Reconstructing Healthcare in a Global Marketplace

When we think of reconstructing healthcare in a global marketplace, are we sensitive to the fact that globalization has given more opportunities for the very wealthy to become wealthier? Economic globalization has indeed produced declines in economic growth, and reduced progress in raising life expectancy and reducing the rate of infant mortality. The United States leads the world in healthcare costs but ranks 21st in life expectancy and 27th in infant mortality. We have the highest drug costs in the world and many hospitals are struggling to keep their doors open. The reduction of available emergency departments is felt nationwide and globally, there are many places where emergency care is simply not available.

We know we are affected by political and social changes that impact our entire lives worldwide. The United States healthcare systems have had extraordinary success and have been encouraged to seek a global marketplace for expanding the economic rewards. A good example of this was when I was chief nurse at Virginia Mason Hospital in Seattle and we developed our Pacific Rim plan to offer healthcare services to those Asian peoples and countries. The successes of these market expansions need to be measured against those who are not served in our own backyards. There is growing discontent when our healthcare system cannot provide even a basic level of care to a large portion of the world's population. I recently was privileged to be the Charlotte Searles Commemorative lecturer for the University of South Africa. I saw such poverty and impossible living conditions surrounding Johannesburg, Pretoria, and CapeTown; row upon row of shacks where the government had placed outhouses in rows between them. There was no running water, plumbing, sewage, or electricity. Healthcare? On the way to Saweto, we drove through the public hospital grounds and facilities, where it was clearly stated that no pictures were allowed. Why? Lines of poverty stricken, ill people waiting outdoors for hours, maybe even days, to get some kind of care. We need to look at globalization of healthcare in different terms than "boutique" marketing.

If we look at other countries and see the overwhelming poverty, lack of any healthcare, unsanitary living conditions, and unbelievable shacks to live in, or on the streets as our own country's "homeless," then we might be able to envision and influence a healthier tomorrow for all people everywhere. However, our ability to restructure and develop global healthcare offerings is enhanced with the explosive technology and scientific advances and is valued worldwide. So this issue of Nursing Administration Quarterly (NAQ), Reconstructing Healthcare in a Global Marketplace, is led by Julian S.A. Cicatiello, RN, MA, MEd, CNAA, Healthcare Consultant, Youngstown, Ohio. Julian has been on the editorial board of NAQ, since I started it in 1975. He is a Nurse Surveyor, Ambulatory Care Accreditation Program - Joint Commission on Accreditation of Healthcare Organizations; a Magnet Appraiser, Magnet Recognition Program - Recognizing Excellence in Nursing Service, American Nurses Credentialing Center; and has spent 4 decades in healthcare. He is Editor of the Nurse Executive Resource Manual and serves as consultant to a number of hospitals and a graduate program in nursing administration. One of Julian's favorite quotes is "To everything there is a season, and a time to every purpose under heaven" (Ecclesiastes 3:1).

What is the time for nursings' purpose in the global marketplace? According to a new report from the Healthcare Financial Management Association in partnership with GE Financial Services, hospitals and healthcare systems nationwide are having growth difficulty using traditional means to support services and facilities needed to meet the burgeoning demand for healthcare services. Between 2001 and 2002, the percentage of hospitals defined as having broad access to capital declined from 42% to 36%, while the percentage of limited-capital-access hospitals nearly doubled from 11% to 19%. Now we have the Bush administration proposals for Medicare/Medicaid tax credit insurance for uninsured and discounts on pharmaceuticals. Is our government sensitive to the global marketplace in pharmaceuticals? Are we protecting large for-profit corporations, like Pfizer, which made more money in 2001 than did homebuilding, apparel, railroad, and publishing industries combined?

Then we have the healthcare biotech industry marketing globally. Yes, the world is wanting our abilities to diagnose and treat illnesses such as cancer with new drugs, software, and medical instruments. The time for nursing is here in this global marketplace. What could we do to present our capabilities in marketing our talents?

1. All nursing home and home care patients could be admitted to facilities and programs by advanced practice nurses and it should not be necessary to have a physician sign for admission. After all, extended care and home care is nursing care, not the practice of medicine. What a worldwide contribution in a cost-effective way this would make.

2. If third-party payers reimbursed nurses directly for care rendered, especially care by nurse midwives, nurse anesthetists, and advanced practice nurses, there would be no need for MD gatekeepers, as these professional nurses would consult physicians as necessary for their patients. This would enable global marketing of nursing services to countries in need. There would be no fee splitting and thus there would be a less costly way of providing services to many underserved areas of the world.

3. If every school would be able to pay for school nurses at all levels of education, we would have a healthier future population. If we could market school nursing globally and have sufficient resources to provide care globally, to ensure better health promotion and maintenance, many health problems of the world would be lessened.

4. The greatest need for global marketing and restructuring is in nursing education. The world shortage of nurses is dependent on our capability to educate nurses, but we are falling behind and unless there is a stronger financial value placed on teaching nursing, there will be no future nurse educators.

I realize that this editorial may seem against the restructuring of healthcare in a global marketplace, but unfortunately the fortunate continue to reap the benefits while the less fortunate people are forgotten. We are fortunate to live in America, where we value diversity, respect all individuals' right to choice in healthcare, and have the freedom to choose to die with dignity. Yes, we have a long way to go for the uninsured and underinsured, but under most circumstances, we do not turn people away from care in an emergency. Maybe we overexpect rather than underachieve in this ever growing competitive world of healthcare.