---

Follow My Blog

Get new content delivered directly to your inbox.

Apples and Oranges
Paul Mersiovsky
Northcentral University, MCA 5012-V4, Assignment 3
Carissa Smock, PhD, MPH
February 16, 2020

Introduction

            Imagine a tale of two fruits: apples and oranges.  A question of preference would undoubtedly form. A question of superiority, however, would be a far more difficult proposition. Such a quandary beckons a universal standard for comparison. Measurement constructs could be made of popularity, nutritional value, cost of production and so on. Such analytical paradigms would, by necessity, bring anthropology, ecology, biology and economics into play. Internal validity would render any attempt at external validity impossible. As it is with fruit, so it is with relative comparisons of healthcare delivery. The staggering aggregate cost and plurality of gross national product give testimony to the magnitude of attention demanded by this aspect of commerce in the United States. Basic axioms of performance improvement prescribe measurement techniques meant to form the basis of analysis and evaluation. The natural progression of this thought leads to the application of such established schemes to the healthcare administration of other countries for comparison.  This is where the fruits of analysis become tainted. Years of reaction and planning have demonstrated that success in healthcare begins and ends beyond the walls of any provider or practitioner. This realization dilutes the purity of any causal relationship one might attempt to establish. Any attempt to compare the relative success of healthcare administration between two countries is, by design, not unlike a comparison of apples and oranges.  To explore this concept fully, one must understand how cultural norms effect the practice of healthcare, the modern understanding of social determinants of health and the halo effect as it relates to public perception of government healthcare administration.

Cultural Norms

The countries of this world each represent centuries of anthropology, ecology and human history.  There is such variance in size, shape and population as to give every nation an identity as individual as a fingerprint. China’s population is high but steady, while India’s continues to expand. Korea has emerged as an economic giant while many African countries have seen a rise of human rights as never seen before.  Utilization of available health resources in each country is equally as varied and separate. Affordability and individual economic circumstances must be taken into account when evaluating the success of health care delivery under such conditions (Volpintesta, 2016). Consider a nation whose population views the use of available resources through the eyes of cultural and religious paradigms inherent to that nation. How much is dealt with at home or with the help of family and friends? Such outcomes might not be recorded or even considered in aggregate analysis schemes. A country whose major religion forbids eating pork or beef, social stigmas which forbid gynecological care or behavioral health: these are all places that might demonstrate lowered spending with recorded outcomes that are spuriously favorable. The presence or absence of homogeneity within a population would dictate the breadth of services needed and the relative cost of specialization in terms of availability.  An all-encompassing normative scale seems doomed at inception due to the enormity of bringing such a thing into existence.  This is a natural side-effect of a planet full of nations as individual as the selection of fruit in a supermarket.  

Population Health Management

            The passage of time and the rigor of investigative science, both retrospective and ongoing, has demonstrated an inescapable quality of successful healthcare. The source of positive outcomes and optimal care plans begins and ends outside the confines of any hospital, clinic or provider’s office (Lincoln, 2019). The perceptions and behaviors replete in a given population will manifest as coefficients of geometric expansion as they regard both successes and failures.  The Carolinas might be in need of smoking secession efforts, Texas mat be in need of childhood obesity treatment, Detroit or Chicago might need opioid treatment. Such things are resistant to long cherished stereotypes and must be re-analyzed to identify valid opportunities for management. True also are the physical characteristics of people places and things and their effect on outcomes management. A lack of available MRI capable clinics in west Texas or Wyoming might suggest the usefulness of new mobile mammography centers. If endoscopy facilities are unavailable, home colorectal cancer testing kits may be in order. Finally, despite the passing of years, disparity between the races is still factor in healthcare delivery.  Health equity is becoming of greater importance in the healthcare administration consciousness. If protected classes can expect different treatment, then surely the individual social makeup of a given nation would affect the outcome results of any measurement intended to evaluate healthcare performance. Population Health Management is an often-costly endeavor to control social determinants of health. These costs would have to be considered in any measurement of cost to benefit examinations of medicine or behavioral health delivery. This is the cost demanded by the science that has demonstrated the relationship between behaviors outside the hospital that promote success within.

Perception

            Consider the many products and services sold within an altruistic package. A pair of socks looks and feels better when the purchaser can congratulate themselves on the same going to the homeless at the conclusion of their purchase. A plain, ringed notebook made with recycled material can give off a luster far more attractive than that of its more pragmatic cohort. Perception is a powerful river than can be bent by the will of a clever marketer. This effect beckons the question of influence of perception on the use of available healthcare resources. There is science to suggest that, even in the presence of suspected corruption, a forgiving eye will transport a constituent to higher levels of support for a publicly funded healthcare system. Consider Fire Departments, Police and other stalwart public services. The provision of such services, and the providers employed there-in, are considered with a level of awe. Healthcare delivered by what are perceived to be profit oriented mega systems can be viewed as the bad guy in comparison. A perceived lack of resources, a lapse in availability or any perceived intrusion of private life could be viewed as the machinations of a villain rather than the altruistic pursuits of a trusted guardian. How much more effective would social services and preventative care be accepted and welcomed in an environment in which the delivery of healthcare is viewed in the same light as the actions of first responders during national tragedies? This is precisely the suggestion of studies meant to examine such haloed views (Hedegaard, 2018). These views are difficult to accurately measure and even more difficult to include in any sort of normative analysis logic. This is yet another in a succession of factors that create individual healthcare statistics in each country in the world. The healthcare delivery models are as individual to each country as that nation’s perception of the effectiveness and honesty of that model.

Conclusions

            The Hawthorne Effect inherit to public healthcare systems, the effect of population related healthcare coefficients and the morays/folkways inherent to each culture make any international comparison of healthcare success a dubious proposition at best. Just as apples and oranges resist Kantian declarations of superiority, national commerce involving medicine and behavioral health suffers from special cause variation endemic to the individual characteristics of a given country. The contamination of cause and effect relationships established through scientific rigor by such endemic properties makes the declaration of exclusive dependent variable behaviors all but impossible. Such properties are rendered manifest by the decades of scientific analysis of population health management. These studies were the eventuality of the abstract concepts of healthcare commerce made concrete through a nigh infinite succession of carefully crafted success metrics. Logic suggests the presence of wisdom to be gathered in baskets of international comparison. The drivers for such planting and harvesting can be found in the incommensurate majority of gross national product devoted to medicine and behavioral health. More’s the fruitlessness evident in comparisons that involve obscure alterations in cause and effect relationships. One must consider the nigh endless succession of conditions that resulted in the emergence of apples and oranges.  When multiplied by the equally long list of things effected by these fruits, the length and breadth of permutation becomes incalculable.  Superiority could only realized within a measurement paradigm that took all these factors into account. So it is that apples and oranges resist any and all attempts to establish which is best.

References

Volpintesta, E. (2016). Shouldn’t compare U.S. healthcare to other countries. Medical Economics, 18, 14.

Lincoln, K. D. (2019). The Role of Social Determinants and Why Community-Based Programming Works: Social needs often are not met during healthcare visits, but HCBS can fill that gap. Generations, 13–18.

Hedegaard, T. F. (2018). Thinking inside the Box: How unsuccessful governments, corruption and lock-in effects influence attitudes towards government spending on public healthcare and public old age pensions across 31 countries. Acta Politologica, 10(1), 1–16