Five Common Health System Deficiencies
“Health,” according to the World Health Organization, “is a state of full physical, emotional and social well being and not just the absence of illness and infirmity.” A variety of other definitions have also been used over time for various purposes. These often vary as each culture has varying views on health.
However, the most commonly accepted definition by the United States Government and most private health care entities is the critical wellness process. This definition includes the physical, emotional and mental wellness, and the knowledge of a person about their own health. This definition is what most private health care organizations to use when determining financing. It is also the least one health system uses to determine the eligibility of a patient for coverage.
The second most common definition is the ability to survive a year after diagnosis with no prior major illness or medical complications. Unfortunately, this definition is often referred to as “life expectancy.” This is because the definition relies on life expectancy, which can be influenced by the underlying illnesses that cause a short time illness (the illnesses that usually set off the short term definition). Life expectancy is a very arbitrary number, most likely determined by the age at diagnosis for a particular major illness. It can also be influenced by the health of the patient prior to diagnosis and may not reflect how long a person may live.
The third most common definition is functional capacity. This includes being able to take basic self-care measures, like bathing and dressing themselves, for a minimum of six hours within a week. Less than optimal health systems use a slightly looser definition, defining functional capacity as being capable of taking basic care but not necessarily presenting a serious problem to the system. Most health systems use a version of this third definition, using the word “serious” to describe something that is more than minor. This is the least one group uses to characterize its diagnosis-screening process and thus is the most likely to lead to false positives and false negatives.
The fourth most common definition is functional loss. This describes the difference between good health and poor health, in that better health prevents the progression of disease, while poor health limits the extent to which it can be affected. This is the definition that health professionals usually use when evaluating whether someone is suffering from either a chronic or minor condition. Because older adults tend to have higher than normal rates of disability and a higher level of health risk, this definition has become one of the main metrics used to evaluate them for compensation.
The fifth definition is the Joint Management Deficit. This refers to the difference between actual and potential disability payments that are owed to the insured under a health system. This is a ratio, comparing the number of disability payments expected to be paid out over the number actually received. An accurate measure of a health system’s Joint Management Deficit is its ratio of actual payments to potential payments. By combining these definitions with additional information on a health system’s financial structure, such as the stability of its payment schedule and its ability to absorb rising claims, a company with a good record of success in its joint management efforts can increase its chances of obtaining more compensation by appealing to a court.