Critique of a Hospital Community Health Needs Assessment (CHNA)
Community health needs assessment (CHNA) is an essential tool that helps practitioners, managers and policymakers to identify vulnerable populations in the society with immediate healthcare needs. St. Thomas hospital through its branches which include Saint Thomas Midtown Hospital, Saint Thomas Hospital for Specialty Surgery, Saint Thomas West Hospital, and Saint Thomas Health conducted community health needs assessment in 2019. The organization partnered with Vanderbilt University Medical Center and the Metro Nashville Public Health Department in ensuring its CHNA covers all the relevant aspects of promoting safety and the general wellbeing of the population with Davidson County, Tennessee (St. Thomas Hospital, 2019).
Among the issues identified by this CHNA report include access and coordination of resources, meeting basic needs and social determinants, mental health and toxic stress and access and affordability of healthcare. The report identified that access and coordination of resources encompassed a wider scope and not limited to only healthcare needs. Some examples of resources that need to be coordinated include clinical services, mental health services and housing assistance. On the same note, in relation to meeting the basic needs and social determinants, the report observed that this entails several things including access to transportation, housing, education and food. Consequently failing to meet the necessary basic needs increases the risk of development of chronic diseases. Similarly, the report identified mental health and toxic stress as a major issue in Davidson country. The specific issues related to mental health include negative stigmas of mental health, treatment of toxic stress and adverse childhood experience (ACEs) (St. Thomas Hospital, 2019). Lastly, in relation to access and affordability of healthcare was also a major healthcare issue in Davidson country. Specific issues identified in this case include access to specialty providers, insurance coverage and insurance affordability.
The report underlined a period of three years to implement an effective change to the several health issues identified. This is quite unrealistic in relation to the affordability of healthcare in the country. The issue of affordable healthcare is a constant problem within the United States’ healthcare system and has been identified as one of the primary factors that contribute to the surge of morbidity and mortality cases. For instance, during the current Covid-19 pandemic the lack of affordability to quality healthcare among several populations in the country resulted in the rapid spread of the virus across the country, which consequently overwhelmed the available scarce healthcare resources in the country (Erickson, Outland, Joy, Rockwern, Serchen, Mire & Goldman, 2020).
The majority of average Americans who form a significant portion of the country’s population cannot afford healthcare. The challenge lies in the individual payment system in the country in which individuals have to cover their own healthcare needs from their limited income. The estimated median household income in the country is $53,678 while the average medical expense from a household with 2.5 persons is $24,625. This means average households will have to spend 46% of their total income on healthcare before considering other basic needs like food, shelter and clothing (Erickson et al., 2020). In reality, such households will only seek healthcare attention when they experience significant healthcare needs that inhibit them from undertaking their routine activities. Through this, the affordability problem will still dominate the United States’ healthcare system for some years to come.
The Affordable Care Act increased the affordability of medical care in the country by ensuring close to half the money spent in the country’s healthcare was covered by the government through expanded Medicaid and Medicare programs (Erickson et al., 2020). The federal and state government also subsidized employer-sponsored coverage by excluding the employee and employer contribution from income and payroll taxes. However, President Trump’s regime scraped off the government funding for insurance coverage for the average Americans. The Trump administration reverted the country back to the affordability problem that had been partly solved by the Affordable Care Act (Erickson et al., 2020). This also presents the political aspect of this challenge. Different political leaders have their preferred approach in dealing with it.
Through all these, the affordability issue is a national challenge that generally results from the two contributors system used in the country in which the coverage of medical expenses is from both the private sector and the public sector. The government is primarily involved through Medicaid and Medicare, which are for specific populations while the private contributors are involved through different insurance schemes that in most cases do not favour the average Americans. This problem cannot be effectively tackled at the country level. It requires a nationwide overhaul of the country’s healthcare system and restructures the contribution to accommodate only one contributor in the form of the government. This will result in the government shouldering all the healthcare costs involved in treating the country’s population and ensuring their safety and general wellbeing. Navigation around the challenge of healthcare affordability requires the collaboration of all stakeholders in the country’s healthcare sector and not just the organizations from one country. Similarly as identified in the affordable care act it also requires close participation of major political representatives in the country. All these cannot be effectively realized in the next three years if Trump’s administration retains power.
References
Erickson, S. M., Outland, B., Joy, S., Rockwern, B., Serchen, J., Mire, R. D., & Goldman, J. M. (2020). Envisioning a Better US Health Care System for All: Health Care Delivery and Payment System Reforms. Annals of Internal Medicine, 172(2_Supplement), S33-S49.
St. Thomas Hospital. (2019). Community health needs assessment-Davidson County, Tennessee Saint Thomas Midtown Hospital, Saint Thomas West Hospital and Saint Thomas Hospital for Specialty Surgery.