Global Healthcare Policy and Healthcare Delivery

Quality of health is one of the most important factors influencing the perception of the quality of humanity life. In most countries, the health issue is one of the key political matters. In some countries, the delivery of medical services is considered as a part of national identity. Over time, the health problem has spread over the whole world. Today, state governments, enterprises, and common individuals are involved in improving the health care system. The aging of population, increasing prevalence of chronic and concomitant diseases, development of new clinical innovations, increased awareness and knowledge of patients, economic costs, and many other issues and trends constitute the basis for the establishment of a global health sector. The global health system is an integral part of the modern world, the functioning of which is influenced by moral issues, healthcare productivity and economic costs, availability of healthcare providers, and some others.

Historical Perspectives on Concern for Global Health Learning in Nursing

Nursing has a long history of serving the world community before the spread of processes of globalization. Not so long ago, globalization has intensified communication and facilitated cultural exchanges in the world bringing societies closer in many spheres of life. History presents two main trends, which are historical perspectives. This is public health care through the control of infectious diseases and the protection of individual health by providing medical care which has formed the policy of international health. At the same time, nursing has always been shaped by historical events (for example, Florence Nightingale’s response to the needs of the Crimean War soldiers or work of nurses in nursing homes during Hurricane Katrina in Louisiana and Mississippi) (Seibert, 2016). Therefore, the question arises as to whether the education of health workers influences the direction of the health care system on a global scale or simply determines how an individual practitioner performs. Today nursing plays an important role in the functioning of the global health system. This involves responding to changes in health needs arising as a result of globalization (that is, life expectancy, cardiovascular disease, and other trends), the development of health promotion measures aimed at counteracting negative trends, and so on. Nursing program of the nursing community in the North includes many international and global health concepts that were integrated. It focuses mainly on the integration of such clinical topics as the distribution of infectious diseases, the need for interventions for care, the needs of vulnerable groups (Breda, 2012). Solving these problems is a prospect for further global nursing education.

 

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Health Care Disparities

Despite the global nature of the health system, it is characterized by various disparities. They point to the difference in health care between different groups of the population. The signs that distinguish the populations of different countries and continents are race and ethnicity, socio-economic status, gender, disability status, and so on. Disparities limit overall improvements in the quality of care for the general population that brings numerous costs. As the population is becoming more diverse, it is important to pay attention to inequalities in health. According to Ubri and Artiga (2016), nearly four out of ten (38%) people living in the United States in 2015 were people of color. It is projected that people of color there will make more than half of the population in 2045 with the highest number of Latin Americans (Ubri & Artiga, 2016). At the same time, the differences between incomes of different households are increasing in most states. Considering that people of color form a disproportionate part of the low-income and uninsured in the population, the growth of communities of color people and the widening of income disparities, the importance of addressing health and health disparities is reinforced. They reflect a complex set of individual, social, and environmental factors. Over the last decade, increased attention has been paid to reducing disparities and an increasing set of initiatives aimed at resolving disagreements at federal, state and civic levels as this will solve many of the problems that currently exist in the healthcare system. It is important to address a wide range of social and environmental factors.

Healthy People 2020 and Other Regulatory Guidelines

In order to solve current health problems that accumulate each year or push for their solution, there were created different regulatory guidelines. One of them is Healthy People 2020 that was unveiled by the U.S. Department of Health and Human Services in 2010. It was created to improve the quality of health of the American population by establishing a framework for public health prevention priorities and activities. The Healthy People 2020 initiative is based on a principle that assesses the establishment of national goals and monitoring progress as one that can motivate action. Herewith, Healthy People 2020 is a product of a wide range of feedbacks from stakeholders that have no analogues in public administration and healthcare. It integrates introductory materials from health professionals, representatives of federal, state and local authorities, a consortium of more than 2000 organizations and the public in its program. The new initiative includes many themes and challenges like adolescent health, dementia, Alzheimer's, global health, healthcare, and many more.

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Healthy People 2020 also helps to encourage developers to create programs for professionals who formulate national health goals and work with state and community health data. Through this program, it is expected to achieve such goals as a better and longer life without injuries, illness, disability, etc.; eliminating inequalities and improving the health of all groups regardless of different social characteristics; promoting healthy development at all stages of life (Centers for Disease Control and Prevention, 2015). The Centers for Disease Control and Prevention (CDC), the National Institute of Dental and Craniofacial Surveys (NIDCR), the Indian Health Service (IHS), and the Administration for Resources and Services (HRSA) are primarily monitoring progress towards these goals.

In addition, there is also the Healthy People 2030 initiative. It aims at forming a common basis for the initiative (including mission, basic principles, action plan) and the definition of new priority objectives (Healthy People, 2017). Different groups of experts, organizations and representatives of the public are involved in this endeavor. As part of this project, the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 plays an important role. The purpose of cooperation with the Committee is to provide recommendations to the Secretary of Health and Social Services (HHS) for Healthy People 2020 in the 2030s (Healthy People, 2017). The Committee meetings are open to the public and will be announced through the Federal Register and through the Healthy People 2020 lists; social media will also be involved. These, and some other regulatory guidelines, are created to achieve promising goals and address current health problems.

Moral Issues in Global Healthcare

Moral problems in the field of health are one of the most topical issues facing different support programs. They often occur in areas such as health planning, public health, or health research (Skolnik, 2012). One of the subspecies of the topic of global health issues relates to human rights. An important aspect is that access to medical services and health information as a human right is recognized by international conventions and international treaties. However, in many countries, there are significant points of concern regarding the access to health services. This is especially true of the poor and disenfranchised people who, in their turn, suffer most from these issues. Particularly important issues in this regard are dangerous diseases such as HIV, tuberculosis, leprosy, and others. For example, many patients cannot get a proper treatment because health workers refuse to work with them being fearing infection. On the other hand, many patients are afraid to seek medical attention due to dangerous illness and, without receiving treatment, infect many other people before dying (Skolnik, 2012). Efforts to maintain public health through the treatment of new diseases, such as SARS or avian influenza, create other moral problems. This concerns the sanitary quarantine of a potential illness, which is an important problem that needs to be addressed. Many researches on global health also address further ethical issues that arise when considering poor people who do not have access to satisfactory health care beyond the scope of the study (Skolnik, 2012). Equally important is the investment in healthcare. It is explained by the fact that even in high-income countries, the available resources in this area are quite limited. Accordingly, in low and middle income countries where resources and needs require significantly less resources, it is difficult to make complex investment decisions where groups of people and groups of diseases should be a priority.

According to many researchers in the field of health, there are three most important moral issues in health care system: the truth, full access, and cost. The first one relates to the cooperation between patients and healthcare providers as well as other health care providers ensuring fair decisions, access to full information, etc. The second fundamental value is the provision of quality and affordable access to medical care. Millions of people are uninsured, and they have no adequate coverage of medical needs. It is estimated that 18,000 people in the United States die annually due to the lack of basic health insurance. The third problem is no less important. Many bankruptcies are related to medical bills. Many people who announce bankruptcy as a result of medical bills have health insurance. In turn, different sources determine the cost of medical care. Some of these costs relate to litigation; many others are related to insurance companies. For example, an insured person could find out that the benefits of her insurance were terminated because the insurer turned to another condition, and so on. Consequently, these and many other moral problems impede the full functioning and development of the global health system. They need an urgent solution, because without it, achieving health goals is unlikely.

Healthcare Productivity and Economic Costs

The main reason why health is so important for countries is that they spend a lot of money on functioning of the health system (Skolnik, 2012). It is also clear that the economic costs incurred by states for the protection of health relate to national values. Herewith, most high-income countries make up about 9-12 percent of their national income for health (Skolnik, 2012). In turn, most low-income countries spend about 3-6 percent of their national income on health care (Bangladesh, Nigeria, Ghana, and many others). However, there are other states, for example, the United States, which spend more on health than any other country in relation to the per capita budget. Cambodia and Cuba spend much more money than other countries with the same level of income.

From this system, there is another question — whether countries that spend higher shares of their national income on health have a higher level of health. In fact, most low-income countries that spend a relatively low share of their GDP on health have a low lifespan of their population (Skolnik, 2012). Examples of such countries are Ghana, Kenya, and Mali. In turn, those countries that spend a relatively high share of their GDP on health at a high level of national income and have a high life expectancy. Among such countries, there is the majority of European states such as Germany or Iceland. However, this system is violated as there are also countries with relatively low national income but they spend more on the health care system. Their population has a longer lifespan than some of the highly developed countries. Cuba, Costa Rica, Sri Lanka and others are among these countries. In some countries, there is also a situation where despite high costs for the health system life expectancy is still relatively low. It is associated with many genetic, social and economic factors, and these factors vary greatly from one country to another (Skolnik, 2012). Also, this is due to the nature of investments by the state, that is, from what the government is investing in.

This also manifests productivity. After all, the more money the state allocates for the functioning of the health system, the greater the productivity is. Moreover, the definition of productivity in healthcare requires a team approach involving doctors, assistant doctors, nurses, insurers, etc. (Glatter, 2012). Productivity should be based not on indicators, but on patients and their special needs. Qualitative performance depends on economic costs. This is an unfinished job, and it will evolve over time, both in each country individually and globally in general. In order to make the global health system environmentally safe for future generations, the challenge of investing in health care should be a priority for consideration and resolution.

Availability of Healthcare Providers

The United States, like many other countries, faces aging population, the projected shortage of doctors and other healthcare workers, and increased prevalence of chronic diseases, healthcare costs and uninsured Americans. This makes access to medical services the most important issue of state policy. Since 1967, there were professions such as doctor’s assistants and medical doctors. Currently, there are about 110,000 assistant doctors and doctors in the United States. Fifty percent of doctors and eighty-five percent of medical doctors are practicing primary care and are more likely to work in rural areas and with poor population, which is a very important aspect. Doctors and patients consider them as providers of medical services. They usually provide quality services to their patients as well as increase productivity and profit practices. Within this framework, these practitioners can play different roles. One of these roles may be the implementation of additional work under which doctors delegate assignments aimed at increasing the effectiveness of the assistance provided and / or an additional role in the primary care groups, performing functions. These roles usually involve supervision and cooperation. However, they can also act as a substitute. This involves occupying physicians and providing them with many services that are within the competence of doctors.

The main difference between nurse practitioners and physician assistants who play a major role in the global health system in the modern world is their specialization. Nurse practitioners are trained in a nursing model while assistant doctors attend programs that are more in line with the medical model (Nurse Journal, n.d.). While the nursing model focuses on patients and their outcomes, the medical model is more relevant to the disease pathology. That is, practicing nurses are guided by the patient and his needs in their work while assistant physicians usually focus on illness. There is also another division that consists in specialization. It is that a practicing nurse can specialize in particular topics such as pediatrics, and so on. On the other hand, the assistant of physician specializes more, for example, in the field of emergency medical care or internal medicine.

There is also staff such as registered nurses who also play a key role in the field of medicine. They, more often than not, supervise patients in order to monitor their health and provide care for acute and chronic diseases, assist physicians with patient examinations and treatments. Unlike nurse practitioners, registered nurses mainly work in hospitals, surgical hospitals, nursing care facilities, home healthcare, and schools (Nurse Practitioner Schools, n.d.). Areas of medicine in which they mainly specialize are cardiac medicine, intensive care, neonatal, orthopedic, pediatric endocrinology, and surgical or operating room work. They provide for closer work with patients.

However, physicians play a unique role in global system of health care. The duties of the physicians are based on regulated areas of practice — they are leaders in developing and monitoring the general health of the patient. In addition to reviewing the history of the disease, conducting physical examination, diagnoses, and providing continuous patient care while staying in the hospital, they collaborate with the healthcare team to provide optimal care for the patient. Besides, a physician plays a very important role in protecting patients and their families. They should strive to provide the best quality treatment and care for patients. Access to healthcare professionals, including physicians, is undeniable priority in the treatment process as they are a source of information and assistance.

In conclusion, the global health system is an extremely important aspect of the functioning of the modern world in which global processes have filled all spheres of life. The current state of the system is determined mainly by the availability of general bases and principles of functioning, presence of medical staff involved in medical processes, as well as moral and ethical, economic and social problems that need to be addressed. All these processes are closely linked and determine the specifics of building a health system in each country. Economic aspect is of great importance in this regard since it determines the functioning of the system as a whole. In addition, in order to overcome current health problems, there are created a variety of programs that determine the plan and procedure for their elimination. They are formed to help restore and develop medical care around the world along with other professional measures.