Eduardo C. Gerding
The purpose of this article is to point out the increase in health expenses
worldwide and the possibility of improving benefits through the use of
Electronic Medical Records in active and retired military personnel but above
all in the universe of our Veterans of war.
Health expenditures
In a decade, nearly $1 in every $5 spent in the United States by 2024 will be on
health care, and this spending grew faster than the
entire economy. 19
Pie chart showing the spending percentages invested in the UK for Fiscal
Year 2017. Health occupies 18 percent
In Argentina, health spending in 2014 was 2.65%
of GDP, a drop of 0.09 points compared to 2013, at which time spending
represented 2.74% of GDP.
In 2014, Argentina spent 6.92% of its total public expenditure on
health, while the previous year had devoted 7.72%, five years earlier to 17.13%
and if we go back ten years ago the percentage was 16.92% of public spending,
that is to say, the proportion destined to health has fallen in recent years.
In reference to the percentage that implies the investment in sanity with
respect to the governmental budget (public expenditure), Argentina is in position
154.
In 2014, public spending on health in Argentina was 262 Euros per
inhabitant and in 2013, 298 Euros. Based on public expenditure on health per
capita, Argentina ranks 74 out of 192 published countries.
In 2014 the public expenditure per capita in sanitation in Argentina was
244 Euros. It is the total expenditure on health divided among all its
inhabitants, regardless of their age or situation. Currently, according to its
public expenditure on health per capita, Argentina is ranked 74 out of
192 published. 2
Interesting studies have been done comparing the health systems of Argentina,
Canada and the USA. 12
Health spending on US war veteransHow is spending on military personnel health divided?
In 2012 at least, the expenses of the US
Department of Defense were divided into three areas: $ 32 billion for the
TRICARE health program that provides assistance to active military personnel, $
19.7 trillion for the TRICARE Lifetime Program Medicare supplemental insurance
for retired military personnel and then a mix that includes payment to military
hospitals and health workers. The program covers 9.6 million Americans.
Unlike TRICARE that hires providers in the private sector, the Veterans
Administration is a single payer system and follows the NHS guidelines in
which the government owns the hospitals and pays the bills. 11,16,20
Health expenditures for military personnel are increasing faster than
inflation. 11
How much does the US spend on its war veterans? In 2014 they spent $
154 billion representing 4 percent of the federal budget. This
included veteran benefits, hospital medical care, housing, education, training,
and rehabilitation. 17
War veterans have an increased risk of suicide, homelessness, mental health
disorders such as Post Traumatic Stress, disabilities, and even unemployment. 17
On the other hand, military spending accounts for 17 percent of federal
spending; A little more than half of the spending at the discretion of 2014.
Military expenditures include the basic defense budget, nuclear weapons,
international assistance and Overseas Contingency Operations. 17
Spending
on the Military and on Veterans in 2014.
spend-our-nations-veterans/
In a very tough article
Jasmine Tucker asked: What does it say about our priorities as a nation that for every dollar
the U.S. spends on its military this year, it will spend less than 24 cents
caring for its veterans? 17
Military personnel and access to medical providers in the US
The active duty military personnel has priority of assistance.
In 1866 the Civil Medical Assistance Program of the Uniformed Services (CHAMPUS) was created and it allowed the Secretary of Defense to contract civilian providers.
In 1980 came the Reform to the CHAMPUS Initiative (CRI). Under the latter,
three types of benefits were offered to the patient: 1) TRICARE Prime
(possibility of choosing provider), 2) TRICARE Extra (offered a list of
providers) and 3) TRICARE standard (could choose provider but costs were higher
). The latter was also offered to retired staff.
With the TRICARE system USA was divided into 12 health regions with a
responsible agent in each of them. Seven civilian welfare providers were hired
to meet the needs of the 12 regions.
In 2014, Senate Committee Chairman Bernie Sanders (Senator for Vermont) and
Senator John McCain announced a bill that expanded veterans' access to various
health facilities and increased reliability In the Department of Veterans
Affairs.
Basically the Sanders-McCain Bill what was established was: 13,14
- War Veterans who have a long waiting time or who live more than 40 km. away from a Veterans Administration´s provider will be authorized to would allow veterans to seek private care. An audit revealed that there were 75,000 war veterans who had to wait more than three months to be assisted by a Veterans Administration professional. It also would require the VA to establish disciplinary procedures for employees who knowingly falsify wait time data.
- US $ 500 million would probably be authorized to hire more doctors and nurses.
- The Senate bill would require the VA to post on the Internet current wait times for appointments in primary and specialty care at each VA medical center.
- Construction of 26 medical centers in 18 states. 6
Electronic Medical Record systems (EMRs)
An Electronic Medical Record system is an accumulation of digitized information from a patient population. Data include clinical history, prescriptions, allergies, vaccination, laboratory analysis, imaging studies, vital signs, age, weight, demographic information and billing. The paperwork is eliminated and the information kept up to date.
According to the US Veterans Administration This system improves its efficiency
by 6% each year elapsed.
Systems have been implemented (Intermedic Trip Tix) that automatically
read the written by the health agents during the ambulance transfer and turn it
into digital information.
With the RME it improves the quality of care. It would serve to reduce costs
primarily in large institutions and not so much in small offices. According to
a study by the Annals of Internal Medicine reduces the hours of
identification of a patient from 130 to 46 hours. 3
Professionals can synchronize their cell phones with EMRs. The threats to EMRs
are: a) By personnel or hackers, b) Environmental disasters (hurricane, fires),
c) Technological failures and traffic accidents.
The general public has not received the EMRs completely because of the
possibility that the government may use these data beyond the purpose for which
they were created or that the information falls into the wrong hands. Several
countries have issued very strict laws in this regard. The European Union made
a General Regulation of Data Protection. 4
In UK, the NHS (similar to our PAMI) has pledged not to use more papers and to
register all health data as EMR by 2020 (Five Year Forward View, NHS England
October 2014) 4
A survey conducted in London in 2015 on 2761 patients reported that 79% were
concerned about RME safety. However 55% support this technique. 9
Systems
In the USA. The MiCare System not only effectively manages the
healthcare demands but also controls the expenses they generate. It has two
components: a) The direct cost of care and b) The indirect administrative cost.
There is also the RelayHealth founded in 1999 by Giovanni Colella with
his headquarters in Atlanta, Georgia. 8.10
Recall that in October 2016 the Legislature of Buenos Aires unanimously
approved the law to create the Integrated System of Electronic Clinical
Histories (ECH), which is already implemented in 10 community centers (CeSAC)
and that by the end of 2017 will be effective in 43 Districts. 1
US Secretary of War Veterans Affairs Dr David J. Shulkin announced on June 5 of this year his decision to implement the EMR for the Department of Veterans Affairs. 18
The MHS GENESIS 7
The MHS GENESIS is the last word in EMR that has acquired the US
Department of Defense. It holds all medical and dental records. It will replace
various systems and will comprise the Armed Forces Longitudinal Health
Technology Applications (AHLTA), the Joint Compound System (CHCS) and
the Joint Medical Theater Program (TMP-J). The Office of Management
of the Joint Medical Operational Information System (JOMIS) is responsible
for the operation of the MHS GENESIS.
The acronym IOC refers to Initial Operational Capacity and
describes the first destinations that will receive the MHS GENESIS. These are: Army
Madigan Medical Center, Bremerton Naval Hospital, Oak Harbor
Naval Hospital and Fairchild Air Force Base (92nd Medical and Dental).
Those patients who move to destinations where MHS GENESIS is not yet applied
may continue to use the RelayHealth / MiCare or Tricare systems
online.
(https//patientportal.mhsgenesis.health.mil)
1.
Manage medical and active duty dental appointments.
2.
View notes from the clinical visits and certain lab/tests results such as blood tests.
3.
Request the prescription renewal of medications.
4.
Exchange secure messages with the health team.
5.
Monitor the health information of the holder and their relatives and
corroborate the care profile.
6.
Complete a pre-visit active duty dental health questionnaire online.
7.
Look up information related to their health concerns and medications.
8.
View, download, transmit and print their health data.
9.
Receive alerts about their medical exams and connect with health education
links.
The patients can access the MHS GENESIS portal:
1.
From 0-12 years: Parents or caregivers will have access to the child's
records.
2.
From 13 to 17 years: To enter require a password.
3.
More than 18 years: To enter require a password
4.
National Guard / Reserve / Retired: Enter your password.
5.
Personnel who have been separated from force but not retired: That is,
personnel who have completed their military service and are on their way to
retirement. They are allowed a period of six months in which they keep their
password.
6.
Deaths: The account of deceased personnel is deactivated but
Your family members can still access the portal.
Your family members can still access the portal.
The password is obtained through the Human Resources Data Center of the US Department of Defense. 7
Bibliography
1. Aprobaron la ley de historias clínicas electrónicas para los
hospitales públicos de la Ciudad http://www.telam.com.ar/notas/201610/168568-legislatura-portena-salud-hospitales-historia-clinica.html
3. Baron, Richard MD- Quality Improvement with an
Electronic Health Record: Achievable, but Not Automatic- 16 October 2007 Annals of Internal Medicine
Volume 147 • Number 8
5. Electronic Health Record-Houses of
Parliament http://researchbriefings.files.parliament.uk/documents/POST-PN-0519/POST-PN-0519.pdf
6. Herb, Jeremy-Sanders-McCain strike VA
deal -06/05/2014. http://www.politico.com/story/2014/06/bernie-sanders-john-mccain-va-deal-107491
7. MHS GENESIS-Health.Mil https://health.mil/MHSGENESIS
9. Papoutsi, C, J. E. Reed, C. Marston, R. Lewis,
A. Majeed, D. Bell, ‘Patient and public views about the security and privacy of
Electronic Health Records (EHRs) in the UK: results from a mixed methods
study’, BMC Medical Informatics & Decision Making, 2015, 15 (1).
11. Roy, Avik-How Health-Care Spending Strains the U.S. Military- Forbes-March
12, 2012
12. https://www.forbes.com/sites/aroy/2012/03/12/how-health-care-spending-strains-the-u-s-military/#7e6629062c54 Salta, Mauricio Hernán-Comparación de los
sistemas de salud de Argentina, Canada y EE.UU.http://www.fbioyf.unr.edu.ar/evirtual/pluginfile.php/2794/mod_resource/content/0/5_Comparacion_de_los_sistemas_de_salud_de_Argentina_protegido_.pdf
13. Simon, Richard-A primer on how the VA crisis broke the usual
congressional gridlock .Los Angeles Times, June 10, 2014. http://www.latimes.com/nation/nationnow/la-na-veterans-affairs-va-legislation-20140610-story.html
14. Simon, Richard, Zarembo, Alan-VA audit sparks outrage in Congress over long
waits for medical care-Los Angeles Time, June 24, 2017-
15. Total Pie Chart UK for 2017 http://www.ukpublicspending.co.uk/piechart_2017_UK_total
17. Tucker, Jasmine- How Much Do We Spend on Our Nation’s
Veterans?-National Priorities Project-Nov 11, 2014 https://www.nationalpriorities.org/blog/2014/11/11/how-much-do-we-spend-our-nations-veterans/
18. US Department of Veterans Affair-News Release-Secretary's
Blog, Top Stories by OMR-June 5, 2017 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2914
19. US Federal spending and revenue
components for fiscal year 2016. https://en.wikipedia.org/wiki/Expenditures_in_the_United_States_federal_budget#/media/File:CBO_Infographic_2016.png
