System Based Practices

System based practice has a significant role in the healthcare system, from combining multiple methods to combining major disciplines, all for the hopes of helping individual patients.  “Systems Based Practice refers to all the processes in the health care system that operate to provide cost effective care to individual patients and to populations. It includes the appointment system and referral process all the way to the governmental organization of health care.” ("Systems Based Practice")  Cost effective care can range from 5,000 dollars to 100,000 dollars, according to the WHO the price of affordable healthcare can triple a person's yearly income for one quality of life year and still be cost effective. (Drexler, "Can cost-effective health care = better health care?") 

            Because the average American makes approximately $40,000 yearly, we can assume that if we used the WHO’s rule of thumb, this persons quality of life year cost could be $120,000. (Drexler, "Can cost-effective health care = better health care?") On average no American could afford to pay for this amount of healthcare.  unfortunately, this occurs for most Americans, and costs become to high for them to afford appropriate healthcare.  for example, it is not cost effective to do a PAP smear every year but more effective to have one done every two to four years, and a new breast cancer drug which is very expensive is still a cost effective drug do to it’s quality of life year is high.  (Drexler, "Can cost-effective health care = better health care?")

            In the US population, healthcare has become about a 2.7 trillion dollar business.  Inopportunely, $.33 of every dollar spent goes to waste.   Antibiotics tend to a big contributer in this waste.  Many doctors prescribe Antibiotics during a common cold knowing it will have no effect, many feel that because of the low cost of antibiotics it will not be problematic, but in truth it costs about $1.1billion a year in wasted antibiotics. (Weisleder, "Can You Ration Health Care in a Just Society?")   How does this relate to the rest of the world?  The worldview of system based practice uses a cost-effectiveness analysis formula to adjust for their populations.  “Most countries of the developed world use cost-effectiveness analysis to form policy around their national health insurance plans. We don’t have a national insurance plan, but we do have Medicare, which is national health insurance for people over 65. Yet Medicare doesn’t look at cost.” (Drexler, "Can cost-effective health care = better health care?")

             In the world many countries use these system based views to better help their populations.  In France, which may be considered one of the best (or the best), healthcare systems in the world.  They base this by having a universal healthcare system.  They do this by using both cost sharing and out-of-pocket spending. Cost-sharing keeps a out-of-pocket spending down which totals about 9.6% of the total healthcare cost. Individuals are also able to pay for private insurance which pays for co-pays and any other costs not covered.

            In France there is 200,000 physicians, 92,000 our primary care physicians and 108,000 are specialists. Most physicians of France are self-employed practitioners itself specialists. “Forty-two percent of GPs, mostly younger doctors, are in group practices. An average practice consists of two or three physicians, and three-quarters of practices consist of physicians only. In the rest, the composition is highly variable and can include a range of allied health professionals, typically paid on a fee-for-service basis.” (Mossialos, 2015)  Possibly the most effective cost control that France has implemented, would be that of the cost control for drugs that started in September 2012. This “scheme” that was implemented a allowed patients who agreed to use generic substitutions to drugs where subject to no copayments.  This substitution for patients jumped from 71 percent to 84 percent in just one year.  In-turn this resulted in a savings of over 200 million euros or the equivalent of 237 million U.S. dollars. (Mossialos, 2015)

            As far as patient France has implemented a plan for each patient as they leave the hospital. Patients that will are in integrated hospitals and are moving to out of hospital care and social care are given a developed patient pathway guide that provides detailed patient to the patient on what each professional healthcare provider has as rules in their healthcare. This educates the patient so that there is no overlap or miscommunication between doctors it also helps coordinate physicians plan the best possible health care for their patient and for targeted populations. Also for patients health and quality of care a major project that started in 2008 with electronic medical records has been underway. This allows communication between hospitals, general practitioners, and specialists. This also allows patients to ask for all of their medical records from the general practitioner no matter which practitioner wrote the records. (Mossialos, 2015)

            Throughout the world access to healthcare remains about the same with an average of about 60% being able to see their general practitioner the next day. Although records show avoidable deaths in the population per 100,000 between the 2006 and 2007 was highest in the United States and lowest in France. (Mossialos, 2015) Although many of the percentages are fairly similar, fundamentally throughout the world (according to developed countries data) all of the system based practices are working in the general population except for in the United States. Across the board the public to use these systems is only needing minor changes except for in the US which the public use is needing major changes or fundamentally changed.

Many Acupuncturists are starting to integrate into the medical field, with medical Doctors, naturopathic physicians, chiropractors, and even psychologists.  In the Oriental Medical Field this is a huge step in the right direction and in many cases gives the patient the choice to decide which form of care they would prefer.  Many schools are now teaching students how to incorporate their practice into the medical field so as to better communicate with physicians.  This is an integral part of the teachings of Oriental medicine to help ready new practitioners into a daunting field. 

                        “biomedicine is at its limits nowadays when confronting degenerative diseases, stress-related diseases, and most chronic diseases, which are more related to the way we think and live than to bacteria and viruses. Most notably, biomedicine lacks reference to the self-healing capacity of the human mind and body and focuses on parts rather than the whole, treatment rather than prevention, the suffering disease rather than the diseased person. (Xu, 2011)  Many other countries around the world have implemented Chinese medicine as a preventative for the disease.  In China, the integration has gone hand in hand, and there is much research being done to show how the integration can be beneficial to a patient.  “the integration of CM and Western medicine has been explored for more than a century.” (Xu, 2011)

            Changes that have been made recently, such as acupuncturists working in oncology wings of hospitals and integrative practices opening nationwide.  Unfortunately, we (acupuncturists) have not been given a terminal degree yet which slightly inhibits this community. Although the acupuncture community must pass four board exams to practice and one of them being biomedicine; we are still considered less qualified by the medical community.  With this being said Acupuncturists are now being allocated to hospitals around the country to work on patients in cancer wings and community outreach centers.  Some changes that may be detrimental to helping combine these many disciplinary skills are more classroom hours of integrating these modalities.

            Some skills that may be beneficial to doctorate TCM practitioners that are needed to promote change in our community is research on specific modalities (such as cardiology), to ensure that a full understanding is available for both parties, and to what is within both party’s abilities.  “TCM-related services should be strengthened within the existing county general hospital system. Policies need to support efforts to identify a range of specific TCM services that are most effective in dealing with certain diseases, especially some non-communicable diseases. Also, a special set of human resource/career development policies for TCM physicians should be developed, considering its unique practices and learning.” (Tang, 2012)

            With more doctoral students and practitioners being trained to have higher skills,  hospitals, and hospital board members who have interests in finding new modalities to help their patients should explore the possibility of hiring on acupuncturists.  This relationship could stem a new system of healthcare in the United States.  Skills that are learned by doctoral students include collaborating with those of other medical communities to help better patients and the community.  Doctorally qualified practitioners can bring about positive changes in the community by getting involved with other specialties.

            With creations of programs such as the acupuncture relief program and acupuncturists without borders, doctorate level practitioners should be on the leading edge of community programs.  With the healthcare in America today, changes must be made.  These changes will be done to help patients and communities, with changes that provide more options for the average American.  TCM train doctoral physicians will have the ability to move this medicine forward in the coming years with research, education to hospitals and communities, and clinical practices. 

 

 

 

 

 

Bibliography

 

Drexler, M. (Ed.). (2009, December 15). Can cost-effective health care = better health care? Retrieved January 17, 2016, From http://www.hsph.harvard.edu/news/magazine/winter10assessment/

 

Weisleder, P. (2015, November 17). Can You Ration Health Care in a Just Society? Retrieved January 17, 2016, from http://pediatricsnationwide.org/2015/11/17/can-you-ration-health-care-in-a-just-society/

 

Systems Based Practice. (n.d.). Retrieved January 17, 2016, from             https://www.med.unc.edu/apselect/educational-activities/systems-based-practice-workbook

 

E. Mossialos, M. Wenzl, R. Osborn, and C. Anderson, International Profiles of Health Care Systems, 2014, The Commonwealth Fund, January 2015.

 

Xu, H., & Chen, K. (2011, February 10). Integrating traditional medicine with biomedicine towards a Patient-Centered healthcare system. Retrieved January 27, 2016, from               http://link.springer.com/article/10.1007/s11655-011-0641-2?LI=true

 

Tang, S. (2012, August 30). The Westernization of Traditional Chinese Medicine Hospitals           in China: What needs to be done? Retrieved January 28, 2016, from Https://globalhealth.duke.edu/media/blogs/china/westernization-traditional-chinese-medicine-hospitals-china-what-needs-be-done