The skyrocketing cost of medications is a current and controversial bioethical issue to healthcare. For 2018, “New York-based Segal Consulting foresaw a 10.3% increase in outpatient prescription drug spending for workers and early retirees” (Kelley, 2018). Medication costs have been rising in the United States, bringing concern to patients, prescribers, payers, and policy makers. Prescription drug spending in the United States exceeds all other countries due to brand-name drug prices that have been increasing at alarming rates. According to Kesselheim, Avorn, and Sarpatwari (2016), “In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations.” The amount of money that Americans spend on medications is far greater than those who live in other countries. At the rate of the rising costs, more and more people cannot afford to buy the medications that they need. The only way to stop the medication costs from going even higher is through policymaking.

There are many reasons to why medication costs keep increasing. “The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents” (Kesselheim et al, 2016). Generic drugs can reduce the prices of drugs, but access to them may be delayed due to numerous business and legal strategies. For widely used medications, manufacturers typically retain market exclusivity for an average of 12.5 years after approval by the Food and Drug Administration, but companies may extend that period by making minor changes to a drug’s formulation. Hence, this delays patent expiration and they can pay competitors to delay or abort the introduction of generic drugs (Sofer, 2016). Therefore, even if a patient is able to go see a doctor and be diagnosed of an illness, if he or she is not able to afford the medications prescribed, all the money and time that is spent at the doctor’s office is wasted.

Many times, medication compliance can be associated with the cost of medications. Patients may try to take half the dose of a medication since it is so expensive. They may feel that taking some of the drug is sufficient to keep them alive and if they take only half the pill, it will last them longer before they need to buy more. Otherwise, they may not take the medication at all. According to Kelley (2018), “Today’s high prices are pushing more and more patients into non-adherence. It is a prescription for trouble for us all.” He explains that even the most effective drug is useless if people do not take it since it is too expensive. People are hurting from the problem of unaffordable drug prices. A second grade teacher in Texas, named Heather Holland, had the flu last February. She did not get her Tamiflu prescription since it would cost her $116. A few days later, she died in the ICU (Kelley, 2018). Many similar tragedies have occurred because people decline to pick up prescriptions due to their high prices. This issue impacts the lives of patients since they are skipping medicines. The high costs of medications are driving non-adherence and it is doing even more damage to patients and healthcare. Since they are not taking the medications prescribed, their illness worsens and they end up in the hospital when the illness is out of control or fatal. President Donald Trump described pharmaceutical companies as “getting away with murder.” In the 2013 National Health Interview Survey done by the National Center for Health Statistics and reported by the CDC, 7.8% of U.S. adults passed up prescribed medications to save money. “The burden of out-of-pocket costs has grown in recent years, as expensive new drugs have entered the market and consumers have been asked to bear a larger share of the cost” (Kelley, 2018). People are risking their lives not taking medications because they are so expensive.

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Roll Back Malaria was another social movement being set up in 1998. Through the expansion of anti-malaria efforts, over 6 million deaths were averted, primarily among children under five in sub-Saharan Africa. As for sanitation issues, through the network of 38,000 Health Extension Workers, UNICEF promotes hygiene and sanitation. WHO can call upon NGOs like the Gates Foundation, and while some of the financially capable organisations can provide monetary support to fund these programmes and initiatives, WHO can provide the expertise and human resources so that the programme can be effectively implemented. The Bill and Melinda Gates Foundation are very active in Africa when it comes to improving sanitation and water sources. The foundation currently provides more than USD $265 million in funding to partner organizations that are operating health and development programs across Africa[8].

WHO and the African government can also choose to adopt the Warangal City Sanitation Model, based in India to be implemented. The model runs on public-private-partnership. Private sector was incentivised by giving land by the government and built the systems and generated revenue. The team started with public toilets where people would pay as they use the systems. Soap, hand wash, and dustbins were provided. Soon after the project was a huge success, private toilets were also built under the project. Toilet applications could be made through a helpline and the applicant would get a toilet built within 10 days. People could also request for subsidies and all this could be done over the helpline. Special ‘She-Toilets’ had also been constructed separately for women with complete menstrual hygiene facilities provided. As of 2010, according to the survey done by ASCI, only 25 % people had toilets. After the implementation of the project, the same figure increased to 50 %. Feedback systems were provided to understand the usefulness and necessities of the users. FSM trackers and GPS systems were used to monitor the sludge collected and the sludge treatment plant was used for bio methanation[12]. Cleanliness of water channels and sewage systems are constantly being checked by municipality officials (once a week) to ensure there are no leaks into the main water systems. WHO can call upon organisations to fund such projects in Africa so that the entire nation can practice sanitary methods to keep safe.

As for the most recent Covid-19 pandemic, Ethiopia has handled it well so far despite the fact that there are some major challenges. One of the major challenges is handling the 900,000 people who are in the refugee camps. Those camps are a vulnerable hotspot as there is minimal social distancing, poor sanitation and a lack of safe water to wash hands. One of the steps in this regard is for WHO to support the Ministry of Health capacity to make nutritional and health needs assessments among vulnerable groups. By providing testing kits, masks and sanitisation packages and isolation centres, the spread of the coronavirus can be reduced, which will also ensure that there is not a sudden spike in the case numbers overwhelming the healthcare system. The young minds of Ethiopia have also come together to innovate low cost ventilators, using 3D printed parts.. Alcohol-based sanitisers are being produced in University and Technology College Campuses in Zimbabwe and being sent over[10]. WHO can call upon NGOs to find these projects so that mass production of these products can be done. African Government can also adopt a policy like the ASEAN Emergency Rice Reserve to ensure food stability levels during crisis periods to reduce malnutrition rates across the continent.

In conclusion there are the major problems faced by Ethiopia namely: lack of public education and awareness, poor sewage, sanitation and water system and weak healthcare facilities. For the period of Ethiopia's current five-year health sector plan (2016–2020), the projection model indicates that if real external resources remain at the levels of 2011, domestic resource mobilization may only provide half of the estimated funds needed[13]. Hence WHO and UN can tap upon international funding to maintain a financially sustainable healthcare system. By enhancing the current programmes and adopting a few international ones, African states can improve their sanitation and water systems leading to a better standard and quality of life. The council must work towards coming up with resolutions to ensure all Ethiopian can enjoy quality life that they deserve.

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With about 109 million people (2018), Ethiopia is the second most populous nation in Africa and the fastest growing economy in the region.While being famous for how quickly the country is picking up economically, it is rather infamous for healthcare. Ethiopia lacks crucial growth in the healthcare and social sector, with severe food insecurity, acute malnutrition, lack of access to clean waters, basic sanitation and other political disputes. As of 2015, about 23.5% of the population is below the poverty line making less than $1.90 a day, limiting access to quality healthcare. Ethiopia is the one of the countries hardest hit by the HIV and AIDS epidemic, with almost 16,000 Ethiopians dying each year. Ethiopia is also one of the 30 High Burden Countries for Tuberculosis (TB) with almost 49,000 deaths in 2016[2]. Ethiopia needs to improve its sanitation system, ramp up its healthcare facilities and increase the social awareness amongst its citizens about the dangers of communicable diseases and how to take precautions.

As of 2018, 690 000 people were living with HIV and AIDS. Biological and social factors (like child marriage by the age of 15) make women more vulnerable to AIDS, especially in adolescence and youth. Only 30.25% know how to prevent sexual transmission of HIV. Menstrual hygiene is extremely poor in Ethiopia leading to other communicable diseases like Hepatitis B. What is stopping young females from receiving help are societal stereotypes. Sexual diseases remain a taboo topic, and this has prevented females from receiving the education they need to prevent these diseases. A study has found that 25% of girls in Ethiopia do not use any menstrual hygiene management (MHM) products to manage their periods and isolate themselves during menstruation. In Northeast Ethiopia, only 25% of schoolgirls had learned about menstruation and hygienic management in school[4]. All these statistics point towards one major flaw, public education and awareness.

Ethiopia also faces long droughts throughout the year, being the second driest state after Australia. 62 million Ethiopians lack access to safe water and 97 million lack access to improved sanitation. Of those who lack access to improved sanitation, 23 million practice open defecation[5]. In Ethiopia, 60 to 80 percent of communicable diseases are attributed to limited access to safe water and inadequate sanitation and hygiene services[7]. Africa is one of the two major regions with the least improvement in accomplishing the MDG on sanitation by 2015. Sub-Saharan Africa only has 30% coverage with only a 4% increase from 1990 [11]. This is a vital concern because of the associated massive health burden as many people who lack basic sanitation engage in unsanitary activities. The practice of open defecation is the primary cause of faecal oral transmission of disease with children being the most vulnerable. When Ethiopia does receive a large amount of rain, the water stagnates due to the poor drainage system in the country. 14% of the new drains and 28% of the old drains are inadequate for storm water removal. The stagnant water is the perfect breeding ground for mosquitoes leading to Malaria. 66.1% of the population is at risk of Malaria, with an estimated 2.9 million deaths in 2016[1]. Another major flaw is the sewage, sanitation and water system.

Over the years, with constant attention and guidelines being set up by the UN and WHO, the Ethiopian Government has put in place several policies to construct a robust healthcare system in the long run. The government has been putting in the effort to make primary care affordable and accessible to all, with special reference to the rural residents of the country. In 1993, the Health Sector Development Programme (HSDP) was set up. This is a 20 year, 4 stage programme. Phases I and II of the HSDP were in place from 1997-2005 with the ambitious focus of improving health service delivery and quality of care, health facility rehabilitation and expansion; human resource development, pharmaceutical supply and management and health care financing. Phase III of the HSDP ran from 2005 to 2010 and focused on improving maternal and child health and addressing communicable diseases[6]. By 2015, 16440 health posts, 3547 health centres and 311 hospitals had been established. In 2018, the Ethiopian Government sanctioned a 1.4 billion dollar budget for the fiscal year of which three quarters of the amount are being channelled towards improving and enhancing the healthcare sector.

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The health care expenditure in the United States of America has increased continuously at high rates, and per capita health care expenditure has consistently surpassed overall economic growth.1 In the year 2017, the United States spent about $3.5 trillion, or 18 percent of GDP, on health expenditures which amounted to more than twice the average among developed countries. Of that $3.5 trillion, $1.5 trillion, is directly or indirectly financed by the federal government. By 2028, the projected estimates will rise to $2.9 trillion, or 9.7 percent of the economy.

Medicare (7.4 percent per year) and Medicaid (5.8 percent per year) are both the major contributors to the increase in the rate of national health expenditure growth. Both these trends reflect the impact of an aging population on the national expenditure. There are various drivers responsible for increase in health expenditures but in recent years, the high price of prescription drugs has been heavily examined as a key contributor to the increase in national healthcare expenditure.

Prescription drug spending:

The United States’ per capita spending on prescription medications was $858 in 2015, more than double the average of $400 among 19 advanced industrialized nations. Among the major sectors of healthcare, spending growth is projected to be fastest for prescription drugs, averaging 6.3 percent for 2017-2026. This is due in part to faster projected drug price growth, particularly by the end of the period, influenced by trends in relatively costlier specialty drugs. 

Major Legislation That Shapes Today’s Pharmaceutical Markets

In 1983 and 1984, Congress enacted two laws that led to development and innovation of new drugs and created competitive market through a generic drug approval process. 

The Drug Price Competition and Patent Term Restoration Act—commonly known as the Hatch-Waxman Act was the first law which extended patent terms and provided marketing exclusivity for certain categories of drugs thereby enabling the manufacturers to recoup the investments on development and research.

The second law, the Orphan Drug Act, provisions for several incentives like research and development tax credits and seven-year market exclusivity for the development of drugs for rare diseases and conditions which affect less than 200,000 people.

In 1992, the Accelerated Approval (AA) was created by Food and Drug Administration (FDA) regulation to mitigate the needs of the AIDS epidemic. FDA enables expedited approvals for drugs of clinical significance. Using AA, the FDA may grant approval for a new drug that offers a significant benefit compared to available therapies for serious medical conditions. It was codified by the FDA Safety and Innovation Act (FDASIA) in 2012.

In 2010, Biologics Price Competition and Innovation Act (BPCIA) under the Accountable Care Act was designed to encourage competition in the market for biologic drugs and provisioned for 12 years exclusivity for biologic therapeutic drugs. 

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Introduction of the Organization

Memorial Hermann is all about redefining healthcare. They integrate care delivery, top notch physicians, and health solutions, a full-service healthcare provider. Memorial Hermann has 5,500 physicians, and 24,000 employees that practice evidence based medicine with a focus on patient safety and satisfaction. Memorial Hermann is the largest not-for-profit healthcare system in all of southeast Texas. This includes 16 hospitals, conveniently located throughout the greater Houston area that are accredited by Joint Commission. Memorial Hermann offers leading-edge diagnostic technologies and treatment techniques to the many different communities that it serves. They have served the community of Greater Houston for more than 105 years, and contribute $451 million annually through school based health centers and other programs (About Us, 2017). Memorial Hermann is ranked among the nation’s top 15 healthcare systems by Truven Health. U.S. News & World Report for 2016-2017 ranked several of the Memorial Hermann hospitals as among best in Houston and considered “high-performing” in many different specialties (Awards and Recognition, 2017).

Examination of the Organization

Memorial Hermann is devoted to providing quality, cost-efficient, and compassionate care. We strive to improve the health and well-being, of our people who live and work in the community that we serve them in. Memorial Hermann’s mission and philosophy is a not?for?profit, community?owned, health care system with spiritual values, dedicated to providing high quality health services in order to improve the health of the people in Southeast Texas (About Us, 2017). The mission is achieved for each individual patient by collaborating with our patients, families, physicians, employees, volunteers, vendors, and communities. We take pride in caring for the whole patient. Memorial Hermann is a Medicare Accountable Care Organization, a type of joint practice. “ACOs are groups of doctors and other health care providers who voluntarily work together with Medicare to give you high quality service and care at the right time in the right setting” (About Us, 2017). This means that your doctor has agreed to participate in a Medicare shared savings ACO and to work thoroughly with other doctors to coordinate the care that is best for you. This benefits our patient’s because all of their healthcare providers will be a part of a better synchronized team, not so much duplicated paperwork, and every MD will know of the medical treatment that and issues that you have had.

Strengths and Limitations

As in every organization there are major strengths and limitations as well. One limitation is availability and access to healthcare services. While Memorial Hermann offers some of the best healthcare services, access still remains a top issue. Another limitation is the minimal access to the behavioral health services. The community identified this as being an unmet need. They plan to expand these types of services to their surrounding communities. “Stakeholders highlighted multiple unmet needs for mental health and substance abuse services in the communities served by MH Texas Medical Center, particularly the burden of mental health needs in the youth and incarcerated populations and unmet demands for mental health treatment” (Ganelin, p. 6). These findings illustrated the importance of pursuing solutions to close this gap in healthcare. On the other hand, Memorial Hermann as an organization possesses strengths as well. We have high quality medical care. A high quality of care is exemplified by the wide availability of health care services and the high quality of those services. Memorial Hermann also provides economic opportunity. Being that a Memorial Hermann facility is not too far from any community in the Greater Houston area it creates economic opportunities for residents and the businesses that surround it.

Care Delivery System

Memorial Hermann prides themselves on providing patient-centered care. “The care delivery system clarifies the authority, accountability and autonomy for clinical decision making and nursing outcomes” (About Us, 2017). Memorial Hermann facilities follow The Nursing Professional Practice Model. “The Nursing Professional Practice Model is an integral step in the journey to Magnet designation, and by better defining the components of nursing practice, professional nurses are able to provide better care for their patients” (King, p. 4). The Nursing Professional Practice Model includes nurses as clinicians, advocates for their patients and their families, leaders, innovators, collaborators, and well educated teachers. Delegation goes in order of manager, charge nurse, licensed staff to unlicensed staff. Manager can delegate to the coordinating of staffing assignments to the charge nurse. The charge nurse is able to delegate patient assignments to the licensed personal. While the licensed personal are able to delegate tasks such as, ADLs, turning, and aiding in care with licensed personal. The system is consistent, and organized and it works. The Nursing Care Delivery System at Memorial Hermann defines the registered nurse as being accountable for the coordination of patient care and the bridge to connect the physician's treatment to the patient's goals treatment plan for the whole patient.

Outcomes and Measurements

Memorial Hermann was named one of the nation’s top 15 health systems in January of 2012. The performance showed lower mortality, better survival, and fewer complications (About Us, 2017). This award is based on criteria such as clinical outcomes, patient safety, patient satisfaction and operational efficiency. This award is a direct reward of the outstanding care that Memorial Hermann provides to its patients. Nursing-sensitive clinical indicators are elements of patient care directly affected by the nursing services provided. The DAISY award is an award presented to exemplify boundless nursing care to the nursing staff. The DAISY Award recognizes one nurse each month for going above and beyond to deliver extraordinary patient care. Last month on our unit was a nurse by the name of Amy. Amy always provides compassion and wide array of clinical skills provided to patients and families.

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A New Partnership Between Systems Engineering and Health Care

The United States has some of the most dominant medical practices in the world. However, even though the U.S. healthcare systems provides high quality, these practices are not cost effective (Reid, Compton and Grossman 11). This is a major problem considering one of the main objectives of a health care system is to delivers services that are cost effective (Khasawneh 11). In order to combat this problem, Systems Engineering is becoming more and more prominent in a health care setting.

Although the U.S. provides relatively high quality care, it is nowhere near the level of quality that it should be. Many patients believe they should be receiving better treatment and 75% of them think the health care system is a “nightmare” according to one survey (Reid, Compton and Grossman 12). The delivery system can be extremely redundant and fragmented at times (Reid, Compton and Grossman 12). This has a direct impact on the extremely high costs. This escalating cost creates a chain reaction and results in worse/no health care benefits with higher co-pays/deductibles (Reid, Compton and Grossman 12). To this day, affordable health care is a major topic of political discussion and the U.S. is yet to find an answer.

The causes of this health care crisis can be boiled down to a few things: rapid technological advances, orientation of delivery system, U.S. market structure, lack of communication technology, and a lack of engineering practices (Reid, Compton and Grossman 12). Although technological advances in the health sector are necessary for improvement, they also create a lot of problems. Patients begin to have higher expectations which can lower customer satisfaction if not properly treated. Technology also causes health care companies to have a lot more information and data to deal with on a day to day basis (Reid, Compton and Grossman 12). There is also a large learning curve and a lot of unknows that come with newer technology, especially in a health care setting.

The next major problem in health care has to do with the structure of the industry. Due to the fact that many professionals specialize in a certain field, this has created a cottage-industry structure (Reid, Compton and Grossman 13). According to Merriam Webster, the definition of a cottage-industry is: “an industry whose labor force consists of family units or individuals working at home with their own equipment” (Merriam Webster). This is not exactly how the U.S. health care system operates, rather it means that hospitals and other medical facilities rely mostly on outside specialist. This independence and fragmentation can cause a lot of problems and slow down treatment time (Reid, Compton and Grossman 13).

The U.S. market structure for health care services can also be tied back to the current health care problems the country is facing. The real cost of health care stems from employers, federal government, and private insurers (Reid, Compton and Grossman 13). People want the best health insurance possible and new technological advances makes it more difficult for the insurance companies. They become pressured into covering new practices and techniques no matter the cost (Reid, Compton and Grossman 13). In doing so, they begin to control the prices by limited these services (Reid, Compton and Grossman 13).

Another major problem with health care has to do with the lack of information/communication technology. Surprising enough, the health care industry has some of the least use of information technology compared to other sectors in the U.S. (Reid, Compton and Grossman 14). Communication is a vital ingredient for success within an organization, and it is time for health care to catch up with the rest of the country’s practices. The financial, transportation, and manufacturing sector have been transformed by increased information technology and communication and health care must do the same (Reid, Compton and Grossman 14). However, this problem isn’t as easy to fix as it sounds. The cost is not so much the problem but rather it lies within the cottage structure that was mentioned before (Reid, Compton and Grossman 14). This makes it very difficult to implement some form of communication tool when there are so many private, specialized medical facilities around the U.S.

The final problem mentioned with the health care system has to do with the lack of systems engineering practices implemented. Systems engineering can be implemented to improve health care just like it has been implemented in manufacturing and other sectors that need continuous process improvement. The health care delivery system is extremely complex and involves a large number of personnel, organization of data and information, finances, sub-processes, etc. (Reid, Compton and Grossman 14). More forms of engineering practices and control tools need to be implemented, just as it is in other sectors (Reid, Compton and Grossman 14).

Ultimately, the U.S. healthcare system is a very complex system with a lot of internal problems inhibiting improvements in quality. Due to this, health care is extremely costly and has been an ongoing problem for a while. Although minor overall improvements are made each year, there is still a lot of work to be done.

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The healthcare sector is a part of the economy that delivers various drugs, medicines & other services for patients with preventive, healing, rehabilitative, & soothing care. “Health care services comprises the grouping of tangible & intangible facet where intangible features dominates the tangible aspects”. Rooms, beds & other decors are included in tangible things.

The different forms of services related to health & welfare are provided by healthcare industry. Healthcare sector is a sector governed at state level with the assistance of Government of India. It is divided into many sub-divisions, & governed with various interdisciplinary teams of skilled professionals & paraprofessionals to serve the health requirements of the individuals.

Evidences are available to prove the existence of healthcare systems even during the period of Ramayana & Mahabharata. Healthcare systems have changed substantially with flow of time, information & has gone through important changes & developed a lot with the upgradation of Medical Science & related technology.

Considerable increments in healthcare facilities & in the number of healthcare professionals happened during 1950's & 1980's, but the total number of certified medical professionals seems to be falling down in as we have 4 practitioner per 10,000 in 1980s which is reduced to 3 per 10,000 in 1981. The reason behind this decrease in number of certified medical professionals is the fast growing population in the country. There were around ten beds on 10,000 individuals in 1991. The number of primary health centers have grown in the decade. There is no doubt that these centers are the keystone for rural health care system.

Around 22,400 primary health centers, 11200 hospitals & 27400 dispensaries were established in India during 1991. These services started as a part of tiered healthcare system with a focus to provide maximum routine facilities to the wide majority of people in town & refer only critical cases to urban hospitals which are having more sophisticated facilities. These centers focused on creating trust on skilled professionals to fulfil their maximum requirements.

The healthcare industry in India is functioning with the help of both public & private sector. The services & facilities governed by the government of sate as well as of central comes under public healthcare system. The system is helpful in a way as it provides varied number of services & other facilities at free of cost or at concessional rates to the people of rural areas as well as the to the people of lower income group in urban areas. Yet there is a long way to go ahead as the industry is still in the development phase.

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Lessons from Uganda’s Approach to Mental Health Concerns

Uganda’s mental health framework has many positive reforms included in its implementation. It consists of a decentralized and integration system comprising of mental health services that are combined through the Primary Health Care (PHC) system. The health care system is essential in terms of dealing with disorders. Other countries have to focus on funding their healthcare systems for them to provide amicable and adequate treatment to mental disorders. Uganda’s system lacks funding, a significant barrier towards its development. Lack of enough funds ensures that a program does not become outdated and offensive. Most of the developing nations have failed to have quality mental health frameworks because they are underfunded by their governments. Governments tend to invest 1% of their general health expenditure on mental health which leaves the population of mentally ill individuals without any services. Other developing nations should provide enough human resources and financial resources to the mental health sector.

Primary, Secondary, and Tertiary Health Care

Primary care refers to the initial medical consultation point. Primary care physicians are in charge of the services. Primary care provides patients with emergency services, in-patient, and out-patient services for the well-being of the patients. Secondary care involves a lack of contact with patients. Secondary care is more specialized in terms of the services it provides. One may acquire heart surgery services. Patients also have the opportunity of receiving acute care. Medical imaging and child-birth attendance are also other services involved in secondary care. Tertiary care involves a higher care level in health facilities. High specialized treatment, in this case, is the main focus of tertiary care. Cardiac surgery, management/treatment of cancer, and plastic surgery.

Healthcare Systems in Germany, the United States, and the United Kingdoms

In Great Britain (The United Kingdom), the government agencies have an open policy of interacting with the hospitals and health organizations. The above stakeholders have the opportunity to bargain with government agencies directly. In Germany, the healthcare sector operates with a framework comprising of public rules. Sickness-fund physicians’ associations and health facilities negotiate with sickness funds. The US medical sector has a more lucrative and entrepreneurial status (Duarte, Goodson, & Dougherty, 2014). The sector possesses a collective negotiation with different payers in public. The healthcare sector had a bifurcated and evolved payer of the pattern.

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Health care organizations in the United States and around the world are always dealing with Management problems. The complexity of the health care system is one of the causes of many management troubles in health care today. Communication in health care setting the implementation depends on behavior rather than technical and there are numerous communication letdowns. The United States is currently Health care organizations are always operating together to come up with ideas and strategies to make their organizations more fruitful and better for everyone to work in as well. Problem solving is an ongoing process in health care organizations, which have been bringing positive results for everyone. Working in the health care field I have experience dealing with different kind of managers. It makes a difference whether you have a caring approachable management or if you don’t have a manager with good morals.

Instead of treating patients, health care administrators are charged with the elaboration, leading and organizing medical and health services. These managers can manage a health care facility such as a hospital, be in charge of a particular medical department, or manage a medical office for a single/group of physicians. They also oversee assistant administrators in greater facilities and administer finances, plus patient fees and billing. The job can also demand for representing a facility at stockholder conferences or on-board meetings, as well as keeping reports of the facility's services, such as the sum of inpatient beds used every year, and collaborating with medical staff and the head of department.

Management task is many times challenging, good staff management means upholding a custom of regular assessment of the staff, their skills, your budget, and for all those to run smoothly. In healthcare facilities management, when you can direct and manage your staff well, you are able to contribute to the overall goals of great patient care that hospitals and clinics attempt.

Communications management is the systematic planning, implementing, monitoring, and revision of all the channels of Communication within an organization, and between organizations. Communication is essential for the proper functioning of any health care organization. Faulty communication is the cause of everyday medical accidents. Hierarchical differences are also the cause of communication failures. Concerns with interpersonal power and conflict which includes upward influences, conflicting role and ambiguity. There is a Communication barrier when two communicators have differences in power. In many cases one party is worry about appearing incompetent or about offending the other. Also, if one the one person believes the other party is not open to communication. Communication is also compromised when people are busy or fatigued. Understanding these issues will help make health care organization run efficiently. Communication failures are increasing daily and being linked to important factors influencing patient safety in hospital as well.

In addition, the different system of horizontal labor and vertical hierarchy of power make communication challenging. The complex system which are composed of different hierarchical levels whose duty is to constantly connect the structure of these system can be substantial in the influence on whether and how critical information is communicated effectively. Data taken from residents regarding to patients test results, where previous diagnoses and treatments were not corrected in the patients’ medical history. Issues with accurate medical information that were not communicated effectively to the practitioner. Also, busy emergency department were the cause o of such miscommunication. Total failures of one kind or other were related or contributed to in 64 errors made with a (91%). One contributors that could lead to failures in healthcare management is the idea that many have about health care, which we see as a system. In many traditional systems, there is a hierarchal component that allows for the effectiveness production of a single product. However, in healthcare as Rouse explains in the “there is no one in charge, no one has the authority” (Rouse 2008).

Health care involves a great number of independent professional, this health care has to be approached as a “complex adaptive system. “Once there is no single point of control figure 1 bellow provides an overall view on how healthcare is willingly delivered to patients. The below figure, shows the network complexity which results in difficulties to understand the health care system. To “commuters’ or patients. To approach the management of this complex system, is which “organizational behaviors such as adopting a human centered that address the abilities, eliminations and inclinations of stake holders. Because, there is “no one really in charge, healthcare managers should emphasize. (Rouse 2008)

The ability to motivate employees is serious for managers in any field. In healthcare, which faces remarkable transformation, hesitation, and encounters, motivation becomes even more fundamental. Nothing can occur without the bond of employees. Helping people see a common vision and feel enough of a connection to it to make the needed efforts for its fulfilment is the important liability of leadership. Motivating the people who are working under management can be a difficult task at times. Everyone is unique, none of us are the exact same and each person needs something different to become motivated and that is where the challenge comes in for the managers, finding the right motivator for the right employee. Knowing and caring about the employees needs, will help managers know what type of rewards to offer as a way to motivate their employees.

A lack of promotion opportunities is one common problem. Studies shown that Nurses in told to be working for ten years without a promotion. This cause them to build resentment, where the studies show that simple statement—such as staff appraisals and plain promotion measures—could lead to better morale. A lack of and non-operational equipment and supplies can make employees become even more frustrated, causing them not to be happy in the place of work. Although money is not necessarily a primary motivator, salaries, particularly for highly trained personnel, also come into question. If employees do not feel as though they are sufficiently paid for their skill, they will then become less motivated. The challenge for managers is to take to equilibrium all these pieces of motivation and improve methods that considers everybody's desires while also keeping in mind the limitations of facilities, budgets, and location.

The success of any company, especially health care establishments only depends on the skills of managers and what kind of work atmosphere they offer for their employees. When employees are motivated they are likely to be more content with their jobs and will stay with the organization for many years. According to a study from the Healthcare Information and Management Systems in order to keep health care workers. 'pay a decent salary, that was established in the research through survey a job offer.

Another manager must do is to involved employees in everything, always taking their opinions into consideration and consider facilitating things. Work together as a team to come up with the best solutions. This is what a good administrator is made of, his staffs in everything that has to do with the occupation.

Maslow's theory was unique because his ideas consisted that each person had five needs and each need had to be met before they could go on to the next need. As the course went on, each old need lost motivational value as the new need was met. According 'Maslow's hierarchy of needs assumes there are five need levels that must be satisfied sequentially. The physiological needs, these needs include things like air, water, food, warmth, shelter, and sex, the basic survival needs. The security needs include a secure physical and emotional environment, examples include the need to be free from worry about money and job security. Belongingness needs involve social processes, they include the need for love and affection and the need to be accepted by one's peers. Esteem needs are actually composed of two diverse set of needs: the need for a positive self-image or self-respect and the need for recognition and respect from others. Self-actualization needs, at the top of the hierarchy, involve understanding one's potential for continued growth and individual improvement”. (management Journey)

While, Maslow's hierarchy of needs theory appears too modest for the human body, which is extremely complex, is a great theory for us people. This theory speaks about each aspect of our lives and in what way one feels about themselves and their surroundings. People who are in management positions will be wise to use this theory when it comes to motivating their employees, in any industry health care or otherwise. It does not matter which theory you think may be best to follow, interesting work and employee pay are the two biggest motivators.

In conclusion, motivating your employees is a difficult duty, it must be done in order to keep them content and to keep things running well. Keeping your employees happy can only bring attainment to the organization. The employees will love performing their duty and they will be very productive, they will attend work happy every day and this will result in a cost-effective organization, the turnover rates will be kept at low in the organization and will not have to be concern about training new employees and expending more money.

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The Witt movie is a very emotional movie and very intellectual because it reflects on a woman named Vivian Bearing is a literal, hardnosed English Professor who has been diagnosed with terminal ovarian cancer. During her story, she reflects on her reactions to the cycles of cancer takes, the treatment, and significant events in her life. The people that watch over her are Jason Posner, who only finds faith in being a doctor; Susie which is the nurse with a human side that is the only one in the hospital that cares for Bearing. Dr. Kelekian is the head doctor who wants results no matter what they are.

This movie gives people the truth about how some medical professionals treat their patients in the health field. Vivian is asked many times “how are you feeling?” so frequently and mechanically that it loses all meaning, and she remarks that she’s a bit sorry she won’t be able to hear herself being asked the question after she has just died. She is applying the analytical skills she honed as a scholar to her life, her condition and the health care system she confronts. As Vivian’s condition grows worse and her fear increases, she starts to question her assumptions about what matters in life.

Dr. Kelekian words see objective and rational, but are essentially euphemism when compared to the reality to human experience. He has many strengths by telling her what is going to happen after signing these papers but the one thing he does not budge on his putting her through pain. He wants to kill all of the cancer so he wants the highest dose of chemotherapy know matter what pain she is in. Since Kelekian is doing an experiment and using Vivian as the Gini pig she gets very sick and he has no empathy for her which is one of his weaknesses.

“Witt” has no interest in deifying the physicians, and who see it may object self- indulgence displayed by the research physician characters. The one person who cares and has many strengths is her primary care nurse Susie, who simply wants to provide Vivian with the care that is consistent with her professional obligation and with basic human decency, a goal which brings her into increasing conflict with the doctors pushing Vivian’s chemotherapy.

Susie care for Vivian like most nurses do because Vivian has no one else to take care of her. Vivian is facing quandaries and can no longer hide behind wit and intellectual games. Once She recovers slightly and tries to remain rational and detached, but only halfheartedly. Susie is there for Vivian during this hard time and giving Vivian kindness and comfort like being a family member, which Vivian has not had since her parent’s death but she accepts the love from Susie. Susie acknowledges her own non-intellectual nature.

John Posner, which is the student doctor has more weaknesses then strength. He tries too hard and comes off like he knows everything but with little care in his patient Vivian. He is former student of Professor Bearing, it is almost like he is uncomfortable around bearing. Jason is fascinated with cancer, that is why he decided to go into this field because it’s so powerful and mysterious in its unstoppable growth and science inability to understand it. He says that the endlessly replicating cancer cells grown in a lab are called “immortality in culture.” Vivian is trying to interact with Jason one-on-one personal level and talks about the important matters but Jason can still only see her as a specimen who might be experiencing certain side effect. His fascination with cancer shows his detachment from her being a human once again.

The doctors speak to Vivian in a detached manner, using medical terminology and careful phrases to avoid stating the fact of the matter, that she is going to die. Susie delivers the news in such a personal and compassionate way, as Jason or Kelekian certainly wouldn’t have been so comforting. Once Susie tells Vivian the news, Vivian makes a crucial decision that she wants to die, even if it means messing up the study and ruining her legacy as a “specimen” but Susie understands her decision.

Since I will be going into the field of cancer and a Nuclear Medicine Technologist, I reflect on this Video. I find this movie very touching and eye-opening on how medical professionals treat their patients. I have always been a kindhearted person and always willing to be there for people so I thought this field would be a good choice for me. After watching this movie, it has made me warm hearted through the tough times the patients are going through with their families. All I can do is listen and give them the most respect in treating the patient as a human being and not like a specimen.

An ethical theory that plays a part in the movie is when Vivian has the right to choose a DNR which allows her to withhold medical treatment if her heart stops from all the chemotherapy and she signs off on it without hesitation since she doesn’t have to suffer anymore from what she already is. Another ethical theory is decision making since she is the only one to make these decision with no family members to help her through this process, Susie steps in and helps her make her decision before it is too late. This goes in Vivian’s best interest and if she doesn’t make these decisions right away, the doctors will do everything to save her. Therefore, Vivian should have a written document with her healthcare proxy and physician orders for staining treatment.

One of the most touched ethical theories in this movie I thought was physician-patient relationship, the physician Dr. Kelekian decided what the right choice was for day one, which was giving Vivian the full dose of treatment. Another is the informative model when Dr. Kelekian gave Vivian all the info but in medical terminology; even though she is an English professor there are some words she did not understand and he only gave her facts but no values. I find her decision making based on a deliberative model for which Dr. Kelekian has persuaded her that this is the best treatment for her case.

In my opinion, there could have been many different ways of treatment for Vivian but Dr. Kelekian choose this in his best interest for his study in giving Vivian the highest dose of treatment and putting her through unbearable pain and discomfort leading her to want to sign off on the DNR so she can relieve herself through the pain and discomfort the medical staff have put her through. 

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Health care is a major concern in our society. In the rising technology, the Internet of Things (IoT) technology is the key technology, attracting everyone's attention towards it which totally revolutionizes the health care system. Internet of Things (IoT) technology has the potential to decrease the stress on the healthcare system mainly caused by an aging population and a continuous rise in chronic illness. The major objective of this paper is to study the background of the health care system and the convergence of IoT in the health care system. This paper mainly focuses on how IoT has changed the traditional way of healthcare monitoring in a smart and efficient way. In last a literature survey also be done on various IoT based healthcare monitoring system which shows that IoT sis a great revolution in the health care system. Keywords—Internet of Things, IoT I. INTRODUCTION The Health care system is a crucial part of our life. Unfortunately, the rising rate of the aging population and related increase in chronic illness has placed a lot of strain on the health care system.

The shortage of hospital resources from hospital beds to doctors and nurses is imminent worldwide and the cost of treating chronic illness is continuously increasing. Obviously, a solution must be required to decrease the load on the health care system and also make it offer high -quality service to patients at high risk. One of the potential solution to alleviate the strain on the health care system is the adoption of the Internet of Things (IoT). Internet of Things (IoT) is a network of devices that connect all the devices directly with each other in order to capture and share vital amount of data through a secure service layer (SSL) and making it possible to collect, record and analyze a new data stream extremely accurate and faster. The idea of connecting devices directly with each other is given by 'Kevin Ashton'. Realization of the IoT concept into the real world is possible through the incorporation of several promising technologies such as Identification, communication and sensing technologies can be integrated with IoT. In IoT, Radio Identification Tag (RFID) can be used to uniquely identify and monitor objects in real time and wireless sensor network used for communication and sensing purpose.

After applying the principles of the Internet of Things (IoT) in health care, it may improve access to services, increase the quality of service and importantly reduce the cost of providing health care service. The concept of 'Smart Healthcare' can be considered as the sub-system under 'Smart City' and has attracted extensive attention now a day. A lot of research has been done in healthcare monitoring and controlling, interoperability and security, big data analysis and management, pervasive healthcare and sensing etc.

Despite of all existing successes, technical challenges and uncertainty issues still exist which should be handled to deploy an intelligent IoT based health care system. In this paper, we summarize the background and advancement of the state of art studies in IoT based health care system and to provide a systematic review on IoT enabling technologies and smart health care devices. This paper also focuses on the major components of IoT based health care system and the methodology used for the implementation of IoT based health care system. In last a literature survey also be done on various IoT based health care monitoring system and a comparison must be made which show the major difference between traditional and IoT based health care system. The structure of this paper is arranged as follows: Section 2 briefly describes the background details of health care along with IoT convergence. Section 3 focused on enabling technologies such as identification, communication and sensing technology and smart health care devices. Section 4 presents the major components of IoT based health care system. Section 5 explains the implementation methodology of IoT based health care system. Section 6 provides a literature survey on various IoT based health care system. Section 7 discusses the conclusion and future study.

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Medical Expenses are outrageous, Children, adults and people all over the world are dying and losing their lives because of the prices of medication. Epi pens, insulin, and medication in general are very expensive. Insurances are paying most of the expenses, but most people are having to pay hundreds, or even thousands of dollars for medication for their families or themselves.

Americans desire a high quality of life and insurers/employers are trying to provide the means, but cost effectively and without raising costs. In order to do this, “consumers will have to make more decisions,pay more and perhaps demand greater quality. (Barr, Paul). The common forces driving utilization and costs are medical technology advancement, demanding consumers and aging population. For much too long, American pharmaceutical companies have been getting away with overcharging American citizens. Canada, France, the United Kingdom, Germany, Japan and Italy have all negotiated pricing with pharmaceutical on behalf of the citizens for lower-price on brand name drugs. Due to the negotiated prices, the citizens in these countries pay significantly less for prescription drugs, which substantially reduces the total medical cost with these countries.

In the United States, corporations, employees, and economy are affected stakeholders. There are three issues when it comes to the health care cost rising. The first is the rising cost in prescription drugs. The second area of rising cost is the increased technologies when it comes to the medical industry. More and more people with medical insurance are relying on the healthcare system as new technologies and treatments come available. This leads to a greater number of claims for payment insurance companies, the costs which are paid back to health care consumers. Most innovative and branded drugs in the market are protected by patients, and this is obviously an obstacle to the market entry of generic drugs. Moreover, most doctors are not responsible for providing patients with drugs, so they would not have motivations to prescribe low cost drugs. This causes the drug cost to be higher. As drug cost keeps rising, the government and pharmacy are still raising prices higher and higher today.

The United States is the only state that has the highest medical expenses and are struggling to resolve the issues of health care system for decades now. Looking at the history of previous policies, all issues have stemmed from one major common factor, the cost of health care. Therefore, the reshaping of the health care system can only be effective by improving the affordability and quality of coverage for those who are currently insured.

Most people in the US say that participating in yoga may take away the medication and maybe help the prices decrease. Yoga helps people relax and feel at peace with a subtle feeling of stimulation. Medication is harsh on the body and some people overuse their privileges of getting medication. There are people out there paying thousands and thousands of dollars for chemo and radiation to stay alive and other people are taking advantage and overdosing. More than 72,000 people overdosed in 2017, there are no telling how many more people have overdosed in 2018. People are paying to fight for their lives and over people are paying to lose theirs. The US needs a law where you have to have a real problem before you get prescribed medication, most people just want it to sell and make money off of.

Medication effects all of us, wherever we live and whatever we do. The problem can tear apart the family structure and make it hard for learning. Difficulties on the job due to drug abuse make it hard for the United Stated to keep businesses open. The world is having problems with drugs and marijuana today. People abuse the use of what they have. Oklahoma just recently legalized medical marijuana and i think it’s great if it’s used for the right reasons. People don’t need to walk and say there back hurts and get an unlimited amount from the doctors. Medical marijuana should be used for Cancer and ADHD medication substitution. It will be a lot cheaper on people if they do that. Chemo and Radiation are the most expensive medications and they are the most important things to keep people alive today. Epi pens, and insulin are the highest things to keep the kids alive, people are prescribed this stuff everyday.

In conclusion, Medication expenses are overpriced and the US should definitely think about getting the prices lowered. Epi pens, insulin, chemo and radiation, are the things most needed to keep people alive who are dying. The people who are disabled and on social security should have it easier for them, the people who are disabled from war shouldn’t have to pay for the medication if they live in a military home. People deserve medication expenses to be cheaper. 

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There are many things to look into when making a health care decision. Some of these include brand name and generic drugs, managed health care, experimental drugs, and orphan drugs. Each of these topics come with their own ethical issues and cultural issues. These factors can make a big impact on a patient’s life. Before making a choice, it is suggested to do research on these issues and topics so the patient can be well informed before making a choice. Disregarding this will result in a choice that may conflict with their ethical and cultural beliefs. With new development and technology as well as constantly changing healthcare laws, these topics are always going to be changing and never remain constant so it is also a good idea for the patient to remain informed continually. Doing this will prevent a patient from making a conflicting choice in the future.

Background

History of Managed Health Care

Managed health care as well as health insurance are created in the 20th century. In which they were not called “insurance” before, but rather “prepaid health care” (“Intro,” n.d., para. 1). It was a way of accessing and paying for healthcare services rather than protecting against financial losses. From its humble beginnings, this set of arrangements is always changing with the occasion of turbulence. From 1910 to the mid- 1940s were the years before World War II. It is where two models have been created providing and paying for health care instead of the patient just paying for the service themselves. The first model was relied on an organization that

was capitated and also provided services directly through its facilities and personnel, resulting in combining the functions of financing and delivery (“Early Years”, n.d., para. 1). What this first model is now called a health maintenance organization or HMO. The second model was the early Blue Cross and Blue Shield plans, which paid for services provided by contracted community doctors and hospitals which also regularly served patients who are not covered by these plans (“Early Years”, n.d., para. 1). In the beginning of 1960, Part A of Medicare was proposed. It was financed through taxes on earned income that was similar to Social Security and was intended to cover mostly hospital services. Later on, Part B of Medicare was installed that is proposed to cover physician and related professional services as well. It was financed through a combination of general revenues and enrollee premiums (“The Onset”, n.d., para. 1). Medicare and Medicaid evolved into benefiting more low-income populations. The combination of Medicare, Medicaid, private insurance, and medical care resulted in the majority of health care being paid for by third-party payers. The third-party payment system is the financial link between the

provider of the service and the patient, however that fostered increases in both the price of services and their utilization (“The Onset”, n.d., para. 2). With health care cost increases, HMO have also been on the same rate because Medicare beneficiaries had option of enrolling in HMOs, which were to be capitated by the Medicare program. The growth of HMOs led to the development of another type of managed care plan: preferred provider organizations or PPO (“The Rise”, n.d., para. 14). People covered under the PPO faced lower cost sharing if they saw a PPO provider rather than a non contracted provider. The difference between HMO and PPO is that PPO benefits did not require authorization from the patient’s primary care physician also known as PCP to access care from specialists or other providers(“The Rise”, n.d., para. 15). While managed care grew rapidly, traditional indemnity health insurance declined changing the U.S healthcare system.

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Pharmaceutical companies play an important role in healthcare. They are able to convince people and medical facilities that every drug formulated helps cure a certain sickness. People need the drugs in order to survive after seeing a doctor. Drugs that are formulated are made to treat and cure sickness and diseases. One major healthcare topic that is an issue of the healthcare financial policy is rising cost of pharmaceutical companies has become a concern for citizens. The price for prescription drugs is too high and continue to increase. Due to the high cost of prescription many people are not able to afford for their drugs. Some people who are unemployed or have no health insurance are unable to afford for their drugs. The purpose of this paper is to understand how the rising cost of prescription drugs has an impact on healthcare and citizens. Also, the purpose of this paper is to understand how the rising cost of prescription drugs became one of the major issues of the healthcare financial policy.

The pharmaceutical industry is part of the healthcare sector that manufactures medication. Medication is prescribed by doctors to individuals who are sick. Pharmaceutical companies manufacture generic and brand name drugs. Brand name drugs are being more advertised and to be more efficient. Brand name drugs are increasing and driving force for-profit for pharmacy industries. In order to get to make profit, the industry began to market and advertise their drugs. They began with commercials and directly advertising the drugs to physicians and medical facilities to prescribe to their patients. In the healthcare industry, adverting drugs on television and to medical offices is a good strategy pharmaceutical companies can use. Patients become more “knowledgeable” and curious about their options of medication and demand their physicians to prescribe them the medicines advertised on television. Physicians and pharmacies also fall for advertisement of the drugs. Due to growth and long-life expectancy of aging population and increasing healthcare demand, and of increased demand and access to healthcare, pharmaceutical industry continue to grow a profitable. According to Glode & May (2017), the reason for high cost of prescriptions is due to research, development, longer clinical trials required to achieve drug approval and the manufacturing of the drugs.

Medication have become very expensive for individuals to be able to afford. Even with health insurance, they do not cover for the cost prescriptions. Also work companies do not also cover a large chunk of healthcare for their employees. Employees have to pay out of pocket for their healthcare and medication. Due to the expense of healthcare, many are not able to pay for prescriptions referred to them. Seniors are the ones who are more affected by the rising cost of medications.

Many medications that are once advertised as FDA approved and safe later become a drug that is harmful, and the industry can be sued. Even though, pharma companies are being sued, they continue to advertisement new drugs and make profit. In 2006, the U.S. Food and Drug Administration approved drugs put that should not have been approved. “A program designed to bring so?called grandfathered medications up to speed with modern safety and efficacy standards. These included 5000 medications that came to the market prior to the 1962 Kefauver?Harris Amendments, which required that drug manufacturers disclose efficacy and side?effect information, a regulatory change spurred by the thalidomide tragedy” (Flannery at el. 2017). When research is conducted on the drugs to make sure it is safe and effective, the drugs prices increase. Also when there is a shortage of medication or not enough medication is formulated than the prices skyrocket. Medication that are scarce are sold at a high cost. The pharmaceutical companies always have a tragedy on how to make profit from the economy. According to Flannery at el., in 2012, the United States spent $328 billion in overall pharmaceutical sales, which was double that of France, Germany, Italy, Spain, and Britain combined (2017). Also in the free market economy, prices for goods and services are determined by supply and demand of the medication. The price of a pharmaceutical drug increases due to demand by individuals and healthcare providers. Patients who are sick need the medication for survival. Individuals have no choice but to purchase the medication. Medication is also helping individuals live longer and because of that there is more demand for the medication. When companies are not regulated by the government prices can increase. There is no price control.

Cancer and ICU medications are very expensive. Cancer medications must go through research and trials to make sure it is efficient and not harmful. Medication for cancer continues to increase because there is different medication always being researched and clinically trialed for its efficiencies. “In the United States in 2015, the total cost of oncology medications rose to $37.8 billion from $15.9 billion in 2010. The costs for protected brand?name drugs increased by $9.6 billion due to broader use of these agents and increasing prices. From 2010 to 2015, generic oncology drug costs rose $1.5 billion, which equates to 10% growth in this area (Glode & May, 2017). Rise of pharmaceutical drug has a negative effect on individuals because they have to save or find options on how they can afford for their medications. It puts strain on the economy. Older medication has increased in price due changes in the generic market and has become frustrating for health care professionals and their patients (Chumock, & Vermeulen, 2017)

According to Koons 2015, prescription drug expenses are nearly 20 percent of health care costs. In healthcare, Prescription spending is growing faster than any other part of the health care. There is more money invested into prescriptions. Well known drugs that were once low in pricing began to increase as well. In 2014, the largest yearly increase with prescription drugs of 13.1 percent. There was a 30.9 percent increase due to the demand of specialty drug. In 2015, spending rose another 12.2 percent (Koons 2015). In 2017, there was 44 percent Specialty drug. Spending on 10 breakthrough drugs alone will cost just three government programs nearly $50 billion over a decade. In 2013, AARP report shows the annual income for specialty prescription drug therapies in 2013 averaged $53,384. Prescription drugs are costlier than the average income of households. The median US household income ($52,250), median income for Medicare beneficiaries ($23,500), the average Social Security retirement benefit ($15,526). The average income for Americans is less than what prescription drugs cost. Over the past five years, specialty drugs have increased by $54 billion (Koons 2015). Specialty drugs are medication that require special handling, administration, or monitoring. They are medication such as cancer, asthma, HIV prescriptions. These drugs are always in demand. Spending on specialty medicines account for 73 percent of all medicine spending growth. “Four of the top 10 prescription drugs in the United States have increased in price by more than 100 percent since 2011 Pfizer Inc., the nation’s largest drug maker, has raised prices on 133 of its brand-name products in the United States in 2016, according to research from UBS, more than three-quarters of those were increases of 10 percent or more” (Koons 2015).

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Over the years, the healthcare industry has always relied heavily on the use of paper records. However, various governments have vigorously encouraged the use and expansion health information technology (HIT) and transition from paper to electronic health records (EHRs)(Glaser, 2010). The United States government has a very high population of people going to prisons, amounting to 5%of the total prison population globally(DesRoches, Audet, Painter& Donelan, 2013). The imprisoned individuals are usually from low-income areas hence are victims of substance abuse, addictions, mental illnesses and other chronic conditions. Historically, due to the segregation of the prisoners from their local communities, people have failed to see jails as sources of healthcare provision. Nonetheless, the county and local jails have taken it upon themselves to implement health information technology systems that are cost saving, efficient, coordinating care and improving on public safety and public care(Goldberg et al., 2012). The use of EHRs is mainly aimed at replacing the outdated paper recording systems and increasing connectivity with healthcare providers. Introduction of HIT and EHRs in prisons will improve both the medical side and information safety side of the jail systems.

Ensuring patient information security and privacy in jails has been an issue in the past years. Lack of information necessitates the introduction and implementation of HIT and EHRs systems in prisons. Fine imposition on offenders, legislation, media attention and consumer advocacy have not effectively put the issue to an end. However, positive strides can be made through the security measures associated with the role played by the HIT and EHRs (Crosson et al., 2011). Health information technology can help these jails in establishing security systems that will make it difficult for hackers and unauthorized people from accessing patient information. Establishment of the HIT systems will be designed in such a way that thieves and hackers will find it hard to get the information, but the legalized users will be able to get the information with ease and later lock the systems (Bredfeldt, Awad, Joseph &Snyder, 2013). Such security steps will significantly reduce privacy breechings, cyber-attacks, and other possible legal implications. Most importantly, the transition to electronic health recording will put to an end stealing of patient documents thus security and privacy of patient information will prevail.

Paper records limit the communication between providers that work in other locations or settings and are more commonly said to be insufficient. If a jail’s records are all stored in one place, an inmate can easily access someone else’s file HIT can help improve this problem with its technological features. The need for a patient’s medical information can be efficiently sent with just a click of a button, instead of going through numerous files and then mailing or faxing it to another location. If implemented correctly, EHRs can help providers treat people accordingly as they return home from prison or jail. Even people such as transition planners can utilize the EHR system with other compatible electronic systems to help administer social benefits to prisoners who might need the necessary support when switching over back to the community after incarceration. EHR’s in prisons will be a more cost effective resource for treatment. The need to control healthcare cost has always been an ongoing debate within society. Several factors affect the cost of healthcare in jails, the rising increase in the incarceration population, the occurrence of mental illness, and the steady expand in pharmaceutical drug cost.

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In the Intelligent Hospital Pavilion ICU video, Dr. Neil A Halpern showed the latest technologies and how important advanced technology can have an effect on the patients. The advanced technology can contribute in improving patient care, reduce in costs, improve patient outcome, and the benefits it will have on the health care professionals. According to Dr. Neil A Halpern, he emphasized how patient safety is important in ICU. It is important as a nurse to avoid any unexpected and unattended harm for the patient. Providing patient safety is critical and providing a safe environment. It is important that all the machines work properly in order to prevent errors. Nurses spend the most time with the patient and Dr. Halpern mentions that advanced technology plays a role in delivering care in the ICU. It is critical as a nurse to be able to learn all the new advance technologies in order to reduced improve safety and reduce errors.

Nurses must be able to maintain patient’s privacy. Dr. Halpern explains different ways in which privacy can be achieved and manages. the video showed the use of the E-glass which is used in the hospital for the separation of one patient to the other. It enabled the health care staff to make sure patients’ privacy and information was kept confidential. The E-class is a great tool that should be at every hospital because it changes color, and no one can see through it. When patient has procedures or are taking a shower or using the restroom, this provides privacy and respect for the patients. Dr. Halpern mentions that the E-glass promotes better cleanliness because a curtain can harbor bacteria and needs to be switched with every patient that comes in. ensuring privacy is beneficial to nurses and to the patients, it provides respect for inherent human dignity (American Nurses’ Association)

Another beneficial technology that is being used in the ICU is the lung sonography which has replaced the stethoscope. This machine is used in the ICU and collects data in real time and is a component of the physical exam. The machine provides accurate information and in helps the physicians and nurses to make a judgment on the patient’s condition. It has reduced and improved the quality of treatment and even reducing mortality and morbidity. Another great technology that is used is an infusion pump that is used to deliver medication in a controlled amount. This is critical device that can reduce medication errors in hospitals.

Critical care is starting to develop advance technologies that will benefits the healthcare professionals as well as improving patient care. Advance technology can be live-saving but can also put some patients at risk. Nurses are relying and spending more time on the machines and less time with the patient, which can lead to missing a change of symptom for the patients. Another negative aspect of technology is that nurses can become “alarm fatigue” and become desensitized due to the frequent ringing of the alarms. The nurses start to ignore them and not respond to them promptly. Another errors that can happen is medication administration errors when using an infusion pump. Nurses can often mistype and enter the wrong medication and can lead to a fatal mistake.

In today’s world of advance technology, it is important to ensure the best possible patient safety. In years to come, hospitals especially in the critical care departments will follow in ensuring highly advance technologies in order to improve patient outcome. It is critical that the nurses do not rely on the machines to do all the work and make sure they are assessing the patents in order to be involved in the patient care. Nurses need to be getting trained and educated every time they are a new device in order to keep up with the new technology devices.

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According to Jacobs, Shepard, and Stone those whose primary language is not English are less likely to use a source of primary care and less likely to receive preventative care (Jacobs, Shepard, Stone, 2004). One study found that infants of parents whose primary language was not English were half as likely to receive all recommended preventive care visits compared with infants of parents whose primary language was English (Cohen & Christakis, 2006). Language barriers have been demonstrated to result in lower participation in cancer screening programs: breast cancer screening, cervical cancer screening, and colorectal cancer screening (Alexandraki & Mooradian, 2010; Ayanian et al, 2005; Fang & Baker, 2013).

Mental health care relies heavily on language to appropriate treat mental health diseases. Older generations of immigrants with limited English-speaking skills present with high rates of mental health disorders but are also less likely to seek help. (Kim et al., 2011). Managing a patient’s pain is also an area effected by language barrier. Patients who unable to effectively communicate the amount of pain they are in are less likely to have it managed effectively. Jimenez reported obstetrical patients who receive interpreter services are more likely to report better pain control and treatment than those who did not receive an interpreter (Jimenez et al., 2014).

One area of concern with language barriers is chronic illness management because the patient will experience symptoms either longer term or for the rest of their life. Leaving them unmanaged can further exacerbate the disease and possible lead to preventable worsening health conditions or death. Using diabetes as an example, there is a lot of important information involved with managing this chronic illness. Knowledge of diabetes management includes knowledge of diet and exercise, both of which aid in lowering blood sugars. A diabetic patient must also know how to check their blood sugars as well as how often to monitor for elevated or low blood sugars that could lead to more health care issues or life-threatening situations. According to studies about language barriers and diabetes, all of these areas are shown to be deficient when compared with English speaking patients (Detz et al., 2014; Fernandez et al., 2011; Karter et al., 2000).

Informed consent for care or a procedure is very important in health care. The provider needs permission from the patient who fully comprehends all aspects of the care or procedure they are receiving. A procedure such as surgery requires that the surgeon explains the reason for the surgery, the steps of the surgery, medications being used, as well as the post-operative symptoms and potential risks. A patient with a language barrier cannot give informed consent if they do not understand everything the surgeon is saying. A study by Schenker showed non English-speaking patients were less likely to have documentation of informed consent for invasive procedures such as surgery (Schenker et al., 2007). Another study showed it was unknown if patients with limited English skills who were not provided an interpreter received adequate information for them to be considered informed (Hunt & de Voogd, 20070).

A safety concern for patients with a language barrier involves medication errors. Patients without interpreter services are at risk for misunderstanding medication administration instructions, will less likely take their medications consistently as directed, will have inadequate symptom management, and are at risk for further complications (Dilworth et al., 2009). In one study conducted, evidence showed Spanish speaking patients were more likely to experience a dosing error than English speaking patients (Samuels-Kalow et al., 2013). ?

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Health care systems around the world are transitioning to new business models in order to improve patient care and operating efficiencies. The pressures on providers to find new models are significant, particularly for patients with chronic diseases— such as diabetes and cardiovascular disease—which now account for 60 percent of deaths globally.

New drugs, devices, and personalized therapies, along with innovations in delivery systems, all offer new approaches for the treatment of a wide range of chronic conditions. These innovations include digital tools and technologies such as

1) Traditional electronic health records (EHRs)

2) Data- based integrated diagnostics platforms

3) Cloud-based patient monitoring systems

4) Wearable sensing mobile devices

Health systems are applying more powerful analytic technologies—including artificial intelligence approaches such as machine-learning algorithms. And researchers are not just unlocking medical data—they are also “re-envisioning” how such data should be collected and applied.

Across health care today, data-driven analytics is a deep foundation for measuring and improving outcomes, minimizing variations in care, and demonstrating its value. To reach these benefits, health systems should seek to align stakeholders on value, bring predictive and prescriptive analytics to personalized care, and further engage and educate patients in their own care.

Done properly, efforts that integrate evidence-based data and sophisticated predictive analytics can identify patients for targeted interventions and improved health behaviors, and allocate resources more efficiently and effectively. The results will include a more effective health system, lower costs, and, most importantly, improved patient health.

CBMG may collaborate with YDY in three areas:

1. Develop infrastructure to incorporate electronic health record (EHR) specific for cell therapy and gene therapy.

2. Query the incidence of the cancers of CBMG interest from the EHRs, with additional clinical and demographic variables (e.g., gender, age, race, zip code of the home address, medication/clinical intervention, cancer stage, primary cancer location, etc), to facilitate patient recruitment in CBMG clinical trials.

3. Work with YNY using Cloud-based patient monitoring systems and remote device to monitor patients and improve care and reduce cost.

4. (Research purpose and also a case study to test infrastructure to be developed.) Incorporate environment variables with EHR. For example, season, weather, temperature, air pollution, pollen count, longitude, latitude, altitude, water quality, etc. We may apply Machine Learning approaches to study:

a. Factors associated with the epidemic diseases.

b. Disease incidence rates are increased by smog.

5. Collaboration with the Million Genome Project (MGP)

UK has completed the BioBank project, a large prospective cohort study of ~500,000 individuals. Many other countries are or going to carry on large genome projects in the similar scale. The MGP is an important project to improve health of Chinese people, which should be launched by Chinese government in the near future. It certainly is an intriguing opportunity for CBMG to get involved in the MGP. CBMG may 1) gain early access to the genetic/genomic data; and 2) establish partnership with other stakeholders in the areas of CBMG’s interest such as hematologic cancer, lung cancer and HCC. This project will need extensive discussion on the top line deliverables and many details that are key to successes.

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Did you know that healthcare in america can cost you up to 10,000 dollars? This is why I think healthcare should be free. Did you know in 2013 the average person spent 8,713 dollars on healthcare and 16 percent of u.s people had healthcare. Also if you need a liver transplant you better have 500,000 dollars cash because that's how much it costs. The change that needs to be made is making healthcare in america either free or much more cheaper. The costs of a transplant surgery can cost much more than you would ever expect. The total cost for a liver transplant from 30 days before the transplant was about a average of average $577,000.00, which is a big financial concern for the healthcare system, If you would need a liver transplant you would need all the money in cash. The cost of a heart transplant can cost you up to 1.4 million dollars that is more expensive than the world most expensive car. If you needed your lungs to be replaced those would be $862,000 each. Bone marrow would cost you $893,000, Your intestine would cost $1.1 million. This is why I believe healthcare should be free because no one should have to pay this much just to live another day.

The total number of people with healthcare in the united states are in 2014, 283.2 million people in the U.S., 89.6 percent of the U.S. population had some type of health insurance, with 66 percent of workers covered by a private health insurance plan. The OECD found that in 2013, the U.S. spent $8,713 per person or 16.4 percent of its GDP on health care that would be 2,465,779,000,000 if everyone paid 8,713 dollars. In my opinion that is so much money the government has so much money they could put aside for hospital bills and ect. Half the people in the united states could maybe not afford this type of healthcare insurance. This is to expensive for just a regular person!

Healthcare for uninsured immigrants is free but not for all. Nevertheless, rough estimates suggest that the nation's 3.9 million uninsured immigrants who are unauthorized likely receive about $4.6 billion in health services paid for by federal taxes. But the people who are born in the united states have to pay for there health care. All told, Americans cross-subsidize health care for unauthorized immigrants to the tune of $18.5 billion a year this is totally unfair if they get it free everyone should get it free why do they only get it for free and not everyone. The government has enough money to do this but they do not. The government is worth $269.6 trillion and they don't pay for healthcare for all. In total, federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016.

The argument that I am trying to solve is for healthcare to be free for everyone in the united states of america Did you know that healthcare can cost up to 10,000 dollars a year. 89.6 percent of people pay for healthcare wouldn't you want them to get it for free.

In conclusion healthcare in america is to much money and hard to afford I would want healthcare in america to either be free or more affordable for the average person because the state that its in right now is way to much money. SO what if it is free to some why not be free to all! 

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Healthcare in the United States is at a crossroads regarding cost. The US spent approximately $5267 per person on health care in 2002. Switzerland, the second most expensive health system, spent $3445 per person on healthcare, representing two thirds of the U.S. amount. Norway, Canada, and Germany, representing the third, fourth and fifth spent less than 60% that of the United States according to their 2002 health expenditures per capita (1).

Health care costs have also been on an upward trajectory. In 2016, U.S. health care costs were $3.3 trillion representing one of the biggest industries in the US with 17.9 percent of gross domestic product (GDP). In comparison, in 1960, health care cost $27.2 billion, a mere 5 percent of GDP. On an individual metric, in 2016, individual annual health care cost was $10,348 versus just $146 per person in 1960(2). Underlying this increase in healthcare spending is the rapid growth in cost in prescription drug cost which represented $326bn in 2016, a 1.3 percent increase from 2015. Additionally, physician and clinical related expenditures have been growing; representing $665bn in 2015, a 5.4 percent increase from 2015(2).

Despite the cost of healthcare in the US, population health outcomes are subpar(3). According to a Harvard population health study, the US had the poorest population health outcomes lowest life expectancy among organization for Economic Cooperation and Development (OECD)countries 78.8 years compared with a mean of 81.7(4). Additionally, outcomes varied across states with life expectancy across the United States ranging from 81.3 years in Hawaii to 75 years in Mississippi(4).

The United States also had the highest infant mortality at 5.8 deaths per 1000 live births compared with an OECD average of 3.6(4). The United States spent approximately twice as much as other OECD countries on health care, yet had similar utilization rates compared to other OECD countries(4). Clearly, something is amiss in the system and various stakeholders are embarking on initiatives to reengineer the healthcare system to reduce excessive spending and improve patient outcomes.

COMPLEXITY IN THE US HEALTHCARE SYSTEM

Understanding the key players and challenging dynamics within the US healthcare system is imperative to solving the problem of high cost and low value. Firstly, each dollar spent on health-related services is an expense to payers and revenue to providers. Payers are incentivized to reduce the dollars they pay for healthcare services and to maximize profit(5). Providers and suppliers want to increase the dollar amount of healthcare services and are less concerned about profit and adhering to business models in healthcare. Patients want to receive adequate care while reducing wait times and administrative or insurance hassle. In summary, payers aim to contain costs while providers and the pharmaceutical industry resist cost containment (5). Balancing this dynamic is the fundamental battle in the US health care economy.

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