Johnson enacted legislation that introduced Medicare and Medicaid into law as part of the Great Society Legislation. Since becoming law, additional rules and regulations have expanded upon the Patient Protection and Affordable Health Care for America Act.
Choosing a healthcare plan illustrates the complexity of health insurance plans in the U. About half of Americans who have private health insurance are covered under self-insured plans, each with their own design. The one commonality among all insurance plans is how dramatically they vary. Deductibles, co-insurance, co-payments, and maximum out-of-pocket expenses are a few of the inconsistent variables among insurance plans. Additionally, some insurance companies are for-profit and others are not-for-profit, indicating another point of confusion.
Insurance is not the only complexity within the system. The Affordable Care Act added more agencies to this list, including state insurance exchanges and the Center for Medicare and Medicaid Innovation. Each area of healthcare has its own complexities.
As components of the larger healthcare system work together, the complex layers unfold. While change is expected in the coming years, it is likely to occur slowly. Changes in the healthcare industry usually occur at the legislative level, but once enacted these changes have a direct impact on facility operations and the use of resources.
For example, the ways patients and administrators utilize resources such as Medicare and Medicaid have changed due to legislation. Technology has had a further impact on how healthcare administrators handle resources and manage medical centers. Cultural shifts, cost of care, and policy adjustments have contributed to a more patient-empowered shift in care over the last century.
Technological advancements contribute to a shift in our patient-centered healthcare system. This trend is expected to continue as new healthcare electronic technologies , such as 3D printing, wearable biometric devices, and GPS tracking, are tested and introduced for clinical use. Policies and procedures in individual facilities may restrict how and when new technologies are introduced, but cutting-edge technology is expected to play an increasingly larger role in our healthcare system within the coming years.
As legislative and demographic changes trickle down into care facilities, the use of hospital services is expected to grow significantly between and This growth is due to an anticipated increase in Medicare beneficiaries in the coming decade. The cost of hospital care is expected to rise from 0. Since then, Congress has made Medicare and Medicaid changes to open eligibility to more people. For example, Medicare was expanded in to cover the disabled, people over 65, and others.
Medicare includes more benefits today, including limitless home health visits and quality standards for Medicare-approved nursing homes. Medicaid has also been expanded to cover a larger group than initially intended. This includes coverage for low-income families, pregnant women, people requiring long-term care, and people with disabilities. Wide variations in Medicaid programs across the nation occur because individual states have the ability to tailor Medicaid programs to serve the needs of their residents.
Potential consumers can now use the Marketplace website to determine their Medicaid eligibility. As the baby boomer generation approaches retirement, thus qualifying for Medicare, healthcare spending by federal, state, and local governments is projected to increase.
Assuming the government continues to subsidize Marketplace premiums for lower-income populations, this increased government healthcare spending will greatly affect the entire healthcare system in the U.
Although Medicaid spending growth decelerated in due to reduced enrollment, spending is expected to accelerate at an average rate of 7. Along with policy and technological changes, the people who provide healthcare are also changing. Providers are an important part of the healthcare system and any changes to their education, satisfaction or demographics are likely to affect how patients receive care.
Future healthcare providers are also more likely to focus their education on business than ever before. This growth may result in more private practices and healthcare administrators.
In recent years, the demographics of the medical profession have shifted. Women currently make up the majority of healthcare providers in certain specialties, including pediatrics and obstetrics and gynecology. Nearly one-third of all practicing physicians are women.
Payers and providers can embrace increased data privacy by focusing on existing compliance efforts, which will require taking time to better understanding HIPAA. As patients assume more financial responsibility for their healthcare costs due to higher premiums, co-pays, co-insurance, and deductibles, they have become more concerned with the value of the care they receive as well as cost. Some ways to do this are to offer better patient portals, expanded hours, improved access, and clear procedure pricing.
Furthermore, Peter Manoogian, principal at ZS, a consulting firm focused on healthcare in Boston, says that the voices of older adults will become comparatively louder as this rapidly growing segment becomes more tech-savvy. The Trump Administration supports increased use of Medicare Advantage and expanding consumer choices. Plan options will reach a record high this year and create an unprecedented amount of choices for this population.
Health plans need to be laser focused on improving their understanding and engagement of their customers-who are evolving themselves. The bar for providing a great experience and retaining members will also increase. Technological innovation will continue to dramatically and rapidly change the manner in which healthcare is delivered, resulting in more personalized care, improved clinical outcomes and patient experience, and overall quality of life. One specific way that care will change is that providers will start seeing telehealth play a more critical role in care delivery as the brick-and-mortar, in-person care model becomes less common.
Technological innovations are occurring due to booming private sector interest and investment in medical technology innovation. The medical and information technology fields are attracting more high-skilled workers, who will continue to drive innovation to new levels as long as investor interest is sustained.
Regarding the increased use of telehealth, Gaines says that many appointments that occur in a hospital today can take place outside of the hospital. For example, a low-risk follow-up appointment after an operation is usually mostly dialogue and has a predictable outcome-it could be conducted electronically.
A lack of insurance coverage is a major impediment to telehealth adoption for most health systems. Therefore, providers should pair guaranteed reimbursement opportunities with change management workflows to advance these efforts, Gaines says.
To embrace technological innovation, payers and providers must continue to be educated and aware of the expanding medical technology landscape and develop technology investment and deployment strategies. The quotes are attributed to the physicians P , registered nurses RN and assistant nurses AN , who were interviewed, numbered from 1 to The health care professionals emphasized the importance of having the opportunity to influence organizational changes that are implemented.
Changes that were initiated by the professionals themselves were considered the easiest and rarely encountered resistance on the part of health care professionals. It is from there, I think, most often the smartest ideas will emerge, but then it is important to ensure that you are responsive and assess [the ideas]. According to the health care professionals, organizational changes that were clearly communicated to allow for preparation increased the chances for successful changes.
We had two weeks to develop new systems and that results in considerable consequences. We had to solve it anyway. The changes might otherwise be perceived as meaningless and unjustified, which may create change resistance. In particular, health care professionals valued and perceived as successful organizational changes with a patient focus, with clear benefits to patients.
Change is pervasive in modern health care. This study aimed to identify characteristics of successful organizational changes from the perspective of health care professionals at the frontline level of health care. The importance of individual responses to organizational changes has been increasingly emphasized [ 25 ].
Three categories i. Many of the statements by the participants were representative of more than one category, suggesting an interdependency between the three categories of this triad of successful change characteristics. For example, a slower change allows for preparation, which facilitates involvement and influence, thus enabling an appreciation for the change.
Alternatively, recognizing the value of a change, e. This interdependence implies that successful change is more likely if more than one of the three categories is accounted for when planning and implementing changes.
The importance of preparation for and involvement in a change has been associated with decisional latitude [ 26 ] and valuing the change in terms of experiencing personal gains has been linked with involvement in the change [ 27 ].
However, we have not been able to find any previous study, either in health care settings or in other environments, which has identified the relevance of this particular triad of characteristics or how they are interlinked. Although our findings suggest these interdependencies, we did not collect data to specifically investigate the underlying mechanisms; thus, exploring these interdependencies would be an important area for future research.
The health care professionals in our study attached great importance to being able to influence changes that may influence their work. Many of the health care professionals complained about the power differential between those who are affected by the changes and higher management and political levels of the health care system who usually decide on what changes to implement.
Physicians in Sweden have often raised complaints that policy making and decisions concerning the medical profession are made without physicians or their professional organizations being involved in the decision-making process [ 28 ]. These findings underscore the importance of changes having frontline support and being perceived as legitimate among the employees affected by the changes.
Organizational research has shown that participation in changes can yield increased acceptance. Indeed, widespread participation in the change process is perhaps the most frequently cited approach to overcoming resistance to change [ 29 , 30 ]. Even assuming a well-justified and well-planned change initiative, research underscores the importance of managers building internal support for change by means of employee participation in the change process [ 31 ].
These are common findings in organizational research in general, but they seem particularly applicable in health care organizations because of the strong professional discretion in performing the work.
Health care professionals emphasized the importance of predictability for them to perceive organizational changes as successful.
Individuals are better able to adjust their behaviour accordingly when they are prepared [ 3 ]. However, despite the relevance of predictability, many changes in our study seemed to be characterized by a lack of preparation. When individuals are unprepared, they have difficulties aligning their thoughts, feelings and behaviours with the expectations of those who lead the changes [ 12 , 32 ]. Contextual factors such as resources and culture also influence their preparedness to implement change [ 33 ].
The importance of management communicating the motives for changes was stressed by the health care professionals in our study. Consistent with our findings, organizational change research has demonstrated that changes have a greater chance of succeeding if employees consider them to be well thought out and respect the managers responsible for the changes, whereas resistance to changes is more likely if employees consider the changes to have little or no value for themselves [ 31 ].
The organizational change literature also stresses the importance of change initiatives resting on coherent and sound causal thinking [ 34 , 35 , 36 ]. The health care professionals in our study argued that the changes must benefit patients to have value.
The overall findings of our study may reflect a tension between the traditional logic of professionalism and the managerial logic introduced into health care with the emergence of NPM. Whereas the logic of managerialism assumes that work should be management led to achieve organizational goals, health care professionals tend to be loyal to their profession and their emotional rewards at work are primarily associated with their patients [ 9 ]. NPM has led to an increase in the use of management systems, e.
According to professional theory, true professionals such as physicians and lawyers independently treat individual cases e. Research suggests that physicians due to their stronger identification with professional logic are more likely than nurses to be critical of management-initiated changes [ 9 ].
Several studies have shown how physicians respond with scepticism or suspicion to different forms of management-led changes in health care [ 44 , 45 ]. Sweden has seen a lively public debate on NPM in recent years, with many scholars, policy makers and both physicians and registered nurses critiquing core NPM principles and their consequences for health care professionals [ 46 , 47 , 48 , 49 , 50 ]. This initiative is new and we are not aware of any studies of the concept, but research is warranted to investigate how this concept is realized in practice.
Future research should assess whether health care professionals perceive changes as more successful under trust-based governance than under NPM principles. The results of our study should be evaluated in the context of the methods that we chose to address our study question.
We chose a qualitative approach because little is known about responses to changes in Swedish health care. For this reason, we considered interviews with physicians, registered nurses, and assistant nurses to gain a deeper understanding of the topic. Participation was voluntary; the interviewees were selected and asked by their respective supervisors about participation in the study, which means that the participants may have been particularly interested in the subject.
The multidisciplinary research team was a strength of the study, because it allowed different perspectives on the issue of changes in health care. Regardless, this enabled us to use quotations from many different participants, adding transparency and trustworthiness to the findings. While many findings of the study are in line with existing research on organizational changes, no previous study has identified this particular triad of interdependent characteristics.
The study provides important knowledge for health care organizations to plan and implement changes with better chances of being successful. In conclusion, organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients. Although changes in health care organizations are inevitable, there are more or less effective ways to carry out changes.
Our results provide important implications for health care organizations concerning how changes in health care can be planned, implemented and managed to increase the chances that they will be supported by health care professionals, which is crucial for successful changes.
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Organisational change and employee burnout: the moderating effects of support and job control.
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