Affordable Health Care

Do you really have an idea how essential affordable health care is for every American citizen? Affordable health care ensures appropriate medical care facilities so as to keep the future of progeny secured beforehand. Nothing comes easy as it seems to be and affordable health care is too distant a dream. Most of the medical treatments are just not in consonance with the size of an average American’s pocket. In such dire conditions what one needs is an affordable health care which entitles you to have secured back up whenever your family requires proper medical attention.

Even if you seek a simple body diagnosis, then do not expect best health care because the cost would drain half of your month’s salary. What would be the case if you have to undergo some major medical treatment, you will end up taking medical loans which will be a liability on your children in future. Spare yourself from such atrocities of medical expenses and resort to an effective affordable health plan which takes cares you health.

In such conditions it becomes essential to find out ways for best health services. Instead of waiting for expenses slashing down to ground you can opt for following steps

* Prescription drugs are indeed effective ones but you can ask chemist to provide you a cheaper alternative for the same prescribed medicine. Do not fret; cheap prices have nothing to do with the quality of drug. It’s just that few brands have high cost and some others offer the same stuff in lesser prices offering you an efficient health care service.

* If you are really looking for an alternative, you can buy over-the-counter drugs as well. These are cheaper and the difference lies just in their packaging and pricing.

* Almost every town has a medical school. Go to medical schools as they offer affordable health care that would not step up your budget.

* If you seek routine check up, then instead of trundling to a hospital you could simply wait for next community health fair. Doctors, nurses, and technicians are experts and can provide required health care service in an efficient manner.

* If you really looking for alternative, try avoiding weekend stay in hospitals as much as possible. Since on weekends most of the medical institutions are closed and ones that are open demands hefty fees. So, Monday would be a far better option for an affordable health care.

* One of the best way to ensure best health services is to check for affordable health insurance plan which would cover your all medical expenses. Make sure you apply in-person to have clear idea of what is at stake.

* Lastly, affordable health services can be acquired if you will scrutinize your medical bill for hidden charges rather paying it immediately. Medical bills are mostly in the form of codes, figures, and accounting which none except medical practitioners can decipher. It should be your motive so better tally the invoice with what all services you have received, negotiate on charges incurred, and bargain enough. This is up to you to turn your expensive treatment into an affordable health care

Health Care Plan is Important

The Obama health care plan, whether you believe in all of it’s tenets or not, is one that at least gets us pointed in a direction. Putting it another way, the cost of inaction will drive us even further into a country that cares more about political lobbying than the real needs of our people. It’s important to really understand what Mr. Obama’s health care plan is about in order to make a fair judgment one way or the other.

I’m a small business owner without the comforts of a big company medical plan. Fortunately for me, my wife IS employed by a large company and we DO have decent, not great health care. But, what if neither of us had this luxury? I was with two of the largest technology companies in the world, Oracle and HP, but was eventually laid off some years back, like so many other unfortunate individuals.

The Obama health care plan is trying to fix some serious flaws in it’s system. I recently visited a terminally ill college friend of mine. He was initially denied even a visit to the hospital. He finally got approval and was diagnosed as having only a few weeks left to live. His family then lobbied to have insurance over his cost of home care to live out his short life in dignity and quality. Now, it has been proven over and over again that home care for the terminally ill saves money and provides for a much better quality of life than a hospital stay. Why deny someone this option?

We all recognize that employers are struggling during these tough economic times. And, costs of hospitalizations and the like have increased over 100%, but consider the options for no health care reform. It will continue to be pushed out to the next generation and then the next. The answer then would be to burden our children and our children’s children. Is this the legacy we want to leave behind?

The Obama health care plan really is about a few key tenets. Probably the most important component to me is that of preventative health care. This hot button is debated amongst so many people. On the one hand, the bloated medical systems want to care for you only after you come down with an illness. Wouldn’t it make more sense to prevent the illness in the first place? Things such as quality screening to make sure you are exercising regularly, eating properly, etc. Wouldn’t you rather stay well, rather than go to the hospital when you’re sick?

Another key component of the health care plan is around the use of technology. The US is one of the few developed countries that really are a leader in this area. How is it possible that we cannot figure out how to fix our antiquated medical reporting system? Transportable medical records would reduce errors, increase efficiency and save all of us money! Why can’t the doctor that I saw for my dislocated shoulder 10 years ago be able to easily share that information to my new doctor who’s treating me for arthritis? An efficient sharing and collaborating of medical records would allow for a better health experience for the patient.

Finally, competition in insurance coverage is a serious flaw in our system today. The Obama health care plan is target to correct this problem. Why should a few insurance companies make the bulk of the money? If there is little to no competition, there’s no way to know whether you are getting insurance at competitive rates and whether the quality of care is at its highest.

The real answer to the debate on the Obama health care plan, though, is the cost of INACTION. We all know that the health care system is severely broken. Let’s make a step forward, instead of lobbying to take two steps backward.

Lean Methodology in Health Care Quality

Lean production (Lean) is a type of quality improvement methodology which has been implemented in many industries. Its principles and practices also have been applied to health care organizations with success. This has been accomplished with refinement for the nuances of health care. Lean is a process management philosophy which has its roots in manufacturing and technology. It was developed as part of the Toyota Production System for the process assembly of automobiles (Toyota Motor Corporation, 2009). The Toyota System is comprehensive and spans a large number of methods and practices. It was initially influenced by the work of W. Edwards Deming and Henry Ford and was also inspired by innovation in the American grocery store industry of the 1950s (Keller, 2006). This is reflected in the Just-in-Time philosophy of productivity improvement, which emphasizes producing quality products efficiently through the complete elimination of waste, inconsistencies, and unreasonable requirements (Toyota Motor Corporation, 2009). Though the Lean methodology was initially developed as part of an overall system focusing on the production of automobiles, its principles also have been adapted for health care. As certain case studies indicate, Lean thinking and tools have been successfully applied to specific health care settings. The scope and value of Lean production within this field will be explored in this paper.

Significance:Value

A significant component of Lean is the concept of value: the theoretical concept of value, the measurement of value, and the tangible processes behind delivering value. Lean is unique in that it accounts for the reduction of waste in order to achieve both real and potential value. Recovering this value can present itself in the form of saved costs or other tangibles. Lean thinking dictates that the expenditure of resources for any purpose other than delivering value to the customer is considered to be wasteful. The reduced expenditure of time, money, and resources is thought to bring additional bottom-line benefit to the customer. The customer-centric focus of Lean thinking is especially relevant to health care. Broader levels of patient/customer satisfaction are constantly being sought. This mode of thinking has been brought on by increased competition among organizations and the need to differentiate services. It is recognized that providing complete customer satisfaction can be vastly beneficial to health care organizations. Customer satisfaction can be an equally important measure of an organization’s performance as the delivery of quality health outcomes. This is a factor which is exemplified in Noriaki Kano’s model. Lean thinking dictates that processes and methods must be efficiently optimized with the needs of customers in mind in order for organizations to be fully effective.

Problem Addressed: Waste

Lean focuses on the maximization of process velocity through the reduction of waste. It provides tools for analyzing process flow and delay times at each activity in a process. The focal point is the separation of “value-added” from “non-value-added” work. This is complemented by tools which aide in the identification and elimination of root causes of non-valued activities. The primary problem addressed by Lean is waste, which can affect value in a number of ways. It may result in lower quality products, higher costs, less favorable customer experiences, excessive time or effort expended to complete goals, or fewer resources available for innovation which could provide potential value at a future date. Waste can be found in people, processes, tangibles, and other areas. Eliminating waste through the lens of Lean production can help to achieve the goals of health care organizations. There are eight generally identifiable centers of waste: overproduction, waiting (time on hand), unnecessary transport or conveyance, over-processing or incorrect processing, excess inventory, unnecessary human movement, defects, and unused employee creativity (United States Army, 2009). There are variations on these categories of waste depending on the setting or industry. For the purpose of health care Caldwell (2005) slightly refines these measures into seven categories of waste. These consist of “in-quality/out-of-quality staffing or overcapacity, overcorrection, over processing, excess inventory, waiting, motion of patients or staff, and material and information movement (Caldwell, 2005, p. 46).” Regardless of the differences in terminologies used, there are common centers of waste in health care which can be targeted for elimination. These can be identified through Lean processes which focus on root cause analysis.

Process: Root Cause Analysis

A crucial process in Lean is the identification of waste through root cause analysis. Root cause analysis in Lean involves a method called 5-Whys (Toyota Manufacturing Kentucky, 2003). This method rapidly identifies root causes and aides in determining the relationship between multiple root causes. It can be learned quickly and does not require statistical analysis. This method is especially effective for an implementation team in the initial stages of problem exploration. The application of this strategy involves asking a series of why-related questions to drill down into a problem area. Asking progressive questions about a perceived difficulty forces team members to think critically about the actual sources of waste and inefficiency. It is suggested that at least five questions (5-Whys) are posed to arrive at the root cause, though a root cause may be discovered in more or less inquires.

The following is an example of a 5-Whys exercise used in a hypothetical hospital setting:

(Q1) Why are patients being diverted to neighboring hospitals?

(A1) Because wait times for our hospital are exceeding industry norms.

(Q2) Why are our wait times exceeding industry norms?

(A2) Because patient volume is exceeding capacity.

(Q3) Why is patient volume exceeding capacity?

(A3) Because not enough hospital beds are available.

(Q4) Why are not enough hospital beds available?

(A4) Because hospital patients are not being discharged efficiently.

(Q5) Why are hospital patients not being discharged efficiently?

(A5) Because ER staff is not following best practices for proper discharge.

In this example, waste in the throughput process comes from incorrect processing. Once hospital management determines the root cause they can implement further training, ensure compliance with existing standards, or eliminate other barriers. In this case the hospital might consider implementing a training program to ensure that ER staff is following best practices for patient discharge. The hospital might also conduct additional 5-Whys analyses to uncover other problem areas. Once root causes of waste are uncovered, the elimination of waste or other related action plans can be executed.

Sources of waste

Sources of waste vary greatly by industry. The majority of waste encountered by health care organizations occurs in flow and throughput. As a result, Lean implementations in this field are primarily focused on the elimination of waste in staffing and staff/patient processes. Unlike manufacturing industries most health care organizations have very little inventory. Thus, some of the Lean concepts related to inventory control are less applicable to health care. Health care organizations typically spend a larger percentage of operating expenses on overhead and labor costs. This can account for 50 percent of the operating costs while inventory is in the range of 2 percent (Caldwell, 2005). Understanding waste in throughput entails a comprehension of the relationships between process variables and costs. Costs are not causes of waste but are indicators of interrelationships between processes. While the ultimate goal of most Lean implementations is to recover costs as tangible benefits, eliminating costs without fully understanding processes is problematic. Looking at the types of cost recovery is essential to determining an action plan.

Solution: Cost Recovery

The ultimate goal of most Lean implementations is to attain a tangible benefit, often in the form of a cost recovery. However, not all process improvement opportunities will result in immediate returns. The actual realization of a benefit depends on the nature of the improvement as well as the additional steps that management takes to achieve it. Caldwell (2005) cites three types of cost recovery through the elimination of waste: Type 1, Type 2, and Type 3. In a Type 1 situation the process throughput improvement will yield a direct cost recovery. For example, a process improvement that reduces length of patient stay would recover costs in the form of reduced resources expended. In a Type 2 situation, the process improvement saves time but does not result in cost recovery without additional hours worked per unit of service. A provider may spend less time per patient because of reduced length of stay but scheduling will need to be adjusted in order to capitalize on the benefit to workflow. Lastly, Type 3 yields savings in the form of immediate optimization of capacity. In this situation a process improvement in an emergency room, for example, may allow a provider to see more patients in the same staffed time without additional action taken by management. This is similar to a Type 2 recovery but with no changes to scheduling. This can occur if the provider is willing to see more patients per unit of time and sufficient patient volume exists to achieve capacity. Maximum velocity is achieved without additional action needed to be carried out by management. These examples show that throughput improvement may not achieve an immediate benefit without other factors. It also brings to light the fact that throughput improvement may yield different benefits such as recovered costs, time saved, or increased revenues. Regardless of the actual benefit achieved and the way that it is realized, the ultimate outcome must increase bottom-line value and satisfaction to customers in some way.

Examples of Lean implementation in Healthcare

The study of actual Lean implementations in health care is essential to understanding their application. One example of a successful implementation is outlined by Fairbanks (2007) at a medical center in Vermont. This implementation dramatically improved overall throughput processes within the organization. An implementation team was assembled and delved into all steps of the processes they were analyzing in order to determine the sources of waste. They utilized various Lean steps and methodologies to conduct root-cause analyses and prioritize process improvements. The team measured time involved, identified activities, and made rapid improvements through the elimination of non value-added activities. A large part of their improvements involved the elimination of redundancy. The topic of redundancy shows the importance of analyzing all processes, even those which are perceived to contribute to customer value. Even though a particular function may provide value in an organization it is possible that a redundant function may exist which can be eliminated. In another case example Lean methodology was used to streamline the physical space and inventory areas of a Denver-area hospital (Gabow, Albert, Kaufman, Wilson, & Eisert, 2008). The implementation team utilized the 5-S approach to organize physical work spaces within the hospital. 5-S is a Lean improvement which incorporates visualization management to organize objects and supplies. The five Ss stand for sort, set in order, shine, standardize, and sustain. These steps involve tasks ranging from simple clean-up and organization to the implementation of detailed visual controls. In a 5-S environment there is “a place for everything and everything in its place, when you need it (Lean Innovations, 2003).” The Denver hospital used this approach in a series of projects focusing on individual offices, nursing stations, entire laboratories, and financial services departments. These spaces were reorganized to achieve optimal work flow and good space management. The successful outcomes included reclaimed physical work space, improved lab turnaround time, reduced time in locating equipment, and better processes which could improve patient care (Gabow et al, 2008). The 5-s method is an excellent first step in implementing Lean programs in a health care organization. Improvement of physical work space can positively affect mindset and mental perception of work. Another case example of a successful 5-S implementation involves a rural health clinic in Georgia. Lean techniques were used in this organization to resolve problems with bottlenecks, turnaround times, customer satisfaction, and overworked nurses (Cross, 2009). 5-S is one of many Lean tools which can provide immediate benefit.

Conclusion

Lean is a multifaceted approach to quality improvement which has tangible benefits to health care organizations. There are aspects which focus on reducing non value-added work and waste to achieve value in various ways. Successfully implementing Lean in health care depends on the setting involved and the motivation of management and teams. Health care encompasses a wide range of organizations and each has unique characteristics which must be considered in light of Lean processes. Important considerations in implementing lean in any environment can be reduced to a few key points: Understanding the concept of value Understanding waste and its sources Learning how to determine and analyze root causes Prioritizing multiple root causes Devising methods to eliminate waste Determining ways to recover costs or achieve benefits Analyzing effectiveness and repeating steps if necessary In addition, it is important to note that eliminating waste through a Lean process may not immediately result in tangible benefit. Management must thoroughly analyze action plans and make adjustments based on actual outcomes. Additional steps may need to be taken following initial process improvements. This is especially relevant in health care where process throughput improvement and staffing are areas which are commonly targeted. These areas may involve more challenges when trying to extract benefit. Freeing time for providers cannot always be capitalized upon without other capacity and throughput improvements. Scheduling or work flow functions may need to be overhauled in order for providers to increase overall process velocity and maximize value per unit for time. It is also crucial to realize that humans are not machines. Theoretical methods of quality improvement in Lean may not always be feasible to achieve at maximum levels. The Lean methodology developed by Toyota is very cognizant of respect for people. It is reflective of a collective culture and a holistic concept rather than a series of parts or steps. This is a fact which cannot be overlooked by management and teams when planning an implementation. People perform processes with normal human variation and improvements must be sensitive, appropriate, and sustainable.

Health Care Reform

As a concerned American citizen, I feel compelled at this time to express some strong personal convictions about what is happening in the United States right now with health care reform. In recent months and especially in the last few weeks, this has swelled into a big issue, almost rivaling the economic crisis in media attention and in many Americans’ minds. Why?

“Health care plan?”

Well, for one thing, everyone recognizes that the U.S. health care system is in dire need of reform (and frankly, just about every other system in this country run by the federal government is in the same boat). The percentage of Americans who lack health insurance has grown substantially in recent years, medical costs have skyrocketed, and many people are not getting the health care they need. Health care is a complex multifaceted issue that involves both the public and private sectors and directly affects all Americans sooner or later. Thus, reform of this system is a big project likely to draw wide attention.

But more than that, health care reform is in the spotlight right now because the administration of President Barack Obama has made it a priority. “Health care reform can not wait, it must not wait, and it will not wait another year,” as President Obama famously declared near the middle of his first year in office. The president has been pushing Congress to quickly pass new legislation that would, with his signature, supposedly deliver better and more accessible health care to the American people.

I have to wonder, though: Why such a rush to health care reform? You can’t fix a broken system overnight, whether it’s the economy or health care. Reform is a major undertaking that requires careful research and accurate analysis of the situation, together with a generous period of honest public discussion and debate concerning short-term, medium-term and long-term measures that should be taken to correctly address the situation. Moreover, these elements of reform need the foundation of common moral and ethical guiding principles.

None of these requirements are being met in the current rush to draft and pass health care bills. As a result, U.S. health care reform is on the road to disaster.

So again, why this hurried effort by the Obama administration to enact health care reform? The administration has its reasons for hurrying. One is that they have a semi-secret agenda to accomplish, and this agenda collides head-on with the will of the American people. Whether the mainstream media will acknowledge it or not, there is in fact a fundamental issue even more important to Americans than the twin heavyweights of economic recovery and quality health care. That issue is the right to life of every human being, especially the most innocent and defenseless–the unborn child in the womb.

In Washington, health care reform is being touted merely as a ruse. It serves as a convenient vehicle to advance the Obama administration’s ever more urgent hidden agenda. That agenda is to increase federal funding of, and expand public access to, abortion. And this is the most important reason why health care reform has drawn the scrutiny of Americans right now.

The urgency of this semi-secret agenda from the viewpoint of its proponents becomes clear when we look at trends in recent years. Since 1993, the annual number of abortions and abortion providers in the United States has been in steady decline. U.S. voters across this country (a majority of whom are women) have built and continue to support a vast infrastructure of state restrictions on abortion, from parental notification laws to bans on state funding for abortions to sonogram viewing and waiting period requirements for pregnant girls prior to their scheduled abortion procedure. These laws, together with adoption, crisis pregnancy care centers and various outreach programs, have been wonderfully beneficial for women, for their unborn children and for society itself. Meanwhile, polls have confirmed that an increasing percentage of American citizens oppose the legalization of abortion through the Roe v. Wade Supreme Court decision of 1973. As of this writing, survey reports indicate that a majority of the American people are pro-life.

However, in Congress the overall trend with abortion has been moving in the opposite direction, especially since a Democratic majority came to power in 2006 in the House and Senate. In 2007 Representative Jerry Nadler and Senator Barbara Boxer introduced an infamous joint resolution deceptively named the Freedom of Choice Act (FOCA). The contents of this revolting abortion bill are so evil and frightening that it could only have come straight from Hell and been conceived by the Devil himself. It would have, at one stroke, demolished all state restrictions on abortion. Moreover, this draconian bill would have far surpassed Roe v. Wade in elevating abortion to the status of a “fundamental human right” subject to unlimited government funding and support. Apparently our Congressional representatives intended to remove every legal barrier and provide every possible incentive for Americans to murder their offspring.

So a rift has opened up between the American people and their federal government on the issue of abortion, and in the past few years this rift has been growing increasingly wider. The Obama administration may have given up on FOCA due to massive public opposition (thank God), but it is still bound and determined to enact at least some of FOCA’s provisions into law-for example, the sickening concept of “abortion coverage” as a “health benefit”-whether the American people support them or not.

And what is driving this wicked agenda to ram abortion down our throats? The answer is money. Abortion is still a big, $100 million-per-year business that makes a handful of doctors and companies in the U.S. quite wealthy. But with the gradual nationwide decline in demand for killing “services” and a fervent pro-life ethic among the younger generation of Americans, abortion providers face the real threat of going out of business altogether sometime within the next decade or two. Thus to salvage a sinking enterprise, the multimillion-dollar abortion industry has turned to the rich and powerful federal government for a hand–just as the financial institutions have turned to the same government for rescue from annihilation since late last year. In both cases, the government has generously responded with legislation and fiat money. This administration is not serving our interests but the interests of rich and powerful lobby groups on Capitol Hill. In my estimation, the Obama administration is the most corrupt administration in American history.

This is another reason for the race to health care reform: President Obama and his cronies don’t want Americans to find out the truth behind their new health care policies. In a democracy, corruption has to hurry or else it can’t achieve its ends. Too much research, analysis, discussion and debate-essential for proper reform and healthy for democracy-would expose this corrupt agenda and result in its doom. The “hurried” and “evil” aspects of health care reform both result from the driving force of corruption. Transparency and accountability are crucial for the correct functioning of democracy, yet little of either is evident with our government’s rapidly coalescing health care plan.

So given the divergence between American respect for life on the one hand and governmental obsession with death on the other, our leaders are forced to pretend that they are representing the wishes of the people while they pursue an agenda contrary to those wishes. How long they can keep up this charade remains to be seen in these uncertain and unpredictable times. However, a few things are certain. The American people want affordable health care reform that respects life. Their elected representatives want a health care plan that pads their own pockets and funds murder. Sooner or later, either the abortion industry or its puppet government or both will cave in. But the pro-life movement in this country is strong, it is steadily advancing, and it is destined to win.