to account for up-to-date findings from research on instructional systems design. In addition, despite recognition that requirements for user training, training materials, and instructions for use are different for lay and professional users of medical equipment, these differences are not reflected in current standards.

Recommendation 3. The U.S. Food and Drug Administration (FDA) should promote development (by standards development organizations, such as the International Electrotechnical Commission, the International Organization for Standardization, the American National Standards Institute, and the Association for the Advancement of Medical Instrumentation) of new standards based on the most recent human factors research for the labeling of and ensuing instructional materials for medical devices designed for home use by lay users. The FDA should also tailor and streamline its approval processes to facilitate and encourage regular improvements of these materials by manufacturers.

Adverse Event Reporting Systems

The committee notes that the FDA’s adverse event reporting systems, used to report problems with medical devices, are not user-friendly, especially for lay users, who generally are not aware of the systems, unaware that they can use them to report problems, and uneducated about how to do so. In order to promote safe use of medical devices in the home and rectify design problems that put care recipients at risk, it is necessary that the FDA conduct more effective postmarket surveillance of medical devices to complement its premarket approval process. The most important elements of their primarily passive surveillance system are the current adverse event reporting mechanisms, including Maude and MedSun. Entry of incident data by health care providers and consumers is not straightforward, and the system does not elicit data that could be useful to designers as they develop updated versions of products or new ones that are similar to existing devices. The reporting systems and their importance need to be widely promoted to a broad range of users, especially lay users.

Recommendation 4. The U.S. Food and Drug Administration should improve its adverse event reporting systems to be easier to use, to collect data that are more useful for identifying the root causes of events

related to interactions with the device operator, and to develop and promote a more convenient way for lay users as well as professionals to report problems with medical devices.

CAREGIVERS IN THE HOME

Health care is provided in the home by formal caregivers (health care professionals), informal caregivers (family and friends), and individuals who self-administer care; each type of caregiver faces unique issues. Properly preparing individuals to provide care at home depends on targeting efforts appropriately to the background, experience, and knowledge of the caregivers. To date, however, home health care services suffer from being organized primarily around regulations and payments designed for inpatient or outpatient acute care settings. Little attention has been given to how different the roles are for formal caregivers when delivering services in the home or to the specific types of training necessary for appropriate, high-quality practice in this environment.

Health care administration in the home commonly involves interaction among formal caregivers and informal caregivers who share daily responsibility for a person receiving care. But few formal caregivers are given adequate training on how to work with informal caregivers and involve them effectively in health decision making, use of medical or adaptive technologies, or best practices to be used for evaluating and supporting the needs of caregivers.

It is also important to recognize that the majority of long-term care provided to older adults and individuals with disabilities relies on family members, friends, or the individual alone. Many informal caregivers take on these responsibilities without necessary education or support. These individuals may be poorly prepared and emotionally overwhelmed and, as a result, experience stress and burden that can lead to their own morbidity. The committee is aware that informational and training materials and tested programs already exist to assist informal caregivers in understanding the many details of providing health care in the home and to ease their burden and enhance the quality of life of both caregiver and care recipient. However, tested materials and education, support, and skill enhancement programs have not been adequately disseminated or integrated into standard care practices.

Recommendation 5. Relevant professional practice and advocacy groups should develop appropriate certification, credentialing, and/or training standards that will prepare formal caregivers to provide care in the home, develop appropriate informational and training materials

for informal caregivers, and provide guidance for all caregivers to work effectively with other people involved.

RESIDENTIAL ENVIRONMENTS FOR HEALTH CARE

Health care is administered in a variety of nonclinical environments, but the most common one, particularly for individuals who need the greatest level and intensity of health care services, is the home. The two recommendations in this area encourage (1) modifications to existing housing and (2) accessible and universal design of new housing. The implementation of these recommendations would be a good start on an effort to improve the safety and ease of practicing health care in the home. It could improve the health and safety of many care recipients and their caregivers and could facilitate adherence to good health maintenance and treatment practices. Ideally, improvements to housing design would take place in the context of communities that provide transportation, social networking and exercise opportunities, and access to health care and other services.

Safety and Modification of Existing Housing

The committee found poor appreciation of the importance of modifying homes to remove health hazards and barriers to self-management and health care practice and, furthermore, that financial support from federal assistance agencies for home modifications is very limited. The general connection between housing characteristics and health is well established. For example, improving housing conditions to enhance basic sanitation has long been part of a public health response to acute illness. But the characteristics of the home can present significant barriers to autonomy or self-care management and present risk factors for poor health, injury, compromised well-being, and greater dependence on others. Conversely, physical characteristics of homes can enhance resident safety and ability to participate in daily self-care and to utilize effectively health care technologies that are designed to enhance health and well-being.

Home modifications based on professional home assessments can increase functioning, contribute to reducing accidents such as falls, assist caregivers, and enable chronically ill persons and people with disabilities to stay in the community. Such changes are also associated with facilitating hospital discharges, decreasing readmissions, reducing hazards in the home, and improving care coordination. Familiar modifications include installation of such items as grab bars, handrails, stair lifts, increased lighting, and health monitoring equipment as well as reduction of such hazards as broken fixtures and others caused by insufficient home maintenance.

Deciding on which home modifications have highest priority in a given

setting depends on an appropriate assessment of circumstances and the environment. A number of home assessment instruments and programs have been validated and proven to be effective to meet this need. But even if needed modifications are properly identified and prioritized, inadequate funding, gaps in services, and lack of coordination between the health and housing service sectors have resulted in a poorly integrated system that is difficult to access. Even when accessed, progress in making home modifications available has been hampered by this lack of coordination and inadequate reimbursement or financial mechanisms, especially for those who cannot afford them.

Recommendation 6. Federal agencies, including the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services, along with the U.S. Department of Housing and Urban Development and the U.S. Department of Energy, should collaborate to facilitate adequate and appropriate access to health- and safety-related home modifications, especially for those who cannot afford them. The goal should be to enable persons whose homes contain obstacles, hazards, or features that pose a home safety concern, limit self-care management, or hinder the delivery of needed services to obtain home assessments, home modifications, and training in their use.

Accessibility and Universal Design of New Housing

Almost all existing housing in the United States presents problems for conducting health-related activities because physical features limit independent functioning, impede caregiving, and contribute to such accidents as falls. In spite of the fact that a large and growing number of persons, including children, adults, veterans, and older adults, have disabilities and chronic conditions, new housing continues to be built that does not account for their needs (current or future). Although existing homes can be modified to some extent to address some of the limitations, a proactive, preventive, and effective approach would be to plan to address potential problems in the design phase of new and renovated housing, before construction.

Some housing is already required to be built with basic accessibility features that facilitate practice of health care in the home as a result of the Fair Housing Act Amendments of 1998. And 17 states and 30 cities have passed what are called “visitability” codes, which currently apply to 30,000 homes. Some localities offer tax credits, such as Pittsburgh through an ordinance, to encourage installing visitability features in new and renovated housing. The policy in Pittsburgh was impetus for the Pennsylvania Residential VisitAbility Design Tax Credit Act signed into law on October 28, 2006, which offers property owners a tax credit for new construction

and rehabilitation. The Act paves the way for municipalities to provide tax credits to citizens by requiring that such governing bodies administer the tax credit (Self-Determination Housing Project of Pennsylvania, Inc., n.d.).

Visitability, rather than full accessibility, is characterized by such limited features as an accessible entry into the home, appropriately wide doorways and one accessible bathroom. Both the International Code Council, which focuses on building codes, and the American National Standards Institute, which establishes technical standards, including ones associated with accessibility, have endorsed voluntary accessibility standards. These standards facilitate more jurisdictions to pass such visitability codes and encourage legislative consistency throughout the country. To date, however, the federal government has not taken leadership to promote compliance with such standards in housing construction, even for housing for which it provides financial support.

Universal design, a broader and more comprehensive approach than visitability, is intended to suit the needs of persons of all ages, sizes, and abilities, including individuals with a wide range of health conditions and activity limitations. Steps toward universal design in renovation could include such features as anti-scald faucet valve devices, nonslip flooring, lever handles on doors, and a bedroom on the main floor. Such features can help persons and their caregivers carry out everyday tasks and reduce the incidence of serious and costly accidents (e.g., falls, burns). In the long run, implementing universal design in more homes will result in housing that suits the long-term needs of more residents, provides more housing choices for persons with chronic conditions and disabilities, and causes less forced relocation of residents to more costly settings, such as nursing homes.

Issues related to housing accessibility have been acknowledged at the federal level. For example, visitability and universal design are in accord with the objectives of the Safety of Seniors Act (Public Law No. 110-202, passed in 2008). In addition, implementation of the Olmstead decision (in which the U.S. Supreme Court ruled that the Americans with Disabilities Act may require states to provide community-based services rather than institutional placements for individuals with disabilities) requires affordable and accessible housing in the community.

Visitability, accessibility, and universal design of housing all are important to support the practice of health care in the home, but they are not broadly implemented and incentives for doing so are few.

Recommendation 7. Federal agencies, such as the U.S. Department of Housing and Urban Development, the U.S. Department of Veterans Affairs, and the Federal Housing Administration, should take a lead role, along with states and local municipalities, to develop strategies that promote and facilitate increased housing visitability, accessibil-

ity, and universal design in all segments of the market. This might include tax and other financial incentives, local zoning ordinances, model building codes, new products and designs, and related policies that are developed as appropriate with standards-setting organizations (e.g., the International Code Council, the International Electrotechnical Commission, the International Organization for Standardization, and the American National Standards Institute).

RESEARCH AND DEVELOPMENT

In our review of the research literature, the committee learned that there is ample foundational knowledge to apply a human factors lens to home health care, particularly as improvements are considered to make health care safe and effective in the home. However, much of what is known is not being translated effectively into practice, neither in design of equipment and information technology or in the effective targeting and provision of services to all those in need. Consequently, the four recommendations that follow support research and development to address knowledge and communication gaps and facilitate provision of high-quality health care in the home. Specifically, the committee recommends (1) research to enhance coordination among all the people who play a role in health care practice in the home, (2) development of a database of medical devices in order to facilitate device prescription, (3) improved surveys of the people involved in health care in the home and their residential environments, and (4) development of tools for assessing the tasks associated with home-based health care.

Health Care Teamwork and Coordination

Frail elders, adults with disabilities, disabled veterans, and children with special health care needs all require coordination of the care services that they receive in the home. Home-based health care often involves a large number of elements, including multiple care providers, support services, agencies, and complex and dynamic benefit regulations, which are rarely coordinated. However, coordinating those elements has a positive effect on care recipient outcomes and costs of care. When successful, care coordination connects caregivers, improves communication among caregivers and care recipients and ensures that receivers of care obtain appropriate services and resources.

To ensure safe, effective, and efficient care, everyone involved must collaborate as a team with shared objectives. Well-trained primary health care teams that execute customized plans of care are a key element of coordinated care; teamwork and communication among all actors are also

essential to successful care coordination and the delivery of high-quality care. Key factors that influence the smooth functioning of a team include a shared understanding of goals, common information (such as a shared medication list), knowledge of available resources, and allocation and coordination of tasks conducted by each team member.

Barriers to coordination include insufficient resources available to (a) help people who need health care at home to identify and establish connections to appropriate sources of care, (b) facilitate communication and coordination among caregivers involved in home-based health care, and (c) facilitate communication among the people receiving and the people providing health care in the home.

The application of systems analysis techniques, such as task analysis, can help identify problems in care coordination systems and identify potential intervention strategies. Human factors research in the areas of communication, cognitive aiding and decision support, high-fidelity simulation training techniques, and the integration of telehealth technologies could also inform improvements in care coordination.

Recommendation 8 . The Agency for Healthcare Research and Quality should support human factors–based research on the identified barriers to coordination of health care services delivered in the home and support user-centered development and evaluation of programs that may overcome these barriers.

Medical Device Database

It is the responsibility of physicians to prescribe medical devices, but in many cases little information is readily available to guide them in determining the best match between the devices available and a particular care recipient. No resource exists for medical devices, in contrast to the analogous situation in the area of assistive and rehabilitation technologies, for which annotated databases (such as AbleData) are available to assist the provider in determining the most appropriate one of several candidate devices for a given care recipient. Although specialists are apt to receive information about devices specific to the area of their practice, this is much less likely in the case of family and general practitioners, who often are responsible for selecting, recommending, or prescribing the most appropriate device for use at home.

Recommendation 9. The U.S. Food and Drug Administration, in collaboration with device manufacturers, should establish a medical device database for physicians and other providers, including pharmacists, to use when selecting appropriate devices to prescribe or recommend

for people receiving or self-administering health care in the home. Using task analysis and other human factors approaches to populate the medical device database will ensure that it contains information on characteristics of the devices and implications for appropriate care recipient and device operator populations.

Characterizing Caregivers, Care Recipients, and Home Environments

As delivery of health care in the home becomes more common, more coherent strategies and effective policies are needed to support the workforce of individuals who provide this care. Developing these will require a comprehensive understanding of the number and attributes of individuals engaged in health care in the home as well as the context in which care is delivered. Data and data analysis are lacking to accomplish this objective.

National data regarding the numbers of individuals engaged in health care delivery in the home—that is, both formal and informal caregivers—are sparse, and the estimates that do exist vary widely. Although the Bureau of Labor Statistics publishes estimates of the number of workers employed in the home setting for some health care classifications, they do not include all relevant health care workers. For example, data on workers employed directly by care recipients and their families are notably absent. Likewise, national estimates of the number of informal caregivers are obtained from surveys that use different methodological approaches and return significantly different results.

Although numerous national surveys have been designed to answer a broad range of questions regarding health care delivery in the home, with rare exceptions such surveys reflect the relatively limited perspective of the sponsoring agency. For example,

The Medicare Current Beneficiary Survey (administered by the Centers for Medicare & Medicaid Services) and the Health and Retirement Survey (administered by the National Institute on Aging) are primarily geared toward understanding the health, health services use, and/or economic well-being of older adults and provide no information regarding working-age adults or children or information about home or neighborhood environments.
The Behavioral Risk Factors Surveillance Survey (administered by the Centers for Disease Control and Prevention, CDC), the National Health Interview Survey (administered by the CDC), and the National Children’s Study (administered by the U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency) all collect information on health characteristics, with limited or no information about the housing context.
The American Housing Survey (administered by the U.S. Department of Housing and Urban Development) collects detailed information regarding housing, but it does not include questions regarding the health status of residents and does not collect adequate information about home modifications and features on an ongoing basis.

Consequently, although multiple federal agencies collect data on the sociodemographic and health characteristics of populations and on the nation’s housing stock, none of these surveys collects data necessary to link the home, its residents, and the presence of any caregivers, thus limiting understanding of health care delivered in the home. Furthermore, information is altogether lacking about health and functioning of populations linked to the physical, social, and cultural environments in which they live. Finally, in regard to individuals providing care, information is lacking regarding their education, training, competencies, and credentialing, as well as appropriate knowledge about their working conditions in the home.

Better coordination across government agencies that sponsor such surveys and more attention to information about health care that occurs in the home could greatly improve the utility of survey findings for understanding the prevalence and nature of health care delivery in the home.

Recommendation 10. Federal health agencies should coordinate data collection efforts to capture comprehensive information on elements relevant to health care in the home, either in a single survey or through effective use of common elements across surveys. The surveys should collect data on the sociodemographic and health characteristics of individuals receiving care in the home, the sociodemographic attributes of formal and informal caregivers and the nature of the caregiving they provide, and the attributes of the residential settings in which the care recipients live.

Tools for Assessing Home Health Care Tasks and Operators

Persons caring for themselves or others at home as well as formal caregivers vary considerably in their skills, abilities, attitudes, experience, and other characteristics, such as age, culture/ethnicity, and health literacy. In turn, designers of health-related devices and technology systems used in the home are often naïve about the diversity of the user population. They need high-quality information and guidance to better understand user capabilities relative to the task demands of the health-related device or technology that they are developing.

In this environment, valid and reliable tools are needed to match users with tasks and technologies. At this time, health care providers lack the

tools needed to assess whether particular individuals would be able to perform specific health care tasks at home, and medical device and system designers lack information on the demands associated with health-related tasks performed at home and the human capabilities needed to perform them successfully.

Whether used to assess the characteristics of formal or informal caregivers or persons engaged in self-care, task analysis can be used to develop point-of-care tools for use by consumers and caregivers alike in locations where such tasks are encouraged or prescribed. The tools could facilitate identification of potential mismatches between the characteristics, abilities, experiences, and attitudes that an individual brings to a task and the demands associated with the task. Used in ambulatory care settings, at hospital discharge or other transitions of care, and in the home by caregivers or individuals and family members themselves, these tools could enable assessment of prospective task performer’s capabilities in relation to the demands of the task. The tools might range in complexity from brief screening checklists for clinicians to comprehensive assessment batteries that permit nuanced study and tracking of home-based health care tasks by administrators and researchers. The results are likely to help identify types of needed interventions and support aids that would enhance the abilities of individuals to perform health care tasks in home settings safely, effectively, and efficiently.

Recommendation 11. The Agency for Healthcare Research and Quality should collaborate, as necessary, with the National Institute for Disability and Rehabilitation Research, the National Institutes of Health, the U.S. Department of Veterans Affairs, the National Science Foundation, the U.S. Department of Defense, and the Centers for Medicare & Medicaid Services to support development of assessment tools customized for home-based health care, designed to analyze the demands of tasks associated with home-based health care, the operator capabilities required to carry them out, and the relevant capabilities of specific individuals.

Association for the Advancement of Medical Instrumentation. (2009). ANSI/AAMI HE75:2009: Human factors engineering: Design of medical devices. Available: http://www.aami.org/publications/standards/HE75_Ch16_Access_Board.pdf [April 2011].

Self-Determination Housing Project of Pennsylvania, Inc. (n.d.) Promoting visitability in Pennsylvania. Available: http://www.sdhp.org/promoting_visitability_in_pennsy.htm [March 30, 2011].

In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.

Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.

Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.

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Essay on Health Care System In The Philippines

Students are often asked to write an essay on Health Care System In The Philippines in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Health Care System In The Philippines

The basics of health care in the philippines.

The Philippines’ health care system is a set of health services provided by public and private providers. Public health care is managed by the Department of Health (DOH), while private health services are offered by various hospitals and clinics.

Public Health Care

Public health care is available to everyone. It is funded by taxes and contributions from workers. The Philippine Health Insurance Corporation (PhilHealth) is the main public health care provider. It gives Filipinos access to basic medical services.

Private Health Care

Private health care is offered by private hospitals and clinics. It’s usually more expensive than public health care. People who can afford it often choose private care for more personalized service and shorter waiting times.

Challenges in the Health Care System

The health care system in the Philippines faces many challenges. These include a lack of resources, unequal access to health services, and a high cost of care. The government is working on these issues to improve the health care system.

Future of Health Care in the Philippines

250 words essay on health care system in the philippines, introduction.

The health care system in the Philippines is a mix of public and private providers. It aims to give medical help to all its citizens. The Department of Health (DOH) is the main body in charge of health care.

The government provides health care through public hospitals and clinics. These are usually free or cost very little. The Philippine Health Insurance Corporation (PhilHealth) is the national health insurance program. It helps people pay for medical services.

There are also private hospitals and clinics. These usually offer better facilities and shorter waiting times. But, they are more expensive. Many people have private health insurance to help cover these costs.

The health care system in the Philippines faces some issues. There are not enough doctors and nurses, especially in rural areas. Also, the quality of care can vary greatly. Some people can’t afford the cost of private health care but need it due to the lack of public facilities.

Improvements

The government is working to improve the health care system. One step is the Universal Health Care Act. This law aims to give all Filipinos access to quality health care, without causing financial hardship.

500 Words Essay on Health Care System In The Philippines

The basics of the health care system in the philippines.

The health care system in the Philippines is a mix of public and private providers. The Department of Health (DOH) is the main public health agency. It sets policies, plans, and programs for health services. It also runs special health programs and research.

The Philippine Health Insurance Corporation (PhilHealth) is another important part of the public health system. It provides health insurance for Filipinos. This helps to make health care more affordable.

Public and Private Health Providers

Private providers include doctors, clinics, and hospitals that are not run by the government. They usually offer more services and shorter waiting times. But, their services cost more.

Health Care Challenges

The health care system in the Philippines faces several challenges. One is the uneven distribution of health services. More health services are available in urban areas than in rural areas. This means people living in rural areas may have to travel far to get health care.

Efforts to Improve Health Care

The government is working to improve the health care system. In 2019, it passed the Universal Health Care Law. This law aims to give all Filipinos access to quality health care. It also aims to make health care more affordable.

The government is also investing in health technology. This includes telemedicine, which allows people to consult with doctors online. This can help people in rural areas get health care more easily.

The health care system in the Philippines is a mix of public and private providers. It faces challenges like uneven distribution of services and high costs. But, the government is taking steps to improve it. It is working to provide universal health care and make health care more affordable. It is also investing in health technology to reach more people. Despite the challenges, the future of health care in the Philippines looks hopeful.

If you’re looking for more, here are essays on other interesting topics:

Apart from these, you can look at all the essays by clicking here .

2021 National Healthcare Quality and Disparities Report [Internet].

Overview of u.s. healthcare system landscape.

The National Academy of Medicine defines healthcare quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Many factors contribute to the quality of care in the United States, including access to timely care, affordability of care, and use of evidence-based guidelines to drive treatment.

This section of the report highlights utilization of healthcare services, healthcare workforce statistics, healthcare expenditures, and major contributors to morbidity and mortality. These factors help paint an overall picture of the U.S. healthcare system, particularly areas that need improvement. Quality measures show whether the healthcare system is adequately addressing risk factors, diseases, and conditions that place the greatest burden on the healthcare system and if change has occurred over time.

Overview of the U.S. Healthcare System Infrastructure

The NHQDR tracks care delivered by providers in many types of healthcare settings. The goal is to provide high-quality healthcare that is culturally and linguistically sensitive, patient centered, timely, affordable, well coordinated, and safe. The receipt of appropriate high-quality services and counseling about healthy lifestyles can facilitate the maintenance of well-being and functioning. In addition, social determinants of health, such as education, income, and residence location can affect access to care and quality of care.

Improving care requires facility administrators and providers to work together to expand access, enhance quality, and reduce disparities. It also requires coordination between the healthcare sector and other sectors for social welfare, education, and economic development. For example, Healthy People 2030 includes 5 domains (shown in the diagram below) and 78 social determinants of health objectives for federal programs and interventions.

Healthy People 2030 social determinants of health domains.

The numbers of health service encounters and people working in health occupations illustrate the large scale and inherent complexity of the U.S. healthcare system. The tracking of healthcare quality measures in this report iii attempts to quantify progress made in improving quality and reducing disparities in the delivery of healthcare to the American people.

Number of healthcare service encounters, United States, 2018 and 2019.

In 2018, there were 860 million physician office visits ( Figure 1 ).
In 2019, patients spent 149 million days in hospice.
In 2019, there were 100 million home health visits.
Overview of Disease Burden in the United States

The National Institutes of Health defines disease burden as the impact of a health problem, as measured by prevalence, incidence, mortality, morbidity, extent of disability, financial cost, or other indicators.

This section of the report highlights two areas of disease burden that have major impact on the health system of the United States: years of potential life lost and leading causes of death. The NHQDR tracks measures of quality for most of these conditions. Variation in access to care and care delivery across communities contributes to disparities related to race, ethnicity, sex, and socioeconomic status.

The concept of years of potential life lost (YPLL) involves estimating the average time a person would have lived had he or she not died prematurely. This measure is used to help quantify social and economic loss from premature death, and it has been promoted to emphasize specific causes of death affecting younger age groups. YPLL inherently incorporates age at death, and its calculation mathematically weights the total deaths by applying values to death at each age. 1

According to the Centers for Disease Control and Prevention (CDC), unintentional injuries include opioid overdoses (unintentional poisoning), motor vehicle crashes, suffocation, drowning, falls, fire/burns, and sports and recreational injuries. Overdose deaths involving opioids, including prescription opioids , heroin , and synthetic opioids (e.g., fentanyl ), have been a major contributor to the increase in unintentional injuries. Opioid overdose has increased to more than six times its 1999 rate. 2

Age-adjusted years of potential life lost before age 65, by cause of death, 2010–2019. Key: YPLL = years of potential life lost. Note: The perinatal period occurs from 22 completed weeks (154 days) of gestation and ends 7 completed days after (more...)

From 2010 to 2019, there were no changes in the ranking of the top 10 leading diseases and injuries contributing to YPLL. The top 5 were unintentional injury, cancer, heart disease, suicide, and complications during the perinatal period ( Figure 2 ). The remaining 5 were homicide, congenital anomalies, liver disease, diabetes, and cerebrovascular disease.
Unintentional injury increased from 791.8 per 100,000 population in 2010 to 1,024.3 per 100,000 population in 2019.
Cancer decreased from 635.2 per 100,000 population in 2010 to 533.3 per 100,000 population in 2019.
Heart disease decreased from 474.3 per 100,000 population in 2010 to 453.2 per 100,000 population in 2019.

Age-adjusted years of potential life lost before age 65, by cause of death and race, 2019. Key: AI/AN = American Indian or Alaska Native; PI = Pacific Islander.

In 2019, among American Indian and Alaska Native (AI/AN) people, the top five contributing factors for YPLL were unintentional injuries (1,284.6 per 100,000 population), suicide (457.7 per 100,000 population), liver disease (451.6 per 100,000 population), heart disease (399.8 per 100,000 population), and cancer (339.6 per 100,000 population) ( Figure 3 ).
In 2019, among Asian and Pacific Islander people, the top five contributing factors for YPLL were cancer (375.7 per 100,000 population), unintentional injuries (299.4 per 100,000 population), complications in the perinatal period (203.4 per 100,000 population), suicide (198.5 per 100,000), and heart disease (197.7 per 100,000 population).
In 2019 among Black people, the top five contributing factors for YPLL were unintentional injuries (1,085.8 per 100,000 population), heart disease (843.5 per 100,000 population), homicide (801.7 per 100,000 population), cancer (652.7 per 100,000 population), and complications in the perinatal period (560.4 per 100,000 population).
In 2019, among White people, the top five contributing factors for YPLL were unintentional injuries (1,080.0 per 100,000 population), cancer (530.1 per 100,000 population), heart disease (406.6 per 100,000 population), suicide (387.6 per 100,000 population), and complications in the perinatal period (215.7 per 100,000 population).

Leading causes of death for the total population, United States, 2018 and 2019.

In 2019, heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, and diabetes were among the leading causes of death for the overall U.S. population ( Figure 4 ).
Overall, kidney disease moved from the 9 th leading cause of death in 2018 to the 8 th leading cause of death in 2019.
Suicide remained the 10 th leading cause of death in 2018 and 2019.

The years of potential life lost, years with disability, and leading causes of death represent some aspects of the burden of disease experienced by the American people. Findings highlighted in this report attempt to quantify progress made in improving quality of care, reducing disparities in healthcare, and ultimately reducing disease burden.

Overview of U.S. Community Hospital Intensive Care Beds

The United States has almost 1 million staffed hospital beds; nearly 800,000 are community hospital beds and 107,000 are intensive care beds. Figure 5 shows the numbers of different types of staffed intensive care hospital beds.

Medical-surgical intensive care provides patient care of a more intensive nature than the usual medical and surgical care delivered in hospitals, on the basis of physicians’ orders and approved nursing care plans. These units are staffed with specially trained nursing personnel and contain specialized equipment for monitoring and supporting patients who, because of shock, trauma, or other life-threatening conditions, require intensified comprehensive observation and care. These units include mixed intensive care units.

Pediatric intensive care provides care to pediatric patients that is more intensive in nature than that usually provided to pediatric patients. The unit is staffed with specially trained personnel and contains monitoring and specialized support equipment for treating pediatric patients who, because of shock, trauma, or other life-threatening conditions, require intensified, comprehensive observation and care.

Cardiac intensive care provides patient care of a more specialized nature than the usual medical and surgical care, on the basis of physicians’ orders and approved nursing care plans. The unit is staffed with specially trained nursing personnel and contains specialized equipment for monitoring, support, or treatment for patients who, because of severe cardiac disease such as myocardial infarction, open-heart surgery, or other life-threatening conditions, require intensified, comprehensive observation and care.

Neonatal intensive care units (NICUs) are distinct from the newborn nursery and provide intensive care to sick infants, including those with the very lowest birth weights (less than 1,500 grams). NICUs may provide mechanical ventilation, care before or after neonatal surgery, and special care for the sickest infants born in the hospital or transferred from another institution. Neonatologists typically serve as directors of NICUs.

Burn care provides care to severely burned patients. Severely burned patients are those with the following: (1) second-degree burns of more than 25% total body surface area for adults or 20% total body surface area for children; (2) third-degree burns of more than 10% total body surface area; (3) any severe burns of the hands, face, eyes, ears, or feet; or (4) all inhalation injuries, electrical burns, complicated burn injuries involving fractures and other major traumas, and all other poor risk factors.

Other intensive care unit beds are in specially staffed, specialty-equipped, separate sections of a hospital dedicated to the observation, care, and treatment of patients with life-threatening illnesses, injuries, or complications from which recovery is possible. This type of care includes special expertise and facilities for the support of vital functions and uses the skill of medical, nursing, and other staff experienced in the management of conditions that require this higher level of care.

U.S. community hospital intensive care staffed beds, by type of intensive care, 2019. Note: Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; (more...)

In 2019, of the more than 900,000 staffed hospital beds in the United States, 86% were in community hospitals (data not shown).
Most of the more than 107,000 intensive care beds in community hospitals were medical-surgical intensive care (51.9%) and neonatal intensive care beds (21.1%) ( Figure 5 ).

Critical access hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services (CMS). The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, CAHs receive certain benefits, such as cost-based reimbursement for Medicare services. As of July 16, 2021, 1,353 CAHs were located throughout the United States. 3 , iv

Distribution of critical access hospitals in the United States, 2021.

According to CMS, CAHs must be located in a rural area or an area that is treated as rural, v so the number of CAHs varies by state ( Figure 6 ).
In 2019, California had a population of 39.5 million and 36 CAHs compared with Iowa, which had a population of only 3.2 million but 82 CAHs.
U.S. Healthcare Workforce

Healthcare access and quality can be affected by workforce shortages, particularly in rural areas. In addition, lack of racial, ethnic, and gender concordance between providers and patients can lead to miscommunication, stereotyping, and stigma, and, ultimately, suboptimal healthcare.

Healthcare Workforce Availability

Improving quality of care, increasing access to care, and controlling healthcare costs depend on the adequate availability of healthcare providers. 4 Physician shortages currently exist in many states across the nation, with relatively fewer primary care and specialty physicians available in nonmetropolitan counties compared with metropolitan counties. 5

The Health Resources and Services Administration (HRSA) further projects that the supply of key professions, including primary care providers, general dentists, adult psychiatrists, and addiction counselors, will fall short of demand by 2030. 6 These concerns have the potential to influence the delivery of healthcare and negatively affect patient outcomes.

Number of people working in health occupations, United States, 2019. Key: EMT = emergency medical technician. Note: Doctors of medicine also include doctors of osteopathic medicine. Active physicians include those working in direct patient care, administration, (more...)

In 2019, there were 3.7 million registered nurses ( Figure 7 ).
In 2019, there were 2.4 million healthcare aides, which includes nursing, psychiatric, home health, and occupational therapy aides and physical therapy assistants and aides.
In 2019, there were 2.1 million health technologists.
In 2019, 2.0 million other health practitioners provided care, including more than 145,000 physician assistants (PAs).
In 2019, there were 972,000 active medical doctors in the United States, which include doctors of medicine and doctors of osteopathy.
In 2019, there were 183,000 dentists.

In recent decades, promising approaches that address the supply-demand imbalance have emerged as alternatives to simply increasing the number of physicians. One strategy relies on telehealth technologies to improve physicians’ efficiency or to increase access to their services. For example, Project ECHO is a telehealth model in which specialists remotely support multiple rural primary care providers so that they can treat patients for conditions that might otherwise require traveling to distant specialty centers. 7

Another strategy relies on peer-led models, in which community-based laypeople receive the training and support needed to deliver care for a (typically) narrow range of conditions. Successful examples of this approach exist, including the deployment of community health workers to manage chronic diseases, 8 promotoras to provide maternal health services, 9 peer counselors for mental health and substance use disorders, 10 and dental health aides to deliver oral health services in remote locations. 11

The National Institutes of Health, HRSA, and the Agency for Healthcare Research and Quality (AHRQ) have sponsored formative research to examine key issues that must be addressed to further develop these models, but all show promise for expanding access to care and increasing overall diversity within the healthcare workforce.

Workforce Diversity

The number of full-time, year-round workers in healthcare occupations has almost doubled since 2000, increasing from 5 million to 9 million workers, according to the U.S. Census Bureau’s American Community Survey .

A racially and ethnically diverse health workforce has been shown to promote better access and healthcare for underserved populations and to better meet the health needs of an increasingly diverse population. People of color, however, remain underrepresented in several health professions, despite longstanding efforts to increase the diversity of the healthcare field. 12

Additional research has found that physicians from groups underrepresented in the health professions are more likely to serve minority and economically disadvantaged patients. It has also been found that Black and Hispanic physicians practice in areas with larger Black and Hispanic populations than other physicians do. 13

Gender diversity is also important. Women currently account for three-quarters of full-time, year-round healthcare workers. Although the number of men who are dentists or veterinarians has decreased over the past two decades, men still make up more than half of dentists, optometrists, and emergency medical technicians/paramedics, as well as physicians and surgeons earning over $100,000. 14

Women working as registered nurses, the most common healthcare occupation, earn on average $66,000. Women working as nursing, psychiatric, and home health aides, the second most common healthcare occupation, earn only $27,000. 14

The impact of unequal gender distribution in the healthcare workforce is observed in the persistence of gender inequality in heart attack mortality. Most physicians are male, and some may not recognize differences in symptoms in female patients. The fact that gender concordance correlates with whether a patient survives a heart attack has implications for theory and practice. Medical practitioners should be aware of the possible challenges male providers face when treating female heart attack patients. 15

Research has shown that some mental health workforce groups, such as psychiatrists, are more diverse than many other medical specialties, and this diversity has improved over time. However, this diversity has not translated as well to academic faculty or leadership positions for underrepresented minorities. It was found that there was more minority representation among psychiatry residents (16.2%) compared with faculty (8.7%) and practicing physicians (10.4%). This difference results in minority students and trainees having fewer minority mentors to guide them in the profession.

Racial and Ethnic Diversity Among Physicians

Diversification of the physician workforce has been a goal for several years and could improve access to primary care for underserved populations and address health disparities. Family physicians’ race/ethnicity has become more diverse over time but still does not reflect the national racial and ethnic composition. 16 , vi

Racial and ethnic distribution of all active physicians (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due (more...)

In 2019, White people were 60% of the U.S. population and approximately 64% of physicians ( Figure 8 ).
Asian people were about 6% of the U.S. population and approximately 22% of physicians.
Black people were 12% of the U.S. population but only 5% of physicians.
Hispanic people were 18% of the U.S. population but only 7% of physicians.
People of more than race made up about 3% of the U.S. population but less than 2% of physicians.
AI/AN people and Native Hawaiian/Pacific Islander (NHPI) people accounted for 1% or less of the U.S. population and 1% or less of physicians (data not shown).

Preventive care, including screenings, is key to reducing death and disability and improving health. Evidence has shown that patients with providers of the same gender have higher rates of breast, cervical, and colorectal cancer screenings. 17

Physicians by race/ethnicity and sex, 2018. Key: AI/AN = American Indian or Alaska Native; NHPI = Native Hawaiian/Pacific Islander. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working (more...)

In 2018, among Black physicians, females (53.0%) constituted a larger percentage than males (47.0%) ( Figure 9 ).
Among White physicians, 65.5% were male.
Among Asian physicians, 55.7% were male.
Among AI/AN physicians, 60.1% were male.
Among Hispanic physicians, 59.5% were male.

White physicians by age and sex, 2018. Note : Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

In 2018, among White physicians, males were the vast majority of those age 65 years and over (79.3%) and of those ages 55–64 years (71.5%) ( Figure 10 ).
A little more than half of White physicians age 34 and younger were females (50.6%).
Among White physicians age 35 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

Black physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

In 2018, among Black physicians under age 55, females made up a larger percentage of the workforce than males. This percentage decreased with increasing age ( Figure 11 ).
Females were 44.2% of Black physicians ages 55–64 and 34.9% of Black physicians age 65 and over.

Asian physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

In 2018, among Asian physicians, males were the vast majority of those age 65 years and over (72.7%) and of those ages 55–64 years (66.3%) ( Figure 12 ).
Among Asian physicians age 34 and younger, there were more females (52.0%) than males (48.0%).
Among Asian physicians age 35 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

American Indian or Alaska Native physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, (more...)

In 2018, among AI/AN physicians, males were the vast majority of those age 65 years and over (73.2%) and of those ages 55–64 years (62.6%) ( Figure 13 ).
Among AI/AN physicians age 34 and younger, there were more females (57.9%) than males (42.1%).
Among AI/AN physicians age 45 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

Hispanic physicians by age and sex, 2018. Note: Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semiretired, temporarily not in practice, (more...)

In 2018, most Hispanic physicians age 65 years and over (77.5%) and ages 55–64 years (67.5%) were males ( Figure 14 ).
Among Hispanic physicians age 34 and younger, there were more females (55.3%) compared with males (44.7%).
Among Hispanic physicians age 35 and over, males made up a larger percentage of the workforce than females. This percentage increased with age.

Racial and Ethnic Diversity Among Dentists

The racial and ethnic diversity of the oral healthcare workforce is insufficient to meet the needs of a diverse population and to address persistent health disparities. 18 However, among first-time, first-year enrollees in dental school, improved diversity has been observed. The number of African American enrollees nearly doubled and the number of Hispanic enrollees has increased threefold between 2000 and 2020. 19 Increased diversity among dentists may improve access and quality of care, particularly in the area of culturally and linguistically sensitive care.

Dentists by race (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and Other are non-Hispanic. If estimates for certain racial and ethnic groups meet data suppression criteria, they are recategorized into (more...)

In 2019, the vast majority of dentists (70%) were non-Hispanic White ( Figure 15 ).
Asian people, 18%,
Hispanic people, 6%
Black people, 5%, and
Other (multiracial and AI/AN people), 1.0%.

Racial and Ethnic Diversity Among Registered Nurses

Ensuring workforce diversity and leadership development opportunities for racial and ethnic minority nurses must remain a high priority in order to eliminate health disparities and, ultimately, achieve health equity. 20

Registered nurses by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and (more...)

In 2019, the vast majority of RNs (69%) were non-Hispanic White ( Figure 16 ).
Black people, 11%,
Asian people, 9%,
Hispanic people, 8%,
Multiracial people, 2%, and
Other (AI/AN and NHPI people), 1%.

Racial and Ethnic Diversity Among Pharmacists

Most healthcare diagnostic and treating occupations such as pharmacists, physicians, nurses, and dentists are primarily White while healthcare support roles such as dental assistants, medical assistants, and personal care aides are more diverse. To decrease disparities and enhance patient care, racial and ethnic diversity must be improved on all levels of the healthcare workforce, not just in support roles. 21

Progress has been made toward increased racial and ethnic diversity, but more work is needed. As Bush notes in an article on underrepresented minorities in pharmacy school, “If we are determined to reduce existing healthcare disparities among racial, ethnic, and socioeconomic groups, then we must be determined to diversify the healthcare workforce.” 22

Pharmacists by race (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and the exclusion of groups (more...)

In 2019, the vast majority of pharmacists (65%) were non-Hispanic White ( Figure 17 ).
Asian people, 20%,
Black people, 7%,
Hispanic people, 5%, and
Multiracial people, 2%.

Racial and Ethnic Diversity Among Therapists

Occupational therapists, physical therapists, radiation therapists, recreational therapists, and respiratory therapists are classified as health diagnosing and treating practitioners. Hispanic people are significantly underrepresented in all of the occupations in the category of Health Diagnosing and Treating Practitioners. Among non-Hispanic people, Black people are underrepresented in most of these occupations.

Asian people are underrepresented among speech-language pathologists, and AI/AN people are underrepresented in nearly all occupations. To the extent they can be reliably reported, data also show that NHPI people are underrepresented in all occupations in the Health Diagnosing and Treating Practitioners group. 21

Therapists include occupational therapists, physical therapists, radiation therapists, recreational therapists, respiratory therapists, speech-language pathologists, exercise physiologists, and other therapists.

Therapists by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and the exclusion (more...)

In 2019, the vast majority of therapists (74%) were non-Hispanic White ( Figure 18 ).
Black people, 8%,
Asian people, 8%,
Hispanic people, 8%, and

Racial and Ethnic Diversity Among Advanced Practice Registered Nurses

The adequacy and distribution of the primary care workforce to meet the current and future needs of Americans continue to be cause for concern. Advanced practice registered nurses are increasingly being used to fill this gap but may include clinicians in areas beyond primary care, such as clinical nurse specialists, nurse-midwives, and nurse anesthetists.

Advanced practice registered nurses are registered nurses educated at the master’s or post-master’s level who serve in a specific role with a specific patient population. They include certified nurse practitioners, clinical nurse specialists, certified nurse anesthetists, and certified nurse-midwives.

While physicians continue to account for most of the primary care workforce (74%) in the United States, nurse practitioners represent nearly one-fifth (19%) of the primary care workforce, followed by physician assistants, accounting for 7%. 23

Nurse practitioners provide an extensive range of services that includes taking health histories and providing complete physical exams. They diagnose and treat acute and chronic illnesses, provide immunizations, prescribe and manage medications and other therapies, order and interpret lab tests and x rays, and provide health education and supportive counseling.

Nurse practitioners deliver primary care in practices of various sizes, types (e.g., private, public), and settings, such as clinics, schools, and workplaces. Nurse practitioners work independently and collaboratively. They often take the lead in providing care in innovative primary care arrangements, such as retail clinics. 24

Advanced practice registered nurses by race (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

In 2019, the vast majority of advanced practice registered nurses (78 %) were non-Hispanic White ( Figure 19 ).
Asian people, 6%,
Hispanic people, 6%, and

Racial and Ethnic Diversity Among Emergency Professionals

Workforce diversity can reduce communication barriers and inequalities in healthcare delivery, especially in settings such as emergency departments, where time pressure and incomplete information may worsen the effects of implicit biases. The racial and ethnic makeup of the paramedic and emergency medical technician workforce indicates that concerted efforts are needed to encourage students of diverse backgrounds to pursue emergency service careers. 25

Emergency medical technicians and paramedics by race (left), and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages do not add to 100 due to rounding. In addition, (more...)

In 2019, the vast majority of emergency medical technicians (EMTs) and paramedics (72%) were non-Hispanic White ( Figure 20 ).
Hispanic people, 13%
Asian people, 3%,

Racial and Ethnic Diversity Among Other Health Practitioners

Other health practitioners include physician assistants, medical assistants, dental assistants, chiropractors, dietitians and nutritionists, optometrists, podiatrists, and audiologists, as well as massage therapists, medical equipment preparers, medical transcriptionists, pharmacy aides, veterinary assistants and laboratory animal caretakers, phlebotomists, and healthcare support workers.

Other health practitioners by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

In 2019, the distribution of other health practitioners closely aligned with the racial and ethnic distribution of the U.S. population ( Figure 21 ).
In 2019, 58% of other health practitioners were non-Hispanic White.
In 2019, Hispanic people accounted for 20% of other health practitioners.
Black people, 12%,
Asian people, 7%,

Racial and Ethnic Diversity Among Physician Assistants

Physician assistants (PAs) are included in the Other Health Practitioners workforce group but are highlighted because they play a critical role in frontline primary care services in many settings, especially medically underserved and rural areas. With the demand for primary care services projected to grow and PAs’ roles in direct care, understanding this occupation’s racial and ethnic diversity is important.

Studies identify the value of advanced practice providers in patient care management, continuity of care, improved quality and safety metrics, and patient and staff satisfaction. These providers can also enhance the educational experience of residents and fellows. 26 However, a lack of workforce diversity has detrimental effects on patient outcomes, access to care, and patient trust, as well as on workplace experiences and employee retention. 27

Physician assistants by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

In 2019, the vast majority of physician assistants (73%) were non-Hispanic White ( Figure 22 ).
Black people, 6%,
Multiracial people, 3%, and

Racial and Ethnic Diversity Among Other Health Occupations

Other health occupations include veterinarians, acupuncturists, all other healthcare diagnosing or treating practitioners, dental hygienists, and licensed practical and licensed vocational nurses.

Other health occupations by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding (more...)

In 2019, the vast majority of staff in other health occupations (61%) were non-Hispanic White ( Figure 23 ).
Black people, 19%,
Hispanic people, 11%
Asian people, 6 %,

Racial and Ethnic Diversity Among Health Technologists

Health technologists include clinical laboratory technologists and technicians, cardiovascular technologists and technicians, diagnostic medical sonographers, radiologic technologists and technicians, magnetic resonance imaging technologists, nuclear medicine technologists and medical dosimetrists, pharmacy technicians, surgical technologists, veterinary technologists and technicians, dietetic technicians and ophthalmic medical technicians, medical records specialists, and opticians (dispensing), miscellaneous health technologists and technicians, and technical occupations.

Health technologists by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and the (more...)

In 2019, the vast majority of health technologists (63%) were non-Hispanic White ( Figure 24 ).
Black people, 14%,
Hispanic people, 13%,
Asian people, 8%, and

Racial and Ethnic Diversity Among Healthcare Aides

Healthcare aides include nursing, psychiatric, home health, occupational therapy, and physical therapy assistants and aides.

Healthcare aides by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, >1 Race, and Other are non-Hispanic. Percentages of the U.S. population do not add to 100 due to rounding and (more...)

In 2019, 41% of healthcare aides were non-Hispanic White ( Figure 25 ).
Black people, 32%,
Hispanic people, 18%,

Racial and Ethnic Diversity Among Psychologists

The United States has an inadequate workforce to meet the mental health needs of the population, 28 , 29 , 30 and it is estimated that in 2020, nearly 54% of the U.S. population age 18 and over with any mental illness did not receive needed treatment. 31 This unmet need is even greater for racial and ethnic minority populations. Nearly 80% of Asian and Pacific Islander people, vii 63% of African Americans, and 65% of Hispanic people with a mental illness do not receive mental health treatment. 29 , 32 , 33 , 34

These gaps in mental health care may be attributed to a number of reasons, including stigma, cultural attitudes and beliefs, lack of insurance, or lack of familiarity with the mental health system. 35 , 36 , 37 However, a significant contributor to this treatment gap is the composition of the workforce.

The current mental health workforce lacks racial and ethnic diversity. 34 , 38 Research has shown that racial and ethnic patient-provider concordance is correlated with patient engagement and retention in mental health treatment. 39 In addition, racial and ethnic minority providers are more likely to serve patients of color than White providers. 34 , 36

Among psychologists, a key practitioner group in the mental health workforce, 37 , 40 minorities are significantly underrepresented. Psychologists in the United States are predominantly non-Hispanic White, while all racial and ethnic minorities represented only about one-sixth of all psychologists from 2011 to 2015.

Reducing the serious gaps in mental health care for racial and ethnic minority populations will require a significant shift in the workforce. Workforce recruitment, training, and education of more racially, ethnically, and culturally diverse practitioners will be essential to reduce these disparities.

Psychologists by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Note: White, Black, Asian, and >1 Race are non-Hispanic. Psychologists include practitioners of general psychology, developmental and child (more...)

In 2019, the vast majority of psychologists (79%) were non-Hispanic White ( Figure 26 ).
Hispanic people,10%,
Asian people, 4%, and
Multiracial people, 2.0%.

Although the outpatient substance use treatment field has seen an increase in referrals of Black and Hispanic clients, there have been limited changes in the diversity of the workforce. This discordance may exacerbate treatment disparities experienced by these clients. 41

Substance abuse and behavioral disorder counselors by race/ethnicity (left) and U.S. population racial and ethnic distribution (right), 2019. Key: AI/AN = American Indian/Alaska Native. Note: White, Black, Asian, AI/AN, and >1 Race are non-Hispanic. (more...)

In 2019, the majority of substance abuse and behavioral disorder counselors (58%) were non-Hispanic White ( Figure 27 ).
Black people, 18%,
Hispanic people, 16 %,
Asian people, 4%,
AI/AN people, 1%.
Overview of Healthcare Expenditures in the United States
Hospital care expenditures grew by 6.2% to $1.2 trillion in 2019, faster than the 4.2% growth in 2018.
Physician and clinical services expenditures grew 4.6% to $772.1 billion in 2019, a faster growth than the 4.0% in 2018.
Prescription drug spending increased by 5.7% to $369.7 billion in 2019, faster than the 3.8% growth in 2018.
In 2019, the federal government (29%) and households (28%) each accounted for the largest shares of healthcare spending, followed by private businesses (19%), state and local governments (16%), and other private revenues (7%). Federal government spending on health accelerated in 2019, increasing 5.8% after 5.4% growth in 2018.

Personal Healthcare Expenditures

“Personal healthcare expenditures” measures the total amount spent to treat individuals with specific medical conditions. It comprises all of the medical goods and services used to treat or prevent a specific disease or condition in a specific person. These include hospital care; professional services; other health, residential, and personal care; home health care; nursing care facilities and continuing care retirement communities; and retail outlet sales of medical products. 43

Distribution of personal healthcare expenditures by type of expenditure, 2019. Key: CCRCs = continuing care retirement communities. Note: Percentages do not add to 100 due to rounding. Personal healthcare expenditures are outlays for goods and services (more...)

In 2019, hospital care expenditures were $1.192 trillion, nearly 40% of personal healthcare expenditures ( Figure 28 ).
Expenditures for physician and clinical services were $772.1 billion, almost one-fourth of personal healthcare expenditures.
Prescription drug expenditures were $369.7 billion, 10% of personal healthcare expenditures.
Expenditures for dental services were $143.2 billion, 5% of personal healthcare expenditures.
Nursing care facility expenditures were $172.7 billion and home health care expenditures were $113.5 billion, 5% and 4% of personal healthcare expenditures, respectively.

Personal healthcare expenditures, by source of funds, 2019. Note: Data are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Personal healthcare (more...)

In 2019, private insurance accounted for 33% of personal healthcare expenditures, followed by Medicare (23%), Medicaid (17%), and out of pocket (13%) ( Figure 29 ).
Private insurance accounted for 37% of hospital, 40% of physician, 15% of home health, 10% of nursing home, 43% of dental, and 45% of prescription drug expenditures.
Medicare accounted for 27% of hospital, 25% of physician, 39% of home health, 22% of nursing home, 1.0% of dental, and 28% of prescription drug expenditures.
Medicaid accounted for 17% of hospital, 11% of physician, 32% of home health, 29% of nursing home, 10% of dental, and 9% of prescription drug expenditures.
Out-of-pocket payments accounted for 3% of hospital, 8% of physician, 11% of home health, 26% of nursing home, 42% of dental, and 15% of prescription drug expenditures.

Prescription drug expenditures, by source of funds, 2019. Note: Data are available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Percentages do (more...)

Private health insurance companies accounted for 44.5% of retail drug expenses ($164.6 billion in 2019).
Medicare accounted for 28.3% of retail drug expenses ($104.6 billion).
Medicaid accounted for 8.5% of retail drug expenses ($31.4 billion).
Other health insurance programs accounted for 3.0% of retail drug expenses ($11.0 billion).

Other third-party payers had the smallest percentage of costs (1.2%), which represented $4.3 billion in retail drug costs.

Variation in Healthcare Quality

State-level analysis included 182 measures for which state data were available. Of these measures, 140 are core measures and 42 are supplemental measures from the National CAHPS Benchmarking Database (NCBD), which provides state data for core measures with MEPS national data only.

The state healthcare quality analysis included all 182 measures, and the state disparities analysis included 108 measures for which state-by-race or state-by-ethnicity data were available. State-level data are also available for 136 supplemental measures. These data are available from the Data Query tool on the NHQDR website but are not included in data analysis.

State-level data show that healthcare quality and disparities vary widely depending on state and region. Although a state may perform well in overall quality, the same state may face significant disparities in healthcare access or disparities within specific areas of quality.

Overall quality of care, by state, 2015–2020. Note: All state-level measures with data were used to compute an overall quality score for each state based on the number of quality measures above, at, or below the average across all states. States (more...)

Some states in the Northeast (Maine, Massachusetts, New Hampshire, and Rhode Island), some in the Midwest (Iowa, Minnesota, North Dakota, and Wisconsin), two states in the West (Colorado and Utah), and North Carolina and Kentucky had the highest overall quality scores.
Some Southern and Southwestern states (District of Columbia, viii Florida, Georgia, New Mexico, and Texas), two Western states (California and Nevada), some Northwestern states (Montana, Oregon, Washington, and Wyoming), and New York and Alaska had the lowest overall quality scores.
More information about the measures and data sources included in the creation of this map can be found in Appendix C .
More information about healthcare quality in each state can be found on the NHQDR website, https://datatools .ahrq.gov/nhqdr .
Variation in Disparities in Healthcare

The disparities map ( Figure 32 ) shows average differences in quality of care for Black, Hispanic, Asian, NHPI, AI/AN, and multiracial people compared with the reference group, non-Hispanic White or White people. States with fewer than 50 data points are excluded.

Average differences in quality of care for Black, Hispanic, Asian, Native Hawaiian/Pacific Islander, American Indian or Alaska Native, and multiracial people compared with White people, by state, 2018–2019. Note: All measures in this report that (more...)

Some Western and Midwestern states (Idaho, Iowa, Kansas, Montana, Nevada, New Mexico, Oregon, Utah, and Washington), several Southern states (Kentucky, Mississippi, Virginia, and West Virginia), and Maine had the fewest racial and ethnic disparities overall.
Several Northeastern states (Massachusetts, New York, and Pennsylvania), two Midwestern states (Illinois and Ohio), two Southern States (Louisiana and Tennessee), and Texas had the most racial and ethnic disparities overall.

Major updates made to three data sources since 2018, specifically the Medical Expenditure Panel Survey, Healthcare Cost and Utilization Project, and National Health Interview Survey, have had an outsized impact on what the 2021 NHQDR can include. Trend data were provided in prior versions of the NHQDR but were not directly comparable for almost half of the core measures at the time this report was developed. Therefore, the 2021 NHQDR does not include a summary figure showing all trend measures or all changes in disparities. The report includes summary figures for trends and change in disparities for some populations and the results for individual measures.

More information on providers that may be eligible to become CAHs and the criteria a Medicare-participating hospital must meet to be designated by CMS as a CAH can be found at https://www .cms.gov/Medicare /Provider-Enrollment-and-Certification /CertificationandComplianc/CAHs .

All the criteria for a Medicare-participating hospital to be designated by CMS as a CAH can be found at https://www .cms.gov/Medicare /Provider-Enrollment-and-Certification /CertificationandComplianc/CAHs .

The most recent data year available is 2018 from the Association of American Medical Colleges, the current source for workforce data broken down by both race/ethnicity and sex.

The National Survey on Drug Use and Health at the Substance Abuse and Mental Health Services Administration combines data for Asian and Pacific Islander populations, which include Native Hawaiian populations.

For purposes of this report, the District of Columbia is treated as a state.

This document is in the public domain and may be used and reprinted without permission. Citation of the source is appreciated.

Cite this Page 2021 National Healthcare Quality and Disparities Report [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2021 Dec. OVERVIEW OF U.S. HEALTHCARE SYSTEM LANDSCAPE.
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5 Critical Priorities for the U.S. Health Care System

Marc Harrison

A guide to making health care more accessible, affordable, and effective.

The pandemic has starkly revealed the many shortcomings of the U.S. health care system — as well as the changes that must be implemented to make care more affordable, improve access, and do a better job of keeping people healthy. In this article, the CEO of Intermountain Healthcare describes five priorities to fix the system. They include: focus on prevention, not just treating sickness; tackle racial disparities; expand telehealth and in-home services; build integrated systems; and adopt value-based care.

Since early 2020, the dominating presence of the Covid-19 pandemic has redefined the future of health care in America. It has revealed five crucial priorities that together can make U.S. health care accessible, more affordable, and focused on keeping people healthy rather than simply treating them when they are sick.

Marc Harrison , MD, is president and CEO of Salt Lake City-based Intermountain Healthcare.

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What has the pandemic revealed about the US health care system — and what needs to change?

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With vaccinations for Covid-19 now underway across the nation, MIT SHASS Communications asked seven MIT scholars engaged in health and health care research to share their views on what the pandemic has revealed about the U.S. health care system — and what needs to change. Representing the fields of medicine, anthropology, political science, health economics, science writing, and medical humanities, these researchers articulate a range of opportunities for U.S. health care to become more equitable, more effective and coherent, and more prepared for the next pandemic.

Dwaipayan Banerjee , associate professor of science, technology, and society

On the heels of Ebola, Covid-19 put to rest a persistent, false binary between diseases of the rich and diseases of the poor. For several decades, health care policymakers have labored under the impression of a great epidemiological transition. This theory holds that the developed world has reached a stage in its history that it no longer needs to worry about communicable diseases. These "diseases of the poor" are only supposed to exist in distant places with weak governments and struggling economies. Not here in the United States.

On the surface, Covid-19 made clear that diseases do not respect national boundaries. More subtly, it tested the hypothesis that the global north no longer need concern itself with communicable disease. And in so doing, it undermined our assumptions about global north health-care infrastructures as paradigmatically more evolved. Over the last decades, the United States has been focused on developing increasingly sophisticated drugs. While this effort has ushered in several technological breakthroughs, a preoccupation with magic-bullet cures has distracted from public health fundamentals. The spread of the virus revealed shortages in basic equipment and hospitals beds, the disproportionate effects of disease on the marginalized, the challenge of prevention rather than cure, the limits of insurance-based models to provide equitable care, and our unacknowledged dependence on the labor of underpaid health care workers.

To put it plainly, the pandemic did not create a crisis in U.S. health care. For many in the United States, crisis was already a precondition of care, delivered in emergency rooms and negotiated through denied insurance claims. As we begin to imagine a "new normal," we must ask questions about the old. The pandemic made clear that the "normal" had been a privilege only for a few well-insured citizens. In its wake, can we imagine a health-care system that properly compensates labor and recognizes health care as a right, rather than a privilege only available to the marginalized when an endemic crisis is magnified by a pandemic emergency?

Andrea Campbell , professor of political science

No doubt, the pandemic reveals the dire need to invest in public-health infrastructure to better monitor and address public-health threats in the future, and to expand insurance coverage and health care access. To my mind, however, the pandemic’s greatest significance is in revealing the racism woven into American social and economic policy.

Public policies helped create geographic and occupational segregation to begin with; inadequate racist and classist public policies do a poor job of mitigating their effects. Structural racism manifests at the individual level, with people of color suffering worse housing and exposure to toxins, less access to education and jobs, greater financial instability, poorer physical and mental health, and higher infant mortality and shorter lifespans than their white counterparts. Residential segregation means many white Americans do not see these harms.

Structural racism also materializes at the societal level, a colossal waste of human capital that undercuts the nation’s economic growth, as social and economic policy expert Heather McGhee shows in her illuminating book, "The Sum of Us." These society-wide costs are hidden as well; it is difficult to comprehend the counterfactual of what growth would look like if all Americans could prosper. My hope is that the pandemic renders this structural inequality visible. There is little point in improving medical or public-health systems if we fail to address the structural drivers of poor health. We must seize the opportunity to improve housing, nutrition, and schools; to enforce regulations on workplace safety, redlining, and environmental hazards; and to implement paid sick leave and paid family leave, among other changes. It has been too easy for healthy, financially stable, often white Americans to think the vulnerable are residual. The pandemic has revealed that they are in fact central. It’s time to invest for a more equitable future.

Jonathan Gruber , Ford Professor of Economics

The Covid-19 pandemic is the single most important health event of the past 100 years, and as such has enormous implications for our health care system. Most significantly, it highlights the importance of universal, non-discriminatory health insurance coverage in the United States. The primary source of health insurance for Americans is their job, and with unemployment reaching its highest level since the Great Depression, tens of millions of workers lost, at least temporarily, their insurance coverage.

Moreover, even once the economy recovers, millions of Americans will have a new preexisting condition, Covid-19. That’s why it is critical to build on the initial successes of the Affordable Care Act to continue to move toward a safety net that provides insurance options for all without discrimination.

The pandemic has also illustrated the power of remote health care. The vast majority of patients in the United States have had their first experience with telehealth during the pandemic and found it surprisingly satisfactory. More use of telehealth can lead to increased efficiency of health care delivery as well as allowing our system to reach underserved areas more effectively.

The pandemic also showed us the value of government sponsorship of innovation in the health sciences. The speed with which the vaccines were developed is breathtaking. But it would not have been possible without decades of National Institute of Health investments such as the Human Genome Project, nor without the large incentives put in place by Operation Warp Speed. Even in peacetime, the government has a critical role to play in promoting health care innovation

The single most important change that we need to make to be prepared for the next pandemic is to recognize that proper preparation is, by definition, overpreparation. Unless we are prepared for the next pandemic that doesn’t happen, we won’t possibly be ready for the next pandemic that does.

This means working now, while the memory is fresh, to set up permanent, mandatorily funded institutions to do global disease surveillance, extensive testing of any at-risk populations when new diseases are detected, and a permanent government effort to finance underdeveloped vaccines and therapeutics.

Jeffrey Harris , professor emeritus of economics and a practicing physician The pandemic has revealed the American health care system to be a non-system. In a genuine system, health care providers would coordinate their services. Yet when Elmhurst Hospital in Queens was overrun with patients, some 3,500 beds remained available in other New York hospitals. In a genuine system, everyone would have a stable source of care at a health maintenance organization (HMO). While our country has struggled to distribute the Covid-19 vaccine efficiently and equitably, Israel, which has just such an HMO-based system, has broken world records for vaccination.

Germany, which has all along had a robust public health care system, was accepting sick patients from Italy, Spain, and France. Meanwhile, U.S. hospitals were in financial shock and fee-for-service-based physician practices were devastated. We need to move toward a genuine health care system that can withstand shocks like the Covid-19 pandemic. There are already models out there to imitate. We need to strengthen our worldwide pandemic and global health crisis alert systems. Despite concerns about China’s early attempts to suppress the bad news about Covid-19, the world was lucky that Chinese investigators posted the full genome of SARS-CoV-2 in January 2020 — the singular event that triggered the search for a vaccine. With the recurrent threat of yet another pandemic — after H1N1, SARS, MERS, Ebola, and now SARS-Cov-2 — along with the anticipated health consequences of global climate change, we can’t simply cross our fingers and hope to get lucky again.

Erica Caple James , associate professor of medical anthropology and urban studies The coronavirus pandemic has revealed some of the limits of the American medical and health care system and demonstrated many of the social determinants of health. Neither the risks of infection nor the probability of suffering severe illness are equal across populations. Each depends on socioeconomic factors such as type of employment, mode of transportation, housing status, environmental vulnerability, and capacity to prevent spatial exposure, as well as “preexisting” health conditions like diabetes, obesity, and chronic respiratory illness.

Such conditions are often determined by race, ethnicity, gender, and “biology,” but also poverty, cultural and linguistic facility, health literacy, and legal status. In terms of mapping the prevalence of infection, it can be difficult to trace contacts among persons who are regular users of medical infrastructure. However, it can be extraordinarily difficult to do so among persons who lack or fear such visibility, especially when a lack of trust can color patient-clinician relationships.

One’s treatment within medical and health care systems may also reflect other health disparities — such as when clinicians discount patient symptom reports because of sociocultural, racial, or gender stereotypes, or when technologies are calibrated to the norm of one segment of the population and fail to account for the severity of disease in others.

The pandemic has also revealed the biopolitics and even the “necropolitics” of care — when policymakers who are aware that disease and death fall disproportionately in marginal populations make public-health decisions that deepen the risks of exposure of these more vulnerable groups. The question becomes, “Whose lives are deemed disposable?” Similarly, which populations — and which regions of the world — are prioritized for treatment and protective technologies like vaccines and to what degree are such decisions politicized or even racialized?

Although no single change will address all of these disparities in health status and access to treatment, municipal, state, and federal policies aimed at improving the American health infrastructure — and especially those that expand the availability and distribution of medical resources to underserved populations — could greatly improve health for all.

Seth Mnookin , professor of science writing

The Covid-19 pandemic adds yet another depressing data point to how the legacy and reality of racism and white supremacy in America is lethal to historically marginalized groups. A number of recent studies have shown that Black, Hispanic, Asian, and Native Americans have a significantly higher risk of infection, hospitalization, and death compared to white Americans.

The reasons are not hard to identify: Minority populations are less likely to have access to healthy food options, clean air and water, high-quality housing, and consistent health care. As a result, they’re more likely to have conditions that have been linked to worse outcomes in Covid patients, including diabetes, hypertension, and obesity.

Marginalized groups are also more likely to be socioeconomically disadvantaged — which means they’re more likely to work in service and manufacturing industries that put them in close contact with others, use public transportation, rely on overcrowded schools and day cares, and live in closer proximity to other households. Even now, more vaccines are going to wealthier people who have the time and technology required to navigate the time-consuming vaccine signup process and fewer to communities with the highest infection rates.

This illustrates why addressing inequalities in Americans’ health requires addressing inequalities that infect every part of society. Moving forward, our health care systems should take a much more active role in advocating for racial and socioeconomic justice — not only because it is the right thing to do, but because it is one of the most effective ways to improve health outcomes for the country as a whole.

On a global level, the pandemic has illustrated that preparedness and economic resources are no match for lies and misinformation. The United States, Brazil, and Mexico have, by almost any metric, handled the pandemic worse than virtually every other country in the world. The main commonality is that all three were led by presidents who actively downplayed the virus and fought against lifesaving public health measures. Without a global commitment to supporting accurate, scientifically based information, there is no amount of planning and preparation that can outflank the spread of lies.

Parag Pathak , Class of 1922 Professor of Economics The pandemic has revealed the strengths and weaknesses of America’s health care systems in an extreme way. The development and approval of three vaccines in roughly one year after the start of the pandemic is a phenomenal achievement. At the same time, there are many innovations for which there have been clear fumbles, including the deployment of rapid tests and contact tracing. The other aspect the pandemic has made apparent is the extreme inequality in America’s health systems. Disadvantaged communities have borne the brunt of Covid-19 both in terms of health outcomes and also economically. I’m hopeful that the pandemic will spur renewed focus on protecting the most vulnerable members of society. A pandemic is a textbook situation in economics of externalities, where an individual’s decision has external effects on others. In such situations, there can be major gains to coordination. In the United States, the initial response was poorly coordinated across states. I think the same criticism applies globally. We have not paid enough attention to population health on a global scale. One lesson I take from the relative success of the response of East Asian countries is that centralized and coordinated health systems are more equipped to manage population health, especially during a pandemic. We’re already seeing the need for international cooperation with vaccine supply and monitoring of new variants. It will be imperative that we continue to invest in developing the global infrastructure to facilitate greater cooperation for the next pandemic.

Prepared by MIT SHASS Communications Editor and designer: Emily Hiestand Consulting editor: Kathryn O'Neill

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Sentimental Analysis Recommendation System on HealthConnect

5 Pages Posted: 21 Aug 2024

Rohit Kohli

Galgotia university, aman aggarawal, dr. monika jain.

Date Written: August 19, 2024

Access to quality healthcare is paramount in today's fast-paced world. However, the existing health care system faces challenges such as delayed doctor appointments, limited real-time consultations, and difficulties in making informed healthcare decisions. These issues can lead to delayed diagnoses and suboptimal healthcare outcome. Our project aims to transform the patient experience by developing a user-friendly web application. This application streamlines doctor appointment scheduling, real-time consultations, and Decision-making based on data,linking the gap between patients and healthcare wage-earners. The technology stack includes web based tools, Node.js, Express.js, MongoDB, WebSocket, NLP tools, and machine learning algorithms for doctor success assessments. We anticipate significant improvements in patient experience, healthcare outcomes, and access to informed healthcare decisions through this project.

Keywords: Healthcare Technology, Patient-Centric CareTelehealth, Machine Learning Healthcare, WebBased Healthcare, Data-Driven Decision-Making

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Guest Essay

Kamala Harris Had a Great Health Care Idea in 2019. She Should Embrace It.

By Jacob S. Hacker

Mr. Hacker is a political science professor at Yale who has researched and written extensively about health care.

From the moment Kamala Harris became the presumptive Democratic nominee, Republicans have sought to paint her as a far-left California liberal. After all, they argue, she supported getting rid of private health insurance in her 2019 presidential campaign.

But Ms. Harris didn’t seek to eliminate private insurance in 2019. The core of her previous campaign’s health plan was an intelligently designed and politically astute public option — a more robust version of the Democratic approach embraced that year by Joe Biden (but one he never pursued after he took office). Essentially, she wanted to encourage Americans to buy into a revamped Medicare program that would give people the choice of public or private coverage.

As the so-called father of the public option , I feel confident in saying that Ms. Harris’s 2019 plan for a public option was — and remains — the strongest ever put forth by a presidential candidate. She shouldn’t run away from it. She should embrace it as a central part of her 2024 campaign both because it is smart policy and because it is smart politics.

Health care is “unbelievably complex,” as President Donald Trump remarked in 2017, as his party’s drive to repeal and replace the Affordable Care Act headed for defeat. Americans hate a lot about the current semi-system — its high prices, its insecure coverage, its rapacious financial practices (and until 2017, they seemed fairly ambivalent about the A.C.A., too).

The G.O.P.’s repeal rout made clear that a majority of Americans don’t want to go back to a time before the Affordable Care Act. It also reinvigorated the Democratic Party. No issue has unified the party or dominated its messaging like health care. It’s where abortion, child and maternal health, the rural health crisis, paid medical and family leave, the health risks of climate change, the continuing threat of Covid and the economic security of working families all come together.

Still, the party does not quite agree on what the big health care policy goal should be. Progressives advocate a universal Medicare program financed by higher taxes, which is to say Medicare for all. Moderates call for upgrading the A.C.A. by adding a public option (which was stripped from the original legislation before its passage in 2010).

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Democratic National Convention (DNC) in Chicago

Samantha Putterman, PolitiFact Samantha Putterman, PolitiFact

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Copy URL https://www.pbs.org/newshour/politics/fact-checking-warnings-from-democrats-about-project-2025-and-donald-trump

Fact-checking warnings from Democrats about Project 2025 and Donald Trump

This fact check originally appeared on PolitiFact .

Project 2025 has a starring role in this week’s Democratic National Convention.

And it was front and center on Night 1.

WATCH: Hauling large copy of Project 2025, Michigan state Sen. McMorrow speaks at 2024 DNC

“This is Project 2025,” Michigan state Sen. Mallory McMorrow, D-Royal Oak, said as she laid a hardbound copy of the 900-page document on the lectern. “Over the next four nights, you are going to hear a lot about what is in this 900-page document. Why? Because this is the Republican blueprint for a second Trump term.”

Vice President Kamala Harris, the Democratic presidential nominee, has warned Americans about “Trump’s Project 2025” agenda — even though former President Donald Trump doesn’t claim the conservative presidential transition document.

“Donald Trump wants to take our country backward,” Harris said July 23 in Milwaukee. “He and his extreme Project 2025 agenda will weaken the middle class. Like, we know we got to take this seriously, and can you believe they put that thing in writing?”

Minnesota Gov. Tim Walz, Harris’ running mate, has joined in on the talking point.

“Don’t believe (Trump) when he’s playing dumb about this Project 2025. He knows exactly what it’ll do,” Walz said Aug. 9 in Glendale, Arizona.

Trump’s campaign has worked to build distance from the project, which the Heritage Foundation, a conservative think tank, led with contributions from dozens of conservative groups.

Much of the plan calls for extensive executive-branch overhauls and draws on both long-standing conservative principles, such as tax cuts, and more recent culture war issues. It lays out recommendations for disbanding the Commerce and Education departments, eliminating certain climate protections and consolidating more power to the president.

Project 2025 offers a sweeping vision for a Republican-led executive branch, and some of its policies mirror Trump’s 2024 agenda, But Harris and her presidential campaign have at times gone too far in describing what the project calls for and how closely the plans overlap with Trump’s campaign.

PolitiFact researched Harris’ warnings about how the plan would affect reproductive rights, federal entitlement programs and education, just as we did for President Joe Biden’s Project 2025 rhetoric. Here’s what the project does and doesn’t call for, and how it squares with Trump’s positions.

Are Trump and Project 2025 connected?

To distance himself from Project 2025 amid the Democratic attacks, Trump wrote on Truth Social that he “knows nothing” about it and has “no idea” who is in charge of it. (CNN identified at least 140 former advisers from the Trump administration who have been involved.)

The Heritage Foundation sought contributions from more than 100 conservative organizations for its policy vision for the next Republican presidency, which was published in 2023.

Project 2025 is now winding down some of its policy operations, and director Paul Dans, a former Trump administration official, is stepping down, The Washington Post reported July 30. Trump campaign managers Susie Wiles and Chris LaCivita denounced the document.

WATCH: A look at the Project 2025 plan to reshape government and Trump’s links to its authors

However, Project 2025 contributors include a number of high-ranking officials from Trump’s first administration, including former White House adviser Peter Navarro and former Housing and Urban Development Secretary Ben Carson.

A recently released recording of Russell Vought, a Project 2025 author and the former director of Trump’s Office of Management and Budget, showed Vought saying Trump’s “very supportive of what we do.” He said Trump was only distancing himself because Democrats were making a bogeyman out of the document.

Project 2025 wouldn’t ban abortion outright, but would curtail access

The Harris campaign shared a graphic on X that claimed “Trump’s Project 2025 plan for workers” would “go after birth control and ban abortion nationwide.”

The plan doesn’t call to ban abortion nationwide, though its recommendations could curtail some contraceptives and limit abortion access.

What’s known about Trump’s abortion agenda neither lines up with Harris’ description nor Project 2025’s wish list.

Project 2025 says the Department of Health and Human Services Department should “return to being known as the Department of Life by explicitly rejecting the notion that abortion is health care.”

It recommends that the Food and Drug Administration reverse its 2000 approval of mifepristone, the first pill taken in a two-drug regimen for a medication abortion. Medication is the most common form of abortion in the U.S. — accounting for around 63 percent in 2023.

If mifepristone were to remain approved, Project 2025 recommends new rules, such as cutting its use from 10 weeks into pregnancy to seven. It would have to be provided to patients in person — part of the group’s efforts to limit access to the drug by mail. In June, the U.S. Supreme Court rejected a legal challenge to mifepristone’s FDA approval over procedural grounds.

WATCH: Trump’s plans for health care and reproductive rights if he returns to White House The manual also calls for the Justice Department to enforce the 1873 Comstock Act on mifepristone, which bans the mailing of “obscene” materials. Abortion access supporters fear that a strict interpretation of the law could go further to ban mailing the materials used in procedural abortions, such as surgical instruments and equipment.

The plan proposes withholding federal money from states that don’t report to the Centers for Disease Control and Prevention how many abortions take place within their borders. The plan also would prohibit abortion providers, such as Planned Parenthood, from receiving Medicaid funds. It also calls for the Department of Health and Human Services to ensure that the training of medical professionals, including doctors and nurses, omits abortion training.

The document says some forms of emergency contraception — particularly Ella, a pill that can be taken within five days of unprotected sex to prevent pregnancy — should be excluded from no-cost coverage. The Affordable Care Act requires most private health insurers to cover recommended preventive services, which involves a range of birth control methods, including emergency contraception.

Trump has recently said states should decide abortion regulations and that he wouldn’t block access to contraceptives. Trump said during his June 27 debate with Biden that he wouldn’t ban mifepristone after the Supreme Court “approved” it. But the court rejected the lawsuit based on standing, not the case’s merits. He has not weighed in on the Comstock Act or said whether he supports it being used to block abortion medication, or other kinds of abortions.

Project 2025 doesn’t call for cutting Social Security, but proposes some changes to Medicare

“When you read (Project 2025),” Harris told a crowd July 23 in Wisconsin, “you will see, Donald Trump intends to cut Social Security and Medicare.”

The Project 2025 document does not call for Social Security cuts. None of its 10 references to Social Security addresses plans for cutting the program.

Harris also misleads about Trump’s Social Security views.

In his earlier campaigns and before he was a politician, Trump said about a half-dozen times that he’s open to major overhauls of Social Security, including cuts and privatization. More recently, in a March 2024 CNBC interview, Trump said of entitlement programs such as Social Security, “There’s a lot you can do in terms of entitlements, in terms of cutting.” However, he quickly walked that statement back, and his CNBC comment stands at odds with essentially everything else Trump has said during the 2024 presidential campaign.

Trump’s campaign website says that not “a single penny” should be cut from Social Security. We rated Harris’ claim that Trump intends to cut Social Security Mostly False.

Project 2025 does propose changes to Medicare, including making Medicare Advantage, the private insurance offering in Medicare, the “default” enrollment option. Unlike Original Medicare, Medicare Advantage plans have provider networks and can also require prior authorization, meaning that the plan can approve or deny certain services. Original Medicare plans don’t have prior authorization requirements.

The manual also calls for repealing health policies enacted under Biden, such as the Inflation Reduction Act. The law enabled Medicare to negotiate with drugmakers for the first time in history, and recently resulted in an agreement with drug companies to lower the prices of 10 expensive prescriptions for Medicare enrollees.

Trump, however, has said repeatedly during the 2024 presidential campaign that he will not cut Medicare.

Project 2025 would eliminate the Education Department, which Trump supports

The Harris campaign said Project 2025 would “eliminate the U.S. Department of Education” — and that’s accurate. Project 2025 says federal education policy “should be limited and, ultimately, the federal Department of Education should be eliminated.” The plan scales back the federal government’s role in education policy and devolves the functions that remain to other agencies.

Aside from eliminating the department, the project also proposes scrapping the Biden administration’s Title IX revision, which prohibits discrimination based on sexual orientation and gender identity. It also would let states opt out of federal education programs and calls for passing a federal parents’ bill of rights similar to ones passed in some Republican-led state legislatures.

Republicans, including Trump, have pledged to close the department, which gained its status in 1979 within Democratic President Jimmy Carter’s presidential Cabinet.

In one of his Agenda 47 policy videos, Trump promised to close the department and “to send all education work and needs back to the states.” Eliminating the department would have to go through Congress.

What Project 2025, Trump would do on overtime pay

In the graphic, the Harris campaign says Project 2025 allows “employers to stop paying workers for overtime work.”

The plan doesn’t call for banning overtime wages. It recommends changes to some Occupational Safety and Health Administration, or OSHA, regulations and to overtime rules. Some changes, if enacted, could result in some people losing overtime protections, experts told us.

The document proposes that the Labor Department maintain an overtime threshold “that does not punish businesses in lower-cost regions (e.g., the southeast United States).” This threshold is the amount of money executive, administrative or professional employees need to make for an employer to exempt them from overtime pay under the Fair Labor Standards Act.

In 2019, the Trump’s administration finalized a rule that expanded overtime pay eligibility to most salaried workers earning less than about $35,568, which it said made about 1.3 million more workers eligible for overtime pay. The Trump-era threshold is high enough to cover most line workers in lower-cost regions, Project 2025 said.

The Biden administration raised that threshold to $43,888 beginning July 1, and that will rise to $58,656 on Jan. 1, 2025. That would grant overtime eligibility to about 4 million workers, the Labor Department said.

It’s unclear how many workers Project 2025’s proposal to return to the Trump-era overtime threshold in some parts of the country would affect, but experts said some would presumably lose the right to overtime wages.

Other overtime proposals in Project 2025’s plan include allowing some workers to choose to accumulate paid time off instead of overtime pay, or to work more hours in one week and fewer in the next, rather than receive overtime.

Trump’s past with overtime pay is complicated. In 2016, the Obama administration said it would raise the overtime to salaried workers earning less than $47,476 a year, about double the exemption level set in 2004 of $23,660 a year.

But when a judge blocked the Obama rule, the Trump administration didn’t challenge the court ruling. Instead it set its own overtime threshold, which raised the amount, but by less than Obama.

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GCSE results day: Grade boundaries and equivalents explained for 2024

Although the numbered grading system has been in place for a few years, many still want to know their letter equivalent, article bookmarked.

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GCSE results day has arrived, as pupils across the UK find out what grades they have achieved in their recent exams.

For many, it’s an emotional time as they secure the grades they have worked hard for, or are disappointed to have just missed out .

Since 2017, the way GCSEs are graded in England has been different . Whereas before they were given letter grades the same as A-Levels, ranging from A* to G, they are now given a number ranging from 9 to 1.

The Conservative government at the time said the change was made to reflect reforms that had been made to GCSEs, giving them new and ‘more demanding’ subject content. They write that the new grades also signal to employers that pupils have taken the new version of the qualifications.

Pupils find out their GCSE results on August 22 (PA)

The numbered grades were rolled out from 2017, with all subjects being brought under the new system by 2020. The changes have meant there are more top grades, with a 9 being equivalent to higher than an A*, which was previously the top possible grade.

These changes only apply in England and Northern Ireland currently, with Wales set to follow course from September 2025. Scottish students take National 4 and 5 exams instead of GCSEs.

Although the change was finalised around four years ago now, many employers who were used to the previous grading system will still ask applicants what the letter grade equivalent to their grade is. Many students will also just be curious about what their grades would be under the previous system.

What are the GCSE grade equivalents?

Grade 9 = above an A*
Grade 8 = between grades A* and A
Grade 7 = grade A
Grade 6 = just above a grade B
Grade 5 = between grades B and C
Grade 4 = grade C
Grade 3 = between grades D and E
Grade 2 = between grades E and F
Grade 1 = between grades F and G

What are the 2024 GCSE grade boundaries?

Grade boundaries, which detail how many marks are required to achieve a certain grade, are released by all the awarding bodies on results day.

You can find the Pearson / Edexcel grade boundaries here
You can find the AQA grade boundaries here
You can find the OCR grade boundaries here

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88 Healthcare Policy Essay Topic Ideas & Examples

🏆 best healthcare policy topic ideas & essay examples.

⭐ Simple & Easy Healthcare Policy Essay Titles

💡 Good Essay Topics on Healthcare Policy

📌 most interesting healthcare policy topics to write about.

Healthcare Policies in Nursing Informatics In this context, nurses aid in the technological transformation of the healthcare delivery system, particularly in the effective and efficient HIT deployment.
Regulatory and Allocative Healthcare Policymaking This essay discusses health policies, the determinants of health, and the connections between the two. The determinants of health are individual and environmental factors that affect people’s physical and mental well-being and the ability to […]
Advanced Practice Nurses: Impact of Healthcare Policy and Advocacy The healthcare policy can also dictate the approach used in compensating the APNs, thus affecting the attractiveness of the job. It influences policy change by making the followers commit to a new strategy that the […]
Health and Social Care Practice and Policy It should begin by evaluating the effectiveness of the current initiatives in attaining various outcomes: William Burns can access health services with the equal quality as the other people and sleeping rough on health to […]
The Health Care Policy Problems and Suggestions The health care policy presented in this paper looks at health care as a public policy that is pertinent to a country’s achievement of its vision.
The Replacement for the ACA Healthcare Insurance Policy For example, the AHCA policy allows a waiver of the ACA’s healthcare provision for societal rating and enables the federal government to charge patients more capital regarding the payment of premiums.
Healthcare Policies and Delivery To gain a better perspective of the healthcare policy and regulations within the organization, an interview with the Chief Nursing Officer was conducted. According to the CNO, the organization is explicitly dependent on the healthcare […]
A Healthcare Public Policy Meeting on Number of Doctors The Committee thought it was crucial to gather all the information regarding the number of physicians needed by hospitals and other healthcare facilities.
Johns Hopkins Healthcare: Policy Evaluation The survey for the patients to determine if the policy was appropriate for their Medicare plans is one of the measures used for evaluation.
Healthcare Policy. S. 3799: Prevent Pandemics Act Among the threats to national security in the sphere of citizens’ health, the risks of complications of the epidemiological situation against the background of the unfavorable situation in foreign countries for a number of dangerous […]
New Health Care Transparency Requirements: Policy Health Brief Access to this data is helpful to policymakers for identifying individuals and entities responsible for increasing the cost of health care.
Standard of Care Delivery and Health Care Policies The providers believe that the services remunerated for are reasonable and correspond to the care offered to the clients. Moreover, they are confident the structures, procedures, and guidelines that are in place guarantee effective and […]
Detailed Description of Healthcare Policy Bill This is due to the fact that from the very beginning of the increasing tendency of the human immunodeficiency virus widespread, people who became infected by this illness are not only physically but also mentally […]
Health Care Policy Development The impact of climate change reduction on the health care delivery system and the existing higher occurrence of asthmatic diseases in the US can be tremendous.
Healthcare Policy Overview and Analysis If the LCR mandated annual water testing in all schools, these schools would have discovered the health risk and taken appropriate measures to counter the effects. The LCR should mandate annual testing, reporting, and mitigation […]
Steer, Not Row Concept of Healthcare Policy This ideology refuses to recognize the role of the clearly societal factors on people’s continual ability to enjoy the ‘fruits of civilization’ while proposing that the task of ensuring the continuation of socio-economic progress is […]
Health Care Policy: HPV Vaccination It is important that these actors among others play a big role in influencing formulation of health policy. In this regard, it is necessary that content is marched up to its objectives of health policy.
Self Evaluation: Healthcare Policy & Planning But upon enrollment and active participation in this course, I have benefited a great deal in not only evaluating the policy implications of healthcare legislation, but also in understanding ways through which I can undertake […]
Evaluation of a Healthcare Policy Analysis This development has caused some legislators to question whether it is right for the federal government to continue funding the organization because it is unlawful for the government to finance abortion services.
Development of Health Care Policies To begin with, the consultation process is carried out to define the benefits and shortcomings of the strategy. Constant monitoring of the results of the already adopted reforms is also necessary to define whether they […]
Health Care Policy: Senate Bill 94 Allowing advanced practice registered nurses to order radiographic imaging tests is identified as the current healthcare policy issue in Georgia. It was intended to remove the barrier provided in the Georgia statutes that restricts APRNs […]
TRICARE Health Care Policy Analysis Tricare has other services like Prime remote and Overseas that cater for service members when they are in areas not accessible to the care.
U.S. Health Care Policy on Counterfeit Drugs These are pharmaceutical products produced and sold with the intention of misrepresenting their active ingredients, efficacy, safety, and authenticity. These include the pharmaceutical products, which are produced and approved in the U.

⭐ Simple & Easy Healthcare Policy Essay

Goals of Healthcare Policy and Prevention of Epidemic A Healthcare policy refers to a statement of a decision about a goal in healthcare. War torn areas such as Afghanistan and Somalia are some of the main targets of the current healthcare policy.
Healthcare: Policy Implementation and Modification Since the enactment of the Medicare Policy Act in 1965, the act has undergone several amendments in a bid to improve the level of accessibility and quality of health insurance coverage to all Americans.
Healthcare Policy and Affordable Care Act: Four Key Issues As reported by the Organization for Economic Co-operation and Development, the United States has the largest nursing workforce in the world, and yet it does not meet its residents’ demands.
Promotoras’ Role in Healthcare and Social Policies Several people discuss promotoras serving as liaisons between communities and agencies, analyzing health and social issues, as well as motivating and informing the residents to participate in resolving said issues.
Healthcare Responses in Health Policy: Reducing Disparities in Access to Health Care The issue of the Action Plan from the Department of Health and Human Services that consisted of the lack of activities’ specifications seems to be reasonable.
Healthcare Reform in Modern Conditions: New Health Policy A healthcare reform in modern conditions is an integral part of the transformation of the social sphere as a whole and the general process of transformation of the American society.
Affordable Care Act: Healthcare Policy Position The history of a single-payer system in the US is long and it dates back to the times of President Franklin Roosevelt in the 1930s when he proposed the adoption of a universal healthcare plan […]
Trump’s Contributions to Healthcare Policy Also, Trump’s contributions to the healthcare system are strictly related to Medicaid services and the costs of insurance plans, but he has not managed to fulfill all of his goals yet.
Clinton’s Plan and Obamacare: Healthcare Policy In September 1993, the president gave a major speech on health care in the US Congress, where he introduced the parts of the healthcare reform, including a mandate for employers, which forced them to cover […]
Healthcare Policy Analysis: Outbreak of Flu in Illinois The seriousness of the problem is obvious, and it is necessary to work on the prevention of such statistics in the future.
Health Care Policy and Regulations in the United States As for the significance of the chosen policy issue, it can be listed among the key problems of the United States as income inequality in the country has significantly increased since the end of the […]
Florida Healthcare System: Policy Planning, Assessment, Evaluation, and Corrective Measures The changes in government revenue pattern and rates are majorly attributed to economic patterns, which affect the stability and financial power of the government and the changes in health care system as well as its […]
Issues of the Health Care Policy in the USA It is also quite important to note that most of the establishments in the Healthcare industry are offices, which have been established for health practitioners such as dentists, physicians and doctors, among others.
Health Care as an Essential Public Policy On the broader spectrum, huge expenditures on health care systems are directly related to the life’s satisfaction derived by individuals and the general public, the generational effects being the baseline of the benefits of the […]
Economic Terms and Healthcare History: Policies to Enhance Access to Healthcare This has led to the evolution of healthcare economics as the costs for accessing medication shift from one sector of the economy to the other. Macroeconomics relates to the expenditure of the government and the […]
Healthcare and Legal Issues: Containment Policies and Its Rates of Efficiency More to the point, the people in the given area will be unable to acquire information concerning the current status of the disease and the existing treatment methods.
The Health Care Policy in the United Kingdom The main principles of the National Health Service are to provide healthcare services to all people, and this means all the medical services that the resident of the United Kingdom might need.
Analyzing the Healthcare Policy – Personal Protective Equipment
Are Remittances Good for Your Health? Remittances and Nepal’s National Healthcare Policy
Linking Congressional Committees and Healthcare Policy
Defining Health and Identifying Influences on Healthcare Policy
Healthcare Advocacy and Its Impact on Healthcare Policy
The Relationships Between Healthcare Policy and Economics
Healthcare Policy Affecting Access, Cost, and Quality
The Relations Between Healthcare Policy and Finance
Healthcare Policy and Complications in the United States
Overview of Healthcare Policy and Improvement of Patient Care
Healthcare Policy and Economics of the Field of Nursing
Analysis of Healthcare Policy and Its Effectiveness
Assessing Quality of the Healthcare Policy
Healthcare Policy and Regulations on Healthcare
Importance of Healthcare Policy and Healthcare Financing
Healthcare Policy Bill and Changes to Medicare
How Healthcare Policy Influences the Working of the Nurses
Healthcare Policy, Finance, and Regulatory Environments
Market Competition: Implications for Healthcare Policy in the United States
Healthcare Policy Issue and Nursing Strategies
Population-Level Intervention and Information Collection in Dynamic Healthcare Policy
Healthcare Policy Report: Medicares New Benefits Catastrophic Health Insurance
Relationship Between Healthcare Policy, Regulations, and Finance
Overview of Service Development and Healthcare Policy
The Complicated Healthcare Policy in the United States
The Current Healthcare Policy: A Stable Healthcare System
The International Healthcare Policy Health and Social Care
Why the American Healthcare Policy Needs a Reform
Development of Healthcare Policy Since 1945 as a Result of Welfare Ideologies
American Healthcare Policies and Nursing Role
Childhood Vaccination as a Healthcare Priority Policy Issue
Nurses and Their Role in New Healthcare Policy
Long-Term Care Facilities and Healthcare Policy
Overview of Healthcare Policy in Mercy Miami Hospital
Healthcare Policy and Pfizer’s Nigeria Scandal
Patient Good Nutrition as a Healthcare Policy
Advocacy in Nursing: The Process of Healthcare Policymaking
Malnutrition and Patient Safety Healthcare Policy
Healthcare Policy Effects on Individuals: Affordable Care Act
Occupational Health Paper Topics
Affordable Care Act Essay Titles
Government Regulation Titles
Health Insurance Research Topics
Pharmacy Research Ideas
Nursing Theory Questions
Obamacare Questions
Alcohol Abuse Paper Topics
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Health Care System Essay
A health care system is a framework of interrelated, interacting, and interdependent descriptions of human development in a given country, region, or community. This system of human development functions as an organized measure to promote and provide treatment in which individuals reach their highest attainable level of physical, mental, and ...
How to build a better health system: 8 expert essays
Health benefits aside, increasing investment in primary prevention presents a strong economic imperative. For example, obesity contributes to the treatment costs of many other diseases: 70% of diabetes costs, 23% for CVD and 9% for cancers. Economic losses further extend to absenteeism and decreased productivity.
Should Healthcare Be Free? Essay on Medical System in America
Conclusion. The Healthcare system is one of the most important components of the U.S. social system since full productivity cannot be achieved without good health. This paper has argued that a free health care system would be the most effective system for America. To reinforce this assertion, the paper has articulated the benefits that the ...
Health Care in the United States, Essay Example
The delivery of healthcare services is considered to be a system; according to the Free Diction- ary (Farlex, 2010), a system is defined as "a group of interacting, interrelated, or interdependent elements forming a complex whole.". This is an apt description of our healthcare structure, as it is compiled of patients, medical and mental ...
Healthcare Essays: Examples, Topics, & Outlines
In 2009, Spain's single-payer health care system was ranked the seventh best in the world by the World Health Organization (Socolovsky, 2009). By comparison, the U.S. health care system ranted at 37 (Satiroglou, 2009). The Spanish system offers coverage as a right of citizenship that is constitutionally guaranteed.
The US Healthcare System Essay
The US Healthcare System Essay Essay. The delivery system of medical care in America today is an extensive institution, with numerous types of institutions such as clinics, hospitals and boarding houses. The US health care system does not provide uniform coverage for citizens at the federal level. In this regard, there are several basic types ...
Challenges and Solutions in The Health Care System
However, the current state of health care systems around the world presents several problems, including limited access, high costs, unequal distribution, poor quality of services, and inefficient systems. The purpose of this essay is to explore the problems in the current health care system, identify the causes of these problems, and propose ...
124 Healthcare Essay Topic Ideas & Examples
To help you get started, here are 124 healthcare essay topic ideas and examples that you can use for inspiration: The impact of healthcare disparities on patient outcomes. Strategies for improving access to healthcare in underserved communities. The role of technology in transforming healthcare delivery.
Healthcare Thesis Statement Examples: Universal Healthcare ...
Get a custom research paper on Healthcare Thesis Statement: Examples of Universal Healthcare Pros and Cons. Universal health care is the provision of healthcare services by a government to all its citizens (insurancespecialists.com). This means each citizen can access medical services of standard quality. In the United States, about 25% of its ...
7 Conclusions and Recommendations
The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost. Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies ...
Essay on Health Care System In The Philippines for Students
In conclusion, the health care system in the Philippines is a mix of public and private providers. It faces some challenges, but efforts are being made to improve it. Everyone in the Philippines deserves access to good health care. 500 Words Essay on Health Care System In The Philippines The Basics of the Health Care System in the Philippines
U.S. Health Care System Essay
U. Health Care System Essay. Macie Smith HCA 255 Professor Kevin Hayes March 20th, 2022. Assuring public health care get entry to insurance has been established to be a challenge in many nations - one which is still a hot topic in monetary, political, or even non-public debates.
Reforming Health Care: The Single System Solution
The flaws of the U.S. health care system have been exposed and exacerbated by the coronavirus pandemic. This paper posits three underlying causes of our persistent poor performance: flawed assumptions; inadequate information; and fragmented delivery, payment, and insurance systems that make it easier to profit by shifting risk or costs to others than by improving value.
U.S. Health Care System Essay
U. Health care System Essay. Quintina D. Palmer Grand Canyon University HCA- Dr. Barri Seif May 2, 2021. 1. While the United States' health-care system is exceptional, it is also complex when compared to other nations. Physicians, insurance providers, big employer companies, and the government are all part of the American health-care system ...
Should Healthcare be Free for Everyone Essay
Should Healthcare be Free for Everyone Essay. Health protection is one of the basic human rights because everyone wants to be healthy. At the same time, assistance in ensuring this health should come from the state as a guarantor of the protection of the person. The right to health is a fundamental aspect of any society; without a health system ...
U.S. Healthcare system Essay
U. Health Care System Essay. Alex Quach Grand Canyon University Course Number: HCA- Professor Bulmini 12/11/ Throughout the United States, the minimal average cost of healthcare varies from state to state, yet the average cost of healthcare in America is twice the cost on average of different countries and their healthcare systems.
Overview of U.s. Healthcare System Landscape
The National Academy of Medicine defines healthcare quality as "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." Many factors contribute to the quality of care in the United States, including access to timely care, affordability of care, and use of evidence ...
Covid-19
A Crisis in Public Health. The United States has 4% of the world's population but, as of July 16, approximately 26% of its Covid-19 cases and 24% of its Covid-19 deaths. 17 These startling ...
5 Critical Priorities for the U.S. Health Care System
They include: focus on prevention, not just treating sickness; tackle racial disparities; expand telehealth and in-home services; build integrated systems; and adopt value-based care. Since early ...
What has the pandemic revealed about the US health care system
Germany, which has all along had a robust public health care system, was accepting sick patients from Italy, Spain, and France. Meanwhile, U.S. hospitals were in financial shock and fee-for-service-based physician practices were devastated. We need to move toward a genuine health care system that can withstand shocks like the Covid-19 pandemic.
612 Healthcare Essay Topic Ideas & Examples
Looking for a good essay, research or speech topic on Healthcare? Check our list of 612 interesting Healthcare title ideas to write about! ... The patient-centered approach means defining patient care as a core aim of the healthcare system. Quality Improvement in Healthcare. The expected execution, appearance, and continuity of an item and the ...
Sentimental Analysis Recommendation System on HealthConnect
Access to quality healthcare is paramount in today's fast-paced world. However, the existing health care system faces challenges such as delayed doctor appointments, limited real-time consultations, and difficulties in making informed healthcare decisions. These issues can lead to delayed diagnoses and suboptimal healthcare outcome.
Opinion
Health care is "unbelievably complex," as President Donald Trump remarked in 2017, as his party's drive to repeal and replace the Affordable Care Act headed for defeat. Americans hate a lot ...
Fact-checking warnings from Democrats about Project 2025 and ...
Project 2025 says the Department of Health and Human Services Department should "return to being known as the Department of Life by explicitly rejecting the notion that abortion is health care."
86 Healthcare Reform Essay Topic Ideas & Examples
The purpose of this paper is to define the ways of the reform's further development as well as to define the role of nursing in such a process. Health Care Reform Recommendations From Experts. First, to improve the quality of healthcare and reduce costs, the government should invest in health information technology.
GCSE Grade boundaries and equivalents explained for 2024 results day
GCSE results day: Grade boundaries and equivalents explained for 2024. Although the numbered grading system has been in place for a few years, many still want to know their letter equivalent
88 Healthcare Policy Essay Topic Ideas & Examples
This essay discusses health policies, the determinants of health, and the connections between the two. The determinants of health are individual and environmental factors that affect people's physical and mental well-being and the ability to […] Advanced Practice Nurses: Impact of Healthcare Policy and Advocacy.