Question

Choose one upstream factor identified in the text and discuss how it can both undermine and promote health.

Answer 1

Generally upstream (or macro-level) determinant factors are government policies, global forces and the fundamental determinants of health.

Government policies:

State and local government have the primary responsibility for the making of healthcare policy under the U.S constitution. In order to achieve this responsibilities state and local engage on the following activities: monitoring diseases and injury of population, identifying groups that have conditions of public health importance, counselling and education.

State and local governments also engage in a broad array of regulatory activities. They seek to ensure that businesses conduct themselves in ways that are safe and sanitary. They seek to ensure that businesses conduct themselves in ways that are safe and sanitary (through the institution of measures such as inspections, licenses, and nuisance abatements) and they oversee the quality of health care provided in the public and private sectors.

Government policies undermine and promotion of healthcare:

Patient cost sharing strategy is one in which the patient himself pays for his health care cost which is not covered. This strategy has become very prevalent in USA. It has been observed that the demand for a healthcare service varies with the percentage of patient cost sharing:

• If patient has high health coverage, he tends to overuse the medical aids of healthcare
• If patient has lower health coverage, he tends to underuse the medical aids of healthcare

A bias in treatment by doctors is also observed based on this cost sharing fundamental. Doctors tend to ineffectively treat the patients with low coverage.

So the basic advantage of inclusion of patient cost sharing, as cost control strategy is that it enhances the cost control in healthcare. This also increases the consumer cost savings in from of deductibles and tax benefits.

The disadvantage, however of inclusion of patient cost sharing, as cost control strategy is that it reduces the cost of inpatient as well as outpatient expenses which may mean under treatment.

Reference:

The Future of the Public's Health in the 21st Century (2003)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106491/