Health Care

Body Overview of the healthcare delivery system Healthcare delivery Is the provision of healthcare, In which deals with the actively of applying or providing something. Although to me healthcare delivery is basically the service or products that has been provided. Healthcare delivery can mean several things; it really depends on the situation and the individual’s involved. It is also a combination of many elements that form the healthcare system today. Whereas it involves the way management interrelate to form an integrated healthcare delivery system (Nonionic, 2011).

The elements that combine the healthcare delivery system today are financing, insurance, delivery and payments. Financing is a subset of the lied of financial management that includes the analysis of the information provided by managerial accounting using techniques, such as ratio and capital analysis. Financing is a way in which healthcare is able to provided services and products to individuals and continuing to update as technology changes , so that they can better serve individuals with the latest treatments, doctors and products available.

Insurance is make up of several aspects like Homos (health maintenance organizations), POS (preferred provider organizations) and many subsystems. For example, managed care which is a system of healthcare delivery that seeks to achieve efficiency by integrating the basic functions of the system; employing mechanisms to control or manage utilizations of medical services and to determine the price at which the services are purchased and how the providers will be paid (Clicking, Baggage, Grubber, Peterson, & Coalman, 2007).

The way that they interrelate to form an integrated healthcare delivery system is by providing a higher quality of healthcare at a reasonable and lower rate to control errors that have been made and for future errors to come. The integrated healthcare delivery system is a system of healthcare providers capable of accepting financial responsibility for and delivering a full range of clinical services to an enrolled population. Also because it’s a system formed of Joint ventures, meaning it has a legal arrangement between two or more entities providing a service, product or both.

Although it has been stated that the most common integration has been between the hospitals and the members of the medical staff. The different methods of managed care reimbursement and compensation, are Homos, POS, or many known as the evidence-based care management used to manage companies partner with providers to determine the best and most efficient way to manage cases based on the current evidence. Another method is the consumer-driven plan in which allows consumers to select the coverage they need or want by paying the corresponding premium.

Medicare and Medicaid are also methods of the manage care reimbursement and compensation, in which they do have standards in regards to the way in which compensation and reimbursements will be paid. For instance, Medicare will only pay reimbursements and compensation to hospitals, physicians and other providers; a percentage based n the services at the time provided and Medicaid states that they will not pay for services that exceed the same charges as Medicare, and only for the services that are allowed to be under the Medicaid plan.

Methods of operational management Two operational management methods that I have chosen to analyze regarding the healthcare finance setting are finance and budgeting, and accreditation. I chose these two methods because I feel as though they have a more intellectual aspect in Finance as stated above is the subset of the field of financial management that includes the analysis of the information provided by managerial accounting using techniques, such as a ratio and capital analysis. And budgeting is the process of converting or tailoring the operating plan into monetary items (Languages, Delineates, & Hilton, 2010).

Finance in regards to the operational management is to make sure that there is enough funds necessary for the company or organization to achieve its purpose. Also to be used when deciding if the organization can make progress toward accomplishing its plan based on the strategic and operating plan that the organization has put in place. Having knowledge as to where the organization stands and will be in the upcoming years helps management to determine the way in which the operating system is to be used.

Therefore it allows management to make measurable decision on the steps that need to be taking during the following years. Budgeting in regards to the operational management system occurs after the operational system steps have been completed. But used as an excellent way to educate financial staff on the overall well-being of the organization. Accreditation as it refers to the operational management system is the Joint Commission, in which is the primary accrediting organization for healthcare organizations.

Though the Joint Commission is responsible for many things, accreditation can be earned by many types of healthcare organizations. These may include hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities and providers of home care services. The Joint Commission has been known as an independent, not-for-profit organization; but it has accredited and certified over twenty-thousand healthcare organizations and programs in the United States.

Known nationwide as a symbol of quality that has reflected their commitment and meeting certain performance standards (The Joint commission, 2014). When talking about the Joint Commission, its mission has been to continuously improve healthcare for the public, in collaboration with stakeholders, evaluating healthcare organizations and inspiring them to excel in the providing of safe and effective care in the highest quality and value. And their vision has always been making sure that the people they serve always get the safest, highest quality and the best care that can be given across all settings.

With this in mind I can say that the accreditation method plays a huge role in the operational management of the financial setting, because without this in place many organizations cannot have an efficient and accurate follow of healthcare. Importance of medical management Medical management within healthcare finance regarding utilization are as follows regarding all aspects that it deals with , which are economics, accounting, and utilization itself.

Economics part of financial management is the downturn or the increases, and boards that are challenging to respond through indiscriminate cuts, y basically driving up the quality and reducing harm and improving efficiency. Accounting and the way that healthcare financial management utilizes the accounting and managerial accounting. The financial part basically deals with Just providing account information and the historical nature to external users, in which will includes the owners, lenders, suppliers, government and the insures.

These are people or individuals that consolidate the financial statements for hospital to show how the organization is either growing or decreasing over time. The managerial accounting part deals with the internal part of accounting including the users and angers, people that prepare information, with supporting information regarding the functions and the changes of the organization. It also means to provide accounting and finance information that assist healthcare managers to accomplish the organization’s purposes.

Many of the healthcare financial management deal with professional and personal behavior when it comes to decision making on the healthcare industry. It also utilizes foundational knowledge, such as economics by improving the quality of healthcare services that are provided. The financial management utilizes all the foundational knowledge surrounding healthcare and the ay in which it uses the information that is given; as well as the changes that technology in making on a regular bases.

The healthcare field cannot be understood through Just the financial management because there are many other part, such as the individuals that help makeup the financial aspect of healthcare. Conclusion In conclusion I have learned that the healthcare delivery system is made up of several different part or aspects that help with the follow of the industry. The healthcare delivery system has several aspects that are broken-down into major essential aspects to give a better understanding of healthcare as a whole.

Europe Medical Device Market Outlook to 2018 – Driven by the Presence of Advanced Healthcare Industry and Ageing Population presents a comprehensive analysis of the industry aspects including market size by production value of medical devices market in Europe. The report also entails market share analysis and company profiles of major players operating in the medical devices market in Europe.

The medical device market of Europe is mainly comprised of medical equipments such as consumables, orthopedic devices, dental devices, respiratory devices, and ophthalmic devices which are manufactured in Germany, France, the I-J, Italy and Spain. The future analysis, trends and developments, government regulations and segmentation by application have also been discussed in the industry research report. The demand for medical devices has been growing owing to a mounting awareness for early diagnosis and treatment of countless disease states in European countries.

Other factors propelling the escalating demand for medical devices are the ageing populace, growth in the number of better informed patients and the accessibility of enhanced technologies. In the recent years, medical devices industry in Europe has witnessed a continuous growth. The key countries that have contributed significantly to the Europe medical devices market during 2008-2013 include Germany, I-J and France. Germany is one of the major European markets and it has been observed that the country contributes immensely to the exports of medical devices.

An increased investment in R&D on healthcare has played a fundamental role in the economic growth of Germany as it has resulted in improved health outcomes and extended years of life. The increasing exports of medical devices, augmenting purchasing power for medical care and increasing demand for innovative medical devices were the key factors purporting the growth of medical devices in Europe. The overall production value witnessed by the market grew from EURO -? million in 2008 to EURO -? million in 2013, growing at a CARR of 2. % dung 2008-2013. Over the past several years, medical device market has constantly been a field of significant innovation, and this endeavor has played a central role in the early detection, diagnosis and treatment of disease. The rising incidences of chronic diseases in Europe such as diabetes, hypertension, osteoporosis and other age related diseases will necessitate enhanced products and long-term, post-sales service. Market participants will be required to develop solutions best matched to customer needs to continue to be competitive.

Owing to the prevalence of high competition and mounting costs of medical devices products Healthcare Industry: Europe Medical Device Market Outlook to 2018 By Snatcher long-term partnerships with companies. The overall medical devices market in Europe is projected to reach EURO -? million in 2018, augmenting at a CARR of 3. 9% dung 2013-2018. Key Topics Covered in the Report Europe medical devices market size. The country wise segmentation of medical device industry of Europe. The market size, future outlook and projections of the medical device industry of Germany, France, the I-J, Italy and Spain. ; Market segmentation by the type of equipments of Germany, France, the ASK, Italy and Spain ; The market size and segmentation of the medical device industry of Germany for general medical instruments and appliances, medical and electrostatics’s devices, medical consumables, dental devices, ophthalmic devices, respiratory devices and other medical devices used in the field of cardiology and neurology.

Future Outlook and Projections of Germany Medical Device Market by Equipments ; The market size and segmentation f the medical devices market of France for medical and electrostatics’s devices, consumables, dental devices, orthopedic devices, respiratory and ophthalmic devices market. ; Future Outlook and Projections of France Medical Device Market by Equipments ; The market size and segmentation of the medical device industry of the I-J for consumables, medical and electro diagnostics instrument, orthopedic devices, dental devices, respiratory, ophthalmic instruments and patient aids market.

Medical information engineering is frequently thought of in the modern context of computing machines, but the careful aggregation and analysis of information related to observation of patient status, effectivity of different interventions, and design of new interventions dates back to the clip of Hippocrates. Hippocrates took punctilious notes that enabled him to do legion discoveries both in the apprehension of the workings of the human organic structure and in the moralss and attack to thought that are indispensable to modern medical pattern and probe. Relatively small invention took topographic point in furthering, the pattern of medical specialty from the clip of Hippocrates until the early twentieth century, with developments such as the variola vaccinum in 1901.

During the twentieth century, the growing of medical engineering has increased continuously, with inventions such as penicillin, X-ray, PET/MRI scanning, computing machines, robotic surgery, radiation therapy, chemo-therapy, and many other signifiers of engineering and interventions. While the usage of medical hardware and information engineering has been indispensable to healthcare for 1000s of old ages, these same tools can make hard jobs. For illustration, the over-use of antibiotics has caused a new signifier of pathogen normally called super-bugs, such as methicillin-resistant staphylococci aureus (MRSA) and other antibiotic opposition strains that are highly hard and expensive to handle.

Healthcare installations (edifices) can besides be considered to be a signifier of engineering. As with other signifiers of engineering, physical installations involve a common interaction between users of the engineering and the engineering. In healthcare contexts, the physical installations are frequently closely interrelated with the staff and other engineering that the edifice contains. Often, engineering is integrated into the edifice itself. As with other signifiers of engineering in health care, organisations spend important amounts of money on their installations. If these financess are non spent sagely, they contribute to the lifting cost of health care and can impact the fiscal or operational viability of the organisation.

Among the innovators of Healthcare Technology, the National Aeronautics and Space Administration (NASA) has been one of the most supportive. Concerned with the health of the spacemans during infinite missions, NASA scientists developed technological devices for the measuring and transmittal of physiological and medical informations between infinite and Earth Stationss in the sixtiess. This attempt was subsequently applied in the 1970s to back up medical services to the rural Papago Native American Reservation in Arizona utilizing a manned nomadic medical unit linked to local infirmaries. The first full service Healthcare Technology operation appeared in 1968 between Logan Airport Health station and the Massachusetts General Hospital (MGH) of Harvard Medical School. The service included 10 remote sites linked through the New Hampshire-Vermont Medical Interactive Television Network with a cardinal hub stationed at Dartmouth. The service supported medical instruction and forte medical services including psychopathology, malignant neoplastic disease, and dermatology.

Another important Healthcare Technology event occurred in the 1990s when NASA launched the first big graduated table international Healthcare Technology undertaking, Spacebridge. Spacebridge presently supplies a assortment of medical specializer audiences and medical educational chances to the Eastern European part. Modern Healthcare Technology in the last century evolved from basic telephone audiences as experimental undertakings. Propelled by emerging engineerings and the information expressway, Healthcare Technology has resurfaced with new content and significance. Healthcare Technology experiments that are presently used in pilot signifier will turn out to be everyday in the hereafter.

Impact of Technology on Healthcare

The intent of this subdivision is to reexamine the literature on the impacts of engineering in health care. Evidence on the impact of engineering in health care is assorted. Literature on engineering impacts in health care have looked at both concluding result steps, such as productiveness or end product or mortality, every bit good as intermediate public presentation steps such as mistake rates, rhythm times, use, and complications. A revenant subject among surveies on engineering and health care is the function of clip slowdowns ; the empirical grounds by and large supports the impression that engineering investings require a significant clip period for users to learn how to utilize the engineering.

Surveies pulling from engineering literature base, consistent with the literature on engineering investing, appeared more likely to include complementary investing factors such as concern procedure reengineering (BPR) and preparation. These surveies find positive impacts to engineering and frequently included. Surveies based in the medical literature painted a more assorted position of results engineering investing. These surveies by and large did non include complementary investings and by and large took a ” tool position ” of engineering investings. The surveies based in the medical literature used a more nuanced pick of results; consistent with the thought that health care is a alone context, including outcome steps such as mistake rate, differential mortality, use rates, and complication rates.

What is losing from this literature is a survey that takes into history the alone nature of engineering investing, every bit good as the alone context of health care. Theory and grounds about the impacts of engineering investing suggest that engineering:

• is a all-purpose engineering which frequently requires complementary investings to give positive returns,
• lowers search costs, which lower the discrepancy of results,
• installations the accretion of ” memory capital ” over clip,
• lowers monitoring costs,
• speeds information diffusion, and
• exhibits web effects.

While many of the possible impact of engineering would look to ensue in positive returns in health care, findings on the impact of engineering in health care to day of the month are mixed. Most surveies on the impacts of engineering in health care have either:

1. used a rich apprehension of engineering investings focused upon the impact of engineering on traditional result steps such as profitableness or response clip, or
2. used a simplified position of engineering investing with a rich understand of the peculiar phenomena which arise out of the alone context of health care.

What is needed in this literature is a survey which takes into history the peculiar impacts of engineering investings on phenomena which are alone to healthcare, such as intervention incompatibility.

Research Conceptual Framework and Theoretical Background

Present research examines the factors that influence patient Healthcare Technology acceptance pulling support from the following theory.

Theory of Reasoned Action

The Theory of Reasoned Action asserts that beliefs influence attitudes. Attitudes, in bend, act upon the purposes that guide behavior, and credence of engineering is so demonstrated through behavior. TRA is well-tested and has been proven valid in foretelling and explicating behaviors in general human behavior. The construct of Theory of Reasoned Action was founded on Fishbein and Ajzen ‘s societal psychological science research. TRA suggested that important dealingss exist between beliefs, attitudes, purposes, and behaviors. Harmonizing to TRA, most societal behaviors are non automatic actions ; alternatively, they are under volitional controls. TRA asserts that people consider the deductions of their action based on the information available to them before they decide to execute behavior.

Since behavior is a consequence of cognitive logical thinking, behavior is predictable. Theory of Reasoned Action is built on three concepts: attitude (AT), subjective norm (SN), and behavioral purpose (BI). TRA has been examined and tested through legion research surveies. In TRA, attitude reflects personal behavioral beliefs and subjective norm refers to societal influences. TRA suggests that behavior purpose is a map of two determiners, a individual ‘s attitude and the subjective norm. A individual ‘s behavioral purpose, in bend, is the immediate determiner of the existent action. Based on the pictural presentation of TRA by Ajzen and Fishbein, TRA may be expressed as:

• BI = AT + SN and existent behavior = BI.

A individual holds different beliefs from past experience about objects, actions, and events. Beliefs service as the immediate deciding factors of a individual ‘s attitude. Positive belief means stronger strong belief and credence toward the behavior in inquiry. With positive beliefs, a individual tends to garner positive attitudinal purpose to behaviour, which in bend leads to more possible realisation of the behavior. Attitude is a individual’s rating of the entity in inquiry. Attitude arises as a map of beliefs. Beliefs may alter due to clip and fortunes or be replaced by new beliefs ; these alterations in bend affect a individual ‘s attitude. Social scientists have long established that attitude is a critical behavioral temperament.

However, a individual ‘s favorable or unfavorable perceptual experience to behaviour in consideration entirely does non ever produce the behavioral result. To accurately predict attitude, an extra variable must be taken into history of the attitude-behaviour relationship. This extra variable in TRA is the subjective norm. Subjective norm refers to a individual ‘s sensed outlooks from relevant persons or groups on whether or non to execute the behavior in inquiry. Subjective norm is a map of normative beliefs, the ensuing influence of the societal environment. Social force per unit area can coerce an person to execute or avoid behavior in consideration regardless of the individual ‘s bing purpose. Since it has the potency of overruling a individual ‘s ain purpose, subjective norm is an independent concept to attitude in the TRA theoretical account.

Concept of Pervasive Healthcare Technology

Many Pervasive Healthcare Technology devices have undergone experimental tests in infirmaries every bit good as in patients ‘ places. Infrared engineering, gesture detectors, picture cameras, and so on, that usage radio, Internet, ISDN, and telephone lines have been installed in health care installations. Traditional non-invasive Pervasive Healthcare Technology frequently requires patient battle with devices at a set clip and location. For at hazard instances, such as post-stroke and postoperative wound-related complications where a close un-obstructive proctor is important in the recovery procedure, periodic monitoring may non catch episodic marks at the critical clip. Recent development of permeant monitoring systems focuses on automated and un-obstructive Pervasive Healthcare Technology without the limitations of clip and topographic point.

Pervasive health care requires wireless engineerings and the duplicate substructure capablenesss. Permeant services are supported through radio LANs, cellular GSM/3G webs, satellite-based systems, and so forth. Pervasive health care applications include ” permeant wellness monitoring, intelligent exigency direction system, permeant health care informations entree, and omnipresent Mobile Healthcare Technology”. Research on permeant Healthcare Technology started in the early 2000s utilizing the so budding permeant calculating engineerings. The end was to use omnipresent communicating engineerings to better patient liberty and health care mobility through uninterrupted monitoring. In instances such as myocardial ischaemia and station abdominal operations, uninterrupted physiological informations for timely sensing of impairment can alter the full attention result.

Extended from Varshney ‘s definition for permeant health care , present research defines permeant Healthcare Technology as a Pervasive Healthcare Technology for anyone, anytime, and anyplace without location, clip, and other restraints. Earlier permeant Healthcare Technology experimented with video-telephony installings. These devices provide unrecorded picture synergistic communicating through field old POTS for its broad handiness and comparatively low costs. Using video-telephony, the healthcare professional can reexamine the therapies and supply support in real-time. More significantly, these devices alleviate the spread of distance, leting attention suppliers to supervise the patient ‘s emotional and mental provinces and non merely physiological information.

Other types of permeant Healthcare Technology are enabled by portable topical detectors that integrate wireless engineering with clinical devices. Tele-devices such as tele-ECG and ring-sensors are worn by the patients for Pervasive Healthcare Technology. Data, such as ECG, pulsation rate, respiration rate, and O impregnation degrees, is collected and forwarded to the health care suppliers automatically. This continuously monitored informations can supply of import clinical penetration for timely and accurate diagnosing. Advanced permeant devices for automatically roll uping multiple clinical parametric quantities have shown success in a organic structure detector web system.

This Pervasive Healthcare Technology system equipped with multiple detectors is able to roll up, procedure, and wirelessly convey the received informations via a secured nexus to a laptop for farther diagnosing. Pervasive Healthcare Technology devices that do non necessitate patients to have on the tele-devices besides have been developed in the past old ages. For illustration, mattresses, lavatories, kitchen contraptions, and vesture embedded with proctors can feel sleep form, organic structure weight, organic structure temperature, pulse rate, and so forth.

Further experiments on advanced tele-sensing systems utilize the Doppler radio detection and ranging technique to garner scattered critical marks from throughout the organic structure.

These systems can garner multiple clinical parametric quantities and are able to run autonomously without upseting the lives of the patients. Pervasive Healthcare Technology is built on widely deployed radio webs and advanced calculating engineerings. Pervasive Healthcare Technology solutions have focused chiefly on at hazard disease direction. However, a turning market in a broad scope of the healthcare field is ready to impel the development and ingestion of permeant Healthcare Technology.

The recent news of a vaccine that could prevent a large percent of cancer deaths in the United States alone would generally be considered a reason to celebrate. However, the current attempts of many states, including the governor of Texas, Rick Perry, to pass an ordinance making it mandatory for preteen girls to have the Gardasil vaccine to protect them from some of the forms of cervical cancer caused by HPV has met a great deal of opposition.

The objections to this legislation getting passed are primarily voiced by concerned parents who believe that the vaccination is too new to the market and that the long term effects are still too unknown.. This essay will discuss what genital HPV is and how it causes cancer in women, will describe the Gardasil shot and the attempts to make it a mandatory vaccine inoculation for schools in the United States and will detail both sides of the controversy surrounding it.

Though the benefits of this vaccine could greatly outweigh the risks, the governor attempting to force a mandate requiring the vaccine to be given to all sixth grade girls could be considered an imposition on parents’ right to choose what is best for their children. Genital HPV is a sexually transmitted disease that is caused by the human papillomavirus (“Genital HPV Infection“), a group of viruses that contains more than 100 strains, 30 of which are sexually transmitted.

This disease is spread by genital contact, and the carrier generally has no signs or symptoms of the infection. The only way to fully protect oneself from contracting HPV is to have no genital contact with another person. That is why it is no surprise that more than 20 million people currently have this infection and that 50 percent of sexually active persons will contract it at some point in their life. There is no cure for HPV, but it is possible for the infection to go away on its own.

Though it is usually an asymptomatic infection, it occasionally causes genital warts and mild discomfort, but the greatest danger of this infection is in the ten identified strains that have been linked to cervical cancer in women. Most of the deaths caused by cervical cancer are in women who did not undergo routine pap smears to check for abnormalities. Since persons infected with HPV rarely show any signs or symptoms of an infection, it is often detected too late if at all.

It is estimated by the American Cancer Society that in 2007, approximately 11,150 cases of invasive cervical cancer will be diagnosed in the United States, and, though the death rate is declining every year because of an increase in pap smear testing, cervical cancer will still kill about 3,670 women this year (“What is cervical cancer? ”). Development of a vaccine to protect against HPV began in 1993, and the trials for the Gardasil vaccine itself began in 1997.

After only nine years of testing, Merck submitted an application to the FDA for fast-track approval (CQ Researcher 419). It took only four clinical trials before the FDA approved Gardasil (Mendenhall), and the drug was approved by the FDA for only eight months before it was first mandated. Gardasil is used to prevent HPV and the cervical cancers that are caused by certain strains of the virus, such as types 16 and 18 which are responsible for about 70 percent of all cervical cancers diagnosed in the United States (McClain).

It also protects against two of the strains that are known to cause genital warts. Gardasil was licensed in June 2006, and within a month states such as Michigan were already proposing to mandate the vaccine for girls as young as eleven. In February 2007, Texas governor Rick Perry ordered the vaccine for sixth-grade girls (“Texas Plans for Mandatory HPV Vaccine Fuel Controversy” ), only to have more than two-thirds of the Texas House of Representatives vote to rescind the executive order (Lang).

In response to the twenty two states that were proposing to mandate this vaccine, Representative Paul Gingrey from Georgia reintroduced the Parental Right to Decide Protection Act (CQ Researcher 419). There are many reasons that this vaccine could be beneficial, not only to our society, but to many of the underdeveloped nations of the world in which HPV and cervical cancer are still considered to be an epidemic (MacDonald). It could save the young women who get the vaccine from the future trouble of ealing with a highly invasive cancer, as well as protect them from the embarrassment that comes with contracting a venereal disease. However, the controversy of this topic is not in whether the vaccine is a benefit to women’s health, which many, including the FDA and the Centers for Disease Control, believe that it is; but in the debate over whether it is the parents’ right, not the states’, to choose what is best for their child. The question of mandatory vaccination raises medical, moral and legal issues that are not easily reconcilable (Lovinger).

Many parents are opposed to the mandating of this vaccine for three reasons. First, HPV is not spread by casual contact, as are the other diseases that children are vaccinated against for the safety of the classrooms. Second, the vaccine has only been approved for a short while, thus not all of the side effects and long term effects are known. Last, parents are afraid that by getting their child vaccinated against a sexually transmitted disease they will be encouraging promiscuity.

Gardasil would become the first vaccine mandated for school-aged children that targets a microbe spread primarily through sex. (Wallis) Many have questioned whether an STD vaccine should be required for school attendance, since genital HPV is sexually transmitted as opposed to being spread by casual contact. Whooping cough, polio, Hepatitis and measles are just a few of the vaccines that children must already have in order to attend many public schools, and all of these infections are easily spread either by being in contact or close proximity of someone who is infected (CQ Researcher 415).

These infections are all rapidly spread and have the possibility of becoming an epidemic at a school, which is the reason that it is necessary for children to have them. You cannot get genital HPV by shaking hands or sitting next to another child in class, so there is insufficient reason for the vaccine to be mandatory for school attendance (CQ Researcher 416). If parents’ would like to willingly give their daughter the shot, then it is a family choice. Also, there is still much uncertainty about the inoculation’s long-term safety and the possibility of dangerous side effects.

While the most common complaint by girls that have received the shot is pain at the site of injection, a national watchdog group using the Freedom of Information Act has uncovered more than 1,600 reports to the FDA of “adverse events” linked to Gardasil, with 371 of those events being ranked as “serious”. These “effects” included three deaths from blood clots and heart problems, which Merck was quick to explain away by blaming birth control pills and pre-existing conditions. Other reactions included paralysis, seizures and fainting (McClain). There has also been some debate on the means in which the trials to test the drug were conducted.

The clinical studies done only included 1,200 girls under the age of 16. Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center is concerned about these studies as well and she stated, “That is just not enough information. What is the scientific evidence that it is safe and effective to use in the age group for which it is recommended? If you look at it on balance, it has not been proven. ” Diane Harper, director of the Gynecological Cancer Prevention Researcher Group at Dartmouth Medical School called the inoculations “a great big public health experiment. Many parents are upset at the thought of their children becoming the “guinea pigs” for this vaccine and are concerned about the many stories that they have heard or read in the news about the possible long-term effects and the side effects that may not be mentioned on the pamphlets at the doctor’s offices (Gulli, George and Intini). Finally, many parents are concerned that they will be sending the wrong message to their children by giving them a shot to protect against an STD.

Some people have raised the issue that we could be sending teenagers the message that we expect them to be sexually active. A study done by the University of North Carolina showed that one in ten parents was concerned that the vaccination would encourage their children to have more sex (“Will Teenage Girls Have More Sex? ”). Though the abstinence based teaching of sexual education in our country falls many times on the deaf ears of the hormone-run youth of society, forcing every student, even those who may not be at risk, to have the Gardasil shot is somewhat extreme.

Overall, this is a decision that needs to be made in the home, not in the courtroom. In conclusion, the controversy surrounding this topic is more a battle of family right to choose verses the state government’s level of involvement in the health of our children. Once the vaccine’s long term effects have been more studied and the vaccine has earned a more respected reputation, I believe that people will grow to accept that it is simply another way to protect those that we love from a devastating disease.

However, it should be the decision of the parents in cooperation with their child’s physician of when and how to protect our children from such obstacles in life. Though the Gardasil vaccine is a victory in protecting the lives and bodies of women all around the world, forcing nine year old girls to have the Gardasil shot as an obligation to school attendance is overstepping the boundaries between a family’s choice and the will of an unacceptably paternalistic government.

Introduction

In the traditional market, consumers decide how much to consume and suppliers decide how much to supply and prices coordinate the decisions. For perfect competition it is assumed inter alia that there is: perfect information so that individuals are fully informed about prices, qualities etc; a lot of buyers and sellers; no single buyer or seller that has influence on the price.

But health care market falls short of the perfect market paradigm as it is dogged by many phenomena that cause it to fail. One such phenomenon is supplier-induced demand (SID), whereby health care providers, usually physicians, exploit their information advantage over patients in order to induce patients to utilize more healthcare services than they would if they were accurately informed. The phenomenon of SID tends to take an important place within social debates because it has an impact on health care expenditures, health status and the allocation of income between patients and physicians.

Therefore, it has attracted considerable attention in the health economics literature since Roemer (1961), who observed a positive correlation between the number of hospital beds available and their use leading to the observation, ‘a bed built is a bed filled’, sometimes referred to as Roemer’s Law. Although a variety of empirical tests of SID have been reported in literature, researchers disagree on the definition of and tests for SID. The validity of the results from the tests is controversial.

Therefore there is no consensus on the development and implementation of public policy based on these results . Indeed, Doessel observed that this area of research can be described as a theoretical and empirical quagmire. After defining the terms, this essay is going to explore and explain the theoretical rationale, the empirical evidence and policy implications for the existence of SID. The argument will be summed up in the conclusion. Health Care Market and SID

A market is a shorthand expression for the process by which households’ decisions about consumption of alternative goods, firms’ decisions about what and how to produce, and workers’ decisions about how much and for whom to work are all reconciled by adjustment of prices. Health care comprises services of health care professionals, which are addressed at health promotion, prevention of illnesses and injury, monitoring of health, maintenance of health, and treatment of disease, disorders, and injuries in order to obtain cure or, failing that, optimum comfort and function (quality of life) (Worldbank website).

In health care market there is: a few buyers and sellers; asymmetry of information therefore violation of consumer sovereignty; allocation of resources by physicians and not price mechanism etc. Therefore patients face a dilemma in translating their desire for good health into a demand for medical care. This requires both information and medical knowledge, which they usually do not have. There is no definitive and widely accepted definition of SID. In literature, the definitions range from positive and value free  to normative with negative connotations (Folland et al 2001, p. 04). McGuire (2000, p504) says that SID ‘exists when the physician influences a patient’s demand for care against the physician’s interpretation of the best interest of the patient’. Labelle et al point out the need to incorporate in the definition of SID both the effectiveness of the agency relationship and the effectiveness of the induced services. This means that inducement can give rise to ‘good’ or ‘bad’ outcomes for patients depending on its clinical effectiveness, e. g. f a doctor persuades a patient to undertake more treatment where the patient would otherwise have opted for a less than clinically effective package of care. Rationale for the existence of SID: The theoretical analysis of SID is based upon the assumption that doctors maximise their utility subject to income and inducement. Dranove (1988, p 281) argues that under certain conditions the physician will have an incentive to recommend treatments whose costs outweigh their medical benefits. SID involves a shift of the demand curve, such that as supply ncreases, demand also increases (Fig. 1). In practice the exact demand curves themselves cannot be measured. Only the equilibrium points (A, B, C and D) of the overall market can be observed. If the supply of doctors increases from Q1 to Q2 (Fig. 1a), then the fee payable decreases from P1 to P2. But if SID exists (Fig. 1b), as the number of doctors increases from Q1 to Q2 the doctor would keep shifting the demand curve from D through to D3 in order to maintain or increase income. Fig. 1: Graphical representation of competing hypotheses

The potential for SID to arise is shaped but not guaranteed by a number of characteristics of the health care market including: information gaps and asymmetries which encourage patients to seek medical advice and delegate decision-making to doctors; potential weaknesses in the agency relationship and the impact of clinical uncertainty on the decision making processes of doctors. Systems for financing, organising and paying for medical services also influence doctor and patient behaviour.

The asymmetry of information between user and provider is the most fundamental peculiarity of health care, and the source of the most serious failures of market processes during resource allocation. Informational asymmetries may also invalidate the assumption of “consumer sovereignty” which underlies evaluative policy assessment in much of economics. Patients will often be relatively poorly informed compared with their doctor about their condition, treatment options, expected outcomes and likely costs. Unlike other professional services, information asymmetry is most pronounced in health care markets.

Many researchers have tested the hypothesis that more knowledgeable patients should be resistant to SID and that they should therefore make less use of medical care. Surprisingly these studies have consistently found that knowledgeable patients frequently use more care [Bunker and Brown (1974); Hay and Leahy (1982) and Kenkel (1990)]. The institutional responses to information asymmetry are professionalisation, self-regulation, and the development of an agency relation between individual transactors and between the professions and society collectively.

Agency relationship is formed whenever a principal (patient) delegates decision-making authority to another party, the agent (doctor). Ill-informed consumers are protected, by provider advice, from consumption of unnecessary or harmful services (inappropriate or poor quality) and also from failure to consume needed services. If this agency relationship were perfect, doctor would take on entirely the patient’s point of view and act as if he/she were the patient. All consumption choices made for the patient by the provider would be made so as to maximize the patient’s (and ultimately society’s) utility function.

Health care providers do not always act as perfect agents for their patients. Their recommendations are sometimes influenced by self-interest, or the interest of the organization for which they work. This imperfect agency arises because the doctor (agent) performs a dual role — the same person who provides advice about a treatment usually provides and receives payment for that treatment. Hence, demand is no longer independent of supply; the agent can shift the demand curve to any position (Fig. 1b).

The demand curve (Figure 1a), assumes that independent consumers of care are not directly influenced by suppliers in their decisions to use care, or alternatively that if such direct influence exists, its level is determined external to the market process itself. On the other hand, it has been shown that in spite of the presumed physician influence over the patient, the physician cannot predict the level of patient compliance . Therefore it is doubtful how much influence the physician wields over the patient when it comes to SID.

Traditionally doctors’ behaviour is controlled by a professional code- “Hippocratic oath”. Financial self-interest on the part of the physicians is only one of the causes of imperfect agency. Another very important cause is the failure of physicians to understand or accept patients’ preferences regarding the impact of health status on utility and provide this information to the patient  The target income theory posits that as the number of physicians has increased, they have induced additional demand to get a particular income, e. g. y increasing the volume and variety of tests and procedures. This is in contrast with conventional economics where increasing supply lowers the price for the consumer. The target income is determined by the local income distribution (Rizzo and Blumenthal, 1996). A professional service like Health care is inherently heterogeneous and nonretradable. A monopolistic competitor selling a nonretradable service sets a quantity to maximize profit and unless there is some cost to inducement, a physician or dental practitioner pursuing net income would induce demand to an infinite extent (Gaynor 1994).

However, physicians prefer not to induce demand and only do so if they are compensated by adequate gains in income. The utility maximisation of physicians is limited by disutility of discretion, i. e. either the physician’s internal conscience  or as a result of a reputation process by which doctors who excessively induce demand are punished through future reductions in true patient demand (Dranove 1988). SID can arise when clinical uncertainty causes provision of ‘unnecessary’ or ‘wasteful’ medical services even if doctors act in the perceived interests of their patients.

If a doctor inadvertently underestimates a patient’s ability to pay for the cost of medical procedures, the level of care recommended might exceed that which the patient would have nominated. However, some analysts maintain that doctors’ responses to clinical uncertainty can give rise to SID fully consistent with the patient’s interests rather than self-interest  e. g. use of diagnostics in excess of ‘standard’ levels in the event of diagnostic uncertainty. Institutional and regulatory arrangements influence how medical markets work.

They create incentives or disincentives for doctors (and patients) to behave in ways that could engender SID. For example, the cost-bearing and financing aspects of the doctor’s service are largely borne by third parties (i. e. governments and private insurers). As a consequence, typically neither the consumer nor the provider carefully considers the price or cost of the service supplied. This can influence the extent and form of SID. Other arrangements that can promote SID include: the system of payment for doctors (i. e. ee-for-service, capitation or salaried); the effect of medical indemnity arrangements on the adoption of ‘defensive medical practices’ by doctors; and the form of monitoring of doctor treatment practices. The link between physicians and pharmaceutical companies can also promote SID. Big pharmaceutical companies approach physicians and “ask” them to prescribe specific drugs to patients in exchange for a reward, such as free holidays. For example, in 2002 drug firms spent nearly $9. 4 billion on marketing to American doctors (The Economist 15th Feb. 2003). As a result, physicians are illing to prescribe extra medicines that are unnecessary and provide no benefit to the patient. Moreover, these drugs favoured by the physicians and produced by big companies might be more expensive than others with equivalent effectiveness However, one major criticism of the SID model is that it focuses on only one price– the nominal fee level–while ignoring access costs. If increased supply reduces travel time and office waits, the total cost of care has fallen even if fees remain constant. Secondly, the SID theory carries an implicit assumption that the extra services are unnecessary.

An alternative view is that few situations in medicine are clear-cut and a broad range of indications is consistent with generally acceptable practice. Empirical evidence of SID Several indirect hypotheses and empirical tests have been carried out but due to the lack of a rigorous theoretical model and the presence of econometric and measurement problems, results concerning the existence of SID still remain controversial and inconclusive. SID is not easy to measure and interpret because of the difficulty of separating out induced from un-induced demand, supply changes from demand changes and SID from other factors influencing demand (e. . income, insurance coverage, health status). However, there is clear evidence that physicians who are paid on fee-for-service basis can adjust the number of services in response to limitations on the levels of fees (Rice, 1983), but such responses are not automatic and health economists don’t have a good understanding of what contextual factors are important in predicting such responses. Nevertheless, the potential for such responses means that inducement is an important factor to consider in policy development. To test for SID early studies looked at changes in utilisation compared to increases in physician/population ratio.

The hypothesis underlying the tests is that, in response to an increase in the doctor/population ratio (i. e. competition), doctors will seek to induce demand or raise their fees so as to maintain their incomes. Cromwell and Mitchell (1986) demonstrated a significant demand inducement for surgical procedures with overall rates of surgery increase by about 0. 08% for each 1% increase in surgeon supply. Rice’s (1984) found that 10% decline in physician reimbursement led to a 6. 1% increase in intensity of medical services and a 2. 7% increase in intensity in surgical services.

However, a similar study found mixed responses to fee changes across procedures (Labelle et al 1990). Another technique used for testing SID is to examine the effect of changes in doctor supply on doctor compared with patient initiated visits. Assumption here is that if SID exists, increases in doctor numbers would lead to an increase in doctor-initiated visits (that is, an income maintenance response test). Tussing and Wojtowycz (1986), using this technique, found that areas with more GPs were associated with much larger proportion of return visits arranged by doctor, i. e. a strong relationship to support SID.

On the other hand, doing a similar experiment, Rossiter and Wilensky (1983) found only very small inducement effect. This approach to investigating the presence of SID effects (increasing physicians and increasing utilisation) fell somewhat out of favour when Dranove and Wehner (1994) found that, according to the standard methodology among SID theorists, an increase in the number of physicians resulted in an increase in childbirths. Recent studies have looked at physician behaviour in response to fee reduction, e. g. Yip (1998) found that physicians compensate for income losses due to public price reduction by increasing volume.

Medicare fee cuts lead to increased amounts of heart surgery enabling physicians to recoup 70% of lost revenue. Gruber and Owings (1996) found that a 13% reduction in fertility rate in the US in 1970-1982 led to an increase in caesarean sections and reduction in the less profitable vaginal births. Between 1971-1981, the number of GPs per capita in Winnipeg, Canada increased by 56%. Remarkably, however, real gross income per physician remained virtually unchanged during the period. GPs simply increased the number of contacts with existing patients – so much so that their average revenue actually increased.

On the other hand, in Norway, Grytten and Sorensen (2001) compared a salaried group of physicians with another one that was compensated by fee for service. Neither of the two groups of physicians increased their output as a response to an increase in physician density. In UK, dentists are paid on a fixed fee-for-service basis. Supplier income can only be increased by increasing utilisation. Therefore, testing for the existence of SID in dentistry has involved looking for a positive correlation between dentist density and utilisation of dental care.

Birch (1988) concluded that a positive correlation between the number of dentists per capita and the treatment content per visit provides sufficient (but not necessary) evidence for the existence of SID, in a fee-regulated market environment. Other researchers [Manning and Phelps (1979); Grytten et al (1990)] found similar correlations. Sintonen and Maljanen (1995) found that individual and general inducement appeared to have considerable effect on utilisation, but no systematic connection with supply conditions (dentist/population ratio).

This was interpreted to indicate that some dentists, regardless of the market situation, have adopted individual inducement. However, there are alternative explanations for a positive correlation between dentist density and the utilisation of medical services: permanent access demand on the market for medical services due to price regulation; demand decisions by rational patients (the opening of new practices, particularly in rural areas, reduces the average time and transport costs, and the average time spent in the waiting room also falls); reversed causality where physicians set up shop in high demand regions.

Policy Implications of SID: SID is of great importance to the policy maker because it threatens the basic market paradigm and severely undermines economic recommendations about market policy. There are differing interpretations of policy significance of SID. According to Carlsen and Grytten (2000), policy makers can compute the socially optimal density of physicians without knowledge of SID. Yet most analysts look at SID from the perspective of manpower and reimbursement policy for purposes of cost containment. They do not consider its contribution to the health status of patients.

The impact of SID on equity, distributional issues and the net social benefits is usually ignored (Labelle et al 1994). The issue of SID raises another major controversy of whether adequate control over resource allocation to and within healthcare is best achieved through the demand side or through regulatory controls on the supply side (Reinhardt 1989, p. 339). Indeed, due to problems with moral hazard and SID, insurers use demand-side incentives (e. g. co-insurance and deductibles), as well as supply-side incentives aimed at providers (e. g. aying physicians through salary or capitation). An example of policy implications of SID to manpower planning is when a government wishes to attract physicians to rural areas, and it does so by paying rural doctors more than those in urban areas. This could precipitate SID within urban practices, hence nullifying the government’s intention. Direct regulation of the supply of physicians—by mandating that all new graduates spend a certain number of years in rural communities, for example —might have some advantages, although this may well affect the number and quality of medical students.

For facility planning purposes, Roemer’s Law has the fundamental implication that there is no external “demand” standard, based on observed utilisation, from which “needed” levels can be inferred. Providers will themselves determine use on the basis of available capacity inter alia. SID means increased demand by patients, which raises costs of care. If it exists, then the policy maker may wish to provide for control of supplier behaviour by mandating evidence-based medicine: cost-effectiveness evaluation of new interventions, medical audits etc, all of which encroach on clinical freedom.

Use of provider payment mechanisms like salaries for doctors, global budgets, and case payments could help. However, Ferguson (2002) argues that overall, demand curve for medical care slopes downward, and that supplier-induced demand is overrated as a policy concern. Conclusion: This essay has explained the rationale for the existence of SID and has explored its policy implications and empirical evidence of its existence. There is arguably sufficient evidence to accept that SID can occur. Even Hippocrates himself realised that as in all things mercenary (in health care it is “fee-for-service”) there is no such thing as pure altruism.

Indeed, the Hippocratic oath is an admission to the potential for pecuniary self-interest and abuse of sacred trust. Imperfect agency and clinical uncertainty are the main causes of SID. If SID is pervasive, there could be a variety of economy-wide impacts, e. g. it could increase health expenditure without a commensurate improvement in health outcomes. Therefore, it has important implications for the health policy process. Strong support for SID hypothesis was found in the UK dentistry. Otherwise, there is no robust evidence on the likely magnitude of SID.

Although inconclusive, most studies suggest that where SID arises, it is small both in absolute terms and relative to other influences. However, it is still worth considering SID-attenuating arrangements say in the case of physician reimbursement policy. As there are a number of fundamental and seemingly irresolvable methodological and data problems associated with trying to assess SID, definitive evidence of its existence most likely will remain illusive.

In the early 1800, public officials were making collective efforts to control communicable diseases such as smallpox, yellow fever, cholera, typhoid, and measles. In order to reduce the presence of communicable diseases, quarantine measures often became law. People who were contaminated were placed in isolation in order to avoid spreading the disease. The education and training of health care workers during this time lacked strong controls and regulations.

The hospitals were not cleaned and they were considered of a place to go to die. By the late 1800, a number of vaccines and serums were developed in order to protect the public against contagious disease. Many health professionals have attempted to define health, which is very broad. Physical health is perceived as the normal functioning of the body”s cells, organs, and systems. Mental health is characterized by an ability to deal constructively with reality.

Social health has to do with education status, crime rates, poverty, and divorce. Spiritual health is giving and receiving love, trust, joy, and peace; having a sense of selflessness, honor, integrity and sacrifice for others. Several factors must be considered in dealing with health problems in a community. Geography, topography, social and cultural factors along with tradition and social norms have significant impact on the community.

Despite marvelous advances in medical technology, health care is limited or even nonexistent for many Americans. That”s the reason why in 1977, the World Health Organization recognized the need for Health for All by the Year 2000″ an unusually optimistic goal. Poverty keeps individuals from obtaining needed health care services. The United States is the only major western country that does not have comprehensive health care for all its citizens.

For a long period of time, there has been power struggle over the answer to this question. Legalization of the drug has been a debate for quite long and still it creates a bone of contention. There are supporting facts why the drug should be legalized, while others claim that it is harmful to the health of human being, and should therefore not be legalized.

In the real essence, marijuana is far from harmless, but it is far less dangerous than most of the drugs. In most cases, the drug is used as medicine to numerous ailments. For these reasons therefore, I am in support of the opinion that the marijuana should be legalized for possession and consumption.

Marijuana has no addictive based on its chemical substance. It is not physically addictive, and those who use it to get addicted make up a tiny minority of those who have tried using it. The use of marijuana does not raise any chance that the user may user some other hard drugs. In fact, marijuana is the most and widely used illicit drug, so it is one of the basics that most users of harder drugs try out sometimes early on. Studies show that marijuana is used for medicinal purposes.

Without reasonable doubt, it is confirmed that it is used for effective treatment of glaucoma and Alzheimer’s. Most of the people suffering from such diseases have gotten treatment through the use of marijuana, and they are healthy up to date. Some people argue that through the use of marijuana, there are increased chances of heart attack. They argue that marijuana can cause cancer and serious lung damage.

However, the increased risk of heart attack due to the use of marijuana is equal to the increased risk of heart attack due to strenuous exercise. Contrary to this ideology, research points out that smoking of marijuana can actually be beneficial to the lungs, because most of the people who smoke it do not inhale it in doses sizable enough that can impair their lung and brain functionality. In this precept, I fully support and agree that the government should legalize the possession and consummation of the drug.