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Future Challenges in the Health Care System 1


Future Challenges in the Health Care System

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Future Challenges in the Health Care System 2

Future Challenges in the Health Care System

Both of the IOM reports have highlighted many barriers; interestingly many of them

are still there even after so many years. Five of them are discussed here:

Assurance of Access to the Benefits of Public Health

It is the sole reason for the existence of public health activities. There is enough

inequality in access to these benefits from state to state (on macro level) and from county to

county (on micro level), as well as by social and income status. Decentralized style of

decision-making and funding from the federal level augments this inequity. In a nation like

US where multi-ethnicity and multi-stratification of society have become unopposed realities

a wide access to specified benefits is desirable. Another problem in this respect is health

insurance (or lack of it). Being uninsured is the biggest barrier to obtaining health care. More

than 41 million people (80 percent of whom are members of working families) are uninsured

is a good reflection of our health care delivery system.

The Need for Well-Trained Public Health Personnel

Lack of well-trained public health professionals who can bring forward solutions

addressing public health problems by using appropriate technical expertise and management

skills is another major problem. Hospitals are facing shortages of RNs, in addition to

shortages of pharmacists, laboratory technologists, and radiological technologists. Low

salaries and unrewarding professional environments inhibit the attraction of expertise even if

a sufficient aggregate supply existed.

Lack of a Clear Delineation of Responsibilities between Levels of Government

The liaison between the state and localities is usually very complex and is a result of

interaction between provisions of state constitutions, political history, and many other factors.

In most of the states, the laws describing the jurisdiction of and relationships between state

and local health agencies are very vague and lack consistency, especially in public health,
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where we observe a cornucopia of relationships. The lack of a clearer demarcation of those

roles hampers desirable cooperation and best possible use of the distinctive capacities

peculiar to each level.

Assessment and Surveillance

An important part of public health activities is assessment and surveillance capacity

that identifies problems, provides data to assist in decisions about appropriate actions, and

monitors progress. Fragmentation has developed in these systems because states and

localities have not developed uniform standards for data elements, collection procedures,

storage, and transmission. This lack of uniformity has made it difficult for states and

localities to work collaboratively among themselves or with the private sector to develop

more effective surveillance systems.

Collaboration with Governmental Public Health Agencies

The activities and interests of our health care delivery system and the governmental

public health agencies clearly overlap in many areas, but there is no real collaboration

between them. Policy development in public health at all levels of government is often ad

hoc, responding to the issue of the moment rather than benefiting from a careful assessment

of existing knowledge, establishment of priorities based on data, and allocation of resources

according to an objective assessment of the possibilities for greatest impact. In many public

health jurisdictions, rapid turnover of leadership has been a problem.


The IOM 2002 has summarized the present situation in these words “Despite this

progress, the committee found that in many important ways, the public health system that was

in disarray in 1988 remains in disarray today.” (Page 100: Institute of Medicine. The Future

of the Public’s Health in the 21st Century. (2002). The National Academies Press,

Washington, D.C.)
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Institute of Medicine. The Future of the Public’s Health in the 21st Century. (2002). The

National Academies Press. Washington, D.C.

Institute of Medicine. The Future of Public Health. (1988). National Academy Press.

Washington, D.C.