Health Care System of Pennsylvania

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HealthCare System of Pennsylvania

HealthCare System of Pennsylvania

Thehospital system in Pennsylvania aims at providing quality and safehealthcare and evaluation services to approximately 48 millioncitizens per annum. The system supports 590,000 jobs across thestate of Pennsylvania and contributes to revenues amounting to 98billion dollars to both the state and local economy. The hospitalsare leaders in the provision of healthcare by helping the patientstake proper care of their health. They have worked towards reducingcentral line associated infections and managed to maintain lower thannational rates of infections. Specifically, Pennsylvania’s rate ofcentral line infections has remained at 28.1 between 2009 to 2015.The success is highly attributed to the ability of the hospitals toform a centerline infection prevention programs. The systems haveconsistently applied evidence-based practices that have reduced theincidence of diseases. Moreover, they have led to the avoidance of218 harm events and saved 3.7 million dollars (Consuelos, 2014).

Second,the hospitals quality emanates from their ability to prevent surgicalsite infections. The number of infections decreased rom6.99 percentin 2009 and 2011 respectively. The surgical site infection reductionprogram included 109 hospital participants. The partnering hospitalscan devise healthier practices during surgery that enhance thereduction of germs on a patient’s body. The programs havesuccessfully helped in avoiding 318 harm events (Consuelos, 2014).

Third,the hospitals have developed expertise in the prevention of adversedrug events. Such events include medication errors made by providingexcessive or deficient drugs to patients. They also include theprovision of drugs with side effects to patients. Pennsylvanianhospitals in conjunction with the Pennsylvania Patient SafetyAuthority held a program that enhanced the use of drugs such asopioids, insulin, and anticoagulants, which are associated withadverse events. The hospitals have managed to avoid 63 harm eventsand an estimated savings in form of cost avoidance amounting to300,000 dollars (Consuelos, 2014).

Pennsylvaniahospitals have developed advanced systems to provide obstetrical carethrough teamwork and communication with the patients and families.The prevention of obstetrical advanced effects program inPennsylvania was launched in 2012. It involved 64 hospitals thatworked in conjunction with the Health Care Foundation to devise andimplement safe and reliable services during labor and delivery. Theprogram has successfully managed to avoid 40 harm events estimated tocost 60,000 dollars (Consuelos, 2014).

MajorDeterminants of Market Force in Pennsylvania: Comparison and Contrast

Thekey determinants of health care in Pennsylvania include technology,the kind of medicine, quality of physician administration, marketingand specialty. Hospitals in Pennsylvania admit all sorts of patientsirrespective of their ethnicity. The facilities liaise in theprovision of specialized care and allow physicians to move from onefacility to another without having to follow lengthy bureaucracies.The unhindered movement is attributed to the uniform remunerationscheme in the state. The demand for medical serviced varies dependingon onsite services. Hospitals with high onsite services experience ahigh demand while those with low-quality services experience weakdemand. Technology also plays a key role in determining patient’spreferences. According to the law of demand and supply, some chargehigh fees because of the increased demand. Hospitals that have enoughdrugs are highly preferred compared to those with irregularpharmaceutical services. Some hospitals in this state indulge inextensive marketing and promotional services. They are highly claimedto be of high class and offering quality health care. Due to thismarketing, the financial burden is transferred to the clients hence,higher healthcare fees than those that do not engage inadvertisements (The Pennsylvania Health Care Landscape, n.d).


Technologyin Healthcare

Thereis demand for state-of-art kind of treatments among Pennsylvanians.Medical technology in the state is a key driving factor indetermining the cost of health. Hospitals that have sophisticatedpractices are preferred. These factors trigger an increase in healthcharges. Some of the advanced medical procedures in such hospitalsinclude diagnostic imaging, in-vitro diagnostic test as well ascardiovascular procedures. They are instrumental in the provision ofclient-centered services (Ruman, 2016)


Marketingis another force that determines the prices of health care. InPennsylvania, there are hospitals doing advertisements regularly,both within the state and other parts. These campaigns make thecenters attractive, and they attract many patients that furthercontribute to higher charges. The hospitals transfer the extra billsto the clients hence making the cost of health services in the areaenormous (The Pennsylvania Health Care Landscape, n.d).


Hospitalsin the state have invested in maintaining high-class administrativestructures. They employ highly educated and experiencedadministrative staff members who demand high managerialremunerations. In return, these hospitals charge high fees from thevisiting clients (Ruman, 2016).


Anotherforce that determines the cost of health care is the kind ofmedicines in different institutions. The demand for services in thefacilities is also attributed to the nature of drugs issued to theclients (The Pennsylvania Health Care Landscape, n.d).

Benefitsof HMO’s

a)To client

Patientshave specific physicians with whom they can build a long-term healthcare relationship. A customer under Health Management Organization(HMO) does not require a claim form to see a physician. The HMOprovides the clients with a fixed charge either through a monthly orannual plan. The strategy also makes it possible to predict the costof various medical procedures (The Commonwealth Fund and The KaiserFamily Foundation, 2015).

b)To hospitals

Hospitalscan attract clients through the plan as it reduces the tiring work ofhandling cash on daily basis. The institutions also secure qualifiedphysicians from other allied facilities. The program provides clientswith a chance to be attended by a given professional and they developa productive relationship. Health centers with such plans arepreferred to those without the HMO plan (The Commonwealth Fund andThe Kaiser Family Foundation, 2015).

c)To physicians

Throughthe program, physicians can concentrate on specific clients. Sincethe plan allocates customers to one practitioner, the doctor canmonitor the progress of his or her client appropriately. Forprofessionals who may opt to work in one facility instead of engagingin rotational services, they find the program appropriate since itcan allocate them a particular group of clients (The CommonwealthFund and The Kaiser Family Foundation, 2015).


Healthproviders rely on government policies to draw their strategies.Through the HMO, they can solicit funds from government and othernon-governmental organizations. Adequate financing is instrumentalfor the provision of quality services (CMS, 2015).

Disadvantagesof HMO

a)To clients

Thestrategy denies them freedom. After being put under the care of aparticular physician, clients lose the autonomy to be attended apractitioner of their choice. Also, they can only visit thestipulated health facility. Another major disadvantage is that itmight be difficult to enjoy specialized care. The rationale for thisis that the client has to obtain a referral first. Any other form ofcare that is not categorized as emergency or referral is not servedunder HMO (The Commonwealth Fund and The Kaiser Family Foundation,2015).

b)To hospitals

Thecomplexity of the strategy requires adequate financing. Hospitalshave to invest a lot in their systems to accommodate the plan. Theyincur additional expenditures that are transferred to the finalconsumers (CMS, 2015).

c)To physician

Itunsettles the physicians since they are required to move from onehospital to the other so as to attend their clients. If a patient isattached to a given doctor and visits another hospital instead therecommended one, the practitioner has to travel to that health center(CMS, 2015).


Healthproviders are likely to lose resources from the activities offraudsters. Besides, some people may not pay the stipulated monthlyor annual fees. Another shortcoming to this group of stakeholders iskeeping records that may be tedious. With this, they have to employmany people most of whom must be well educated and they may requirehigh remunerations (The Commonwealth Fund and The Kaiser FamilyFoundation, 2015).

Efficiencyof Economic Incentives in Pennsylvania

Theoverall impact and effectiveness of these plans are still widelydebatable. Some patients claim that the incentives are not beneficialdue to their restrictive nature. However, proponents argue that thestrategies have increased efficiency as well as improving the overallquality of healthcare. A significant section of the population earnlow incomes and cannot afford the fee-for-service kind of structure,through the plan, they can access the service sufficiently. Healthcare delivery has been made efficient by these incentives, and mostpeople can access various facilities that are stakeholders of theplan. In addition, the monthly and annual contributions have reducedthe need to pay lump sums after receiving services (The CommonwealthFund and The Kaiser Family Foundation, 2015).

Theincentives have brought some clear understanding of quality andrelationship. There is no direct correlation between health care costand the quality. The efficiency of these incentives is also underscrutiny due to some report issued on the poor quality of health careservices and a misuse of funds (The Commonwealth Fund and The KaiserFamily Foundation, 2015).

CapitationPayment System

Theproviders bear the financial risk of a capitation payment system. Thepremise of this arrangement is to let the providers bear the duty ofcontrolling the financial risk. Organizations will accomplish thegoal through spreading the cost of care to different patients. Theplan is best used in large health centers because they have numerouspatients therefore, they can extend the fiscal risk to many clients(Frakt &amp Mayes, 2016).

Theplan is executable because there are numerous companies dealing withthe management of the physician practices. Most of the firms arecorporate entities dedicated to ensuring physician duties areaccomplished smoothly.Moreover, there are profit-based companiesthat finance the activities of the providers with the objective ofgenerating profit from the venture (Frakt &amp Mayes, 2016).

Anotherbenefit of adopting this financial arrangement is the fact that itenhances the providers’ determination to refer their patients toother health care facilities. For some patients, a treatment facilitymay lack the necessary resources to offer the particular care needed.For example, if a patient needs a colon surgery, the doctor in agiven clinic that does not have the equipment will most likely referthe client to another facility where he or she can receive the bestcare. Referring patients to other hospitals that specialize inoffering given services ensures that individuals receive the besttreatment services available (Frakt &amp Mayes, 2016).

Recommendationand Conclusion

Allowingthe physicians to select the method of remuneration may cause severalproblems than it solves. If the procedure is to be followed, then thepractitioners can only influence the amount expected per patient butnot the reasons for settling to the given. If allowed to giverationales, then the providers may treat the patients selectively.They may overlook complex illnesses citing wastage of time.

Besidesbeing discriminatory, the practitioners are likely to choose a planbased on personal preferences that would favor them financiallyinstead of working towards the best interest of the patients. Theremuneration system should ensure positive implications to theparties involved. The government and other stakeholders should adoptan effective system by drawing conclusions from predefined factors.


Centersfor Medicare &amp Medicaid Services, (2015, Jan 26). Better care,smarter spending, healthier people: Improving our health caredelivery system. Centersfor Medicare &amp Medicaid Services.Web. Retrieved on 15 Aug 2016 from

Consuelos,M. (2014).Pensylvania Hospital quality Achieving MoreTogether 2014Highlights. TheHospital &amp Health System Association of Pensylvannia. Retrieved from

Frakt,A.B. , &amp Mayes, R. (2016). Beyond capitation: How new paymentexperiments seek to find the ‘sweet spot’ in amount of riskproviders and payers bear. HealthAffairs, 35 (8),1951-1958. doi: 10.1377/hlthaff.2012.0344

Greenberg,M &amp Woolever, K. (2014). Pennsylvania Scorecard Fall 2014 &amp Analysis.Pensylvania Business Council Foundation.Retrieved from

Ruman, R. (2016, May 25). Pennsylvania market remains competitive asreview process begins for health plans in 2017. PRNews Wire.Retrieved on 15 August, 2016 from

TheCommonwealth Fund and The Kaiser Family Foundation, (2015). PrimaryCare Providers` Views of Recent Trends in Health Care Delivery andPayment. Web. Retrieved on August 15 2015 from

ThePennsylvania Health Care Landscape, (n.d). KFF.Org.Retrieved on 15 August, 2016from

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