Research Proposal

An Analysis of Quality of Care in the Hierarchy

A. Rahman and P. Mellacheruvu

Introduction

Healthcare is the provision of medical and related services aimed at maintaining good health. The National Health Service (NHS) of the UK strives to provide healthcare from the top-down. In a nutshell, the NHS is the pinnacle of socialized medicine, as the British government pays almost any bill to the extent to which the maximum cost of receiving any prescribed medicine is a mere $12. The NHS was formed in 1948, in the wake of the atrocities of World War II. There was incredible opposition to the plan at the time, especially by the British Medical Association (BMA) stating that it was unsupportable and too ambitious. Today, some citizens of the UK have a similar opinion regarding NHS. Others believe that the NHS has done well, as Britain has a higher average life expectancy, lower infant mortality, and fewer medical and surgical mishaps. But how does this opinion vary among the classes? How related is quality of care with class structure in the UK? These are some of the questions that are to be explored on the ensuing analysis of how quality of care differs among the classes with NHS.

Research Questions

Considering the possible tensions in the healthcare system with respect to the class divisions of the UK, we began questioning how this system of care manifests itself. We wonder if there was a difference in the quality of care experienced by the different classes. Does it vary? Is the variance significant in any way? Considering this, how can we look at healthcare across classes? How can we take more recent immigration into account? To break down these questions even further, we began thinking about how quality of healthcare could possibly be measured. Importantly, we need to be able to somehow quantify quality in a way that is meaningful. We decided that an effective way to measure quality would be to measure time. What are the wait times for people in clinics that are public versus those which are private? Who frequents private clinics as opposed to private clinics? This led us to question the availability of difference clinics. How can we map the number of clinics in a geographical area, like Oxford, in relation to different demographic areas? Is there a correlation between the number of private and public clinics and property value? Also, how does the number of A&E’s factor in? Are they denser in certain locations as opposed to others? Who is more likely to use an A&E, and can this also be mapped and correlated with income distribution and/or property value? We feel that these are questions that we could possibly answer during our time at Oxford.

Methods

The overall approach to this project will be very hands on. A close attention will be on demographics and first-hand opinions of patients and physicians. With regards to demographics, the city of Oxford will be mapped by creating loose socioeconomic sectors of the city based on metrics such as property values. This data will be obtained from the Oxford City Council databases that are free to the public on the web and through other various real estate websites. Thus an analysis of the built environment is vital for the mapping process. Then the number of NHS clinics and private clinics for each sector can be counted. Then there will be a test to see whether there is a correlation between the socioeconomic sectors of the city and the ratio of NHS to private clinics in each sector. An offshoot of this process is the counting of the number of A&E departments in each sector. An A&E department is a clinic that accepts patients with accidents and emergencies requiring urgent care. Here, a similar ratio can be formulated with the A&E clinics. Finally, an integral aspect of the project is communicating with physicians and patients in the NHS clinics and private clinics. One day interviews can be conducted with willing participants at the NHS sponsored John Radcliffe Hospital and another day interviews can be conducted at private clinic: The Manor Hospital. Since there isn’t a way of quantifying “quality of care,” the interviews shed light on patient and physician experiences and opinions on NHS healthcare and private healthcare. Some examples of questions asked with include, “What are waiting times like for [x] procedure?” “How easy is it to pick and choose a particular hospital? A particular physician?” “What is the appointment scheduling process like? Time consuming or painless?” Even though only a small sample size of physicians and patients will speak for the system, through these questions one can get a gist for the overarching thoughts and opinions on the public vs. private sectors of healthcare in the United Kingdom.

Field Research Schedule

            While conducting our research, we will need to consult people, places, and many writer documents. Because they may be somewhat time consuming, we will need to set aside appropriate time to do interviews. Ideally we will be able to interviews the second week we are in Oxford, and we will need to include both doctors and patients. We are still working on figuring out which doctors and which hospitals and when, but hopefully we will be able to get a start on that soon. As for patients, we are looking to interview a few patients at a private clinic and a few at a public clinic. Ideally we will be able to pick patients who will be able to provide us with information we need in terms of wait times. We will need to probably take audio recordings with a device. We will also be able to assess the quality and differences between the clinics when we visit them to conduct interviews. It will be helpful to take pictures of these locations so that we can reference them in our research. We will also need to spend some time looking at maps of the Oxford area (including Oxfordshire). On these maps, we will have to locate all the public clinics, private clinics, and A&E’s. We will probably spend the first week doing this in order to get a feel for the places we will visit at the geographical relationship between the various clinics. We will also need to reference the demographics of the Oxford area and map them, possibly using property values. For this, we will need to utilize real estate information, likely through websites or by speaking to someone directly, for property values and other useful pieces of information. In order to set a basis for our understanding of class structure in the UK and the history of the NHS, we will also need to consult literature about these histories. Web sources will likely be the most helpful with this. Much of this part can be done before we even travel to the UK, and when we are there we can clarify things we hadn’t previously considered to be important to our understanding. If we decided to look into existing research about class and healthcare, we would also consult online publications and journals that contain papers about these topics. By the third week in Oxford, we should be able to analyze all the data we have collected and begin to compile it into a cohesive paper.

Exploring Topics of Research

NHS v. ACA. A comparative analysis of each programme 

I plan to assess, in an unbiased manner, the healthcare systems of the United States and England. The United Kingdom itself does not have an extensive health plan, but individual countries such as England and Scotland have their own respective organizations. The English healthcare system is the National Health Service (NHS). I would like to compare and contrast NHS with the Affordable Care Act health coverage plan recently set in the United States. In the process, I hope to focus in on the positives of both plans and perhaps hybridize them into another plan that may in fact be better than the present plans in place.

Pro’s of the National Health Service: https://www.gov.uk/government/organisations/department-of-health

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Con’s of the National Health Service: http://article.wn.com/view/2014/04/27/Hospitals_in_England_failing_to_provide_safe_care_have_tripl_p/

Pro’s of the Affordable Care Act: http://www.mass.gov/eohhs/feature-story/top-10-reasons-why-the-affordable-care-act-is-good.html

Con’s of the Affordable Care Act: http://www.huffingtonpost.com/dr-john-jackson/why-the-affordable-care-a_b_4082251.html

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More specifically I would like to understand what sort of political maneuvers were employed to pass these plans and to what degree medical science was considered during the respective parliamentary processes. Thereby, I will analyze the conjunction between two fields: politics and medicine. Some of the questions I will consider include: “How were practicing physicians and hospital administrators involved in the legislative process? What medical papers were quoted or cited in the debates leading up to the votes on these measures? How were the small hospital/clinic staff’s voices heard?” Using these questions, I would like to draw on the interplay between the humanities and sciences and understand how the two work hand in hand as well as repel each other. Although this single conjunction may not answer the age old debate between the humanities and sciences, it creates a path for further exploration into the debate.

 

 

Among the Hustle and Bustle of “The Ave”

 

 

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It is rare for me to leave my normal routes around the University between classes or club meetings, but the other day I decided to take a different stroll around my community outside of campus. I never realized the multitude of activities that dance around me day by day as I pass by them without even the slightest of acknowledgements. This walk was different. It was eye-opening…

I started walking with my SLR and tripod up University Way or lovingly called “The Ave” by students. It was in the afternoon around noon that I made my first trip. I was slightly intrigued by the lack of traffic on the Ave during this time of the day as normally my trips on the Ave took place during the evening hours where “The Ave” is generally vibrant. It was surprisingly sunny that day and the sky yelled “Summer is fast approaching” as I took each step. 

 

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The stark contrasts in building styles and designs were enormous! I would walk out of Alder Hall, which looked like a 5-star hotel compared to the Rick’s Gyros stall just a block ahead. Cafe Solstice was reminiscent of the crammed, small Amsterdam coffee shops I had visited a few years ago. Shalimar, an upscale Indian restaurant with a small waterfall inside looked magnificent whereas its counterpart, Spice of India, looked like an army canteen with a touch of elegance. I couldn’t help but compare the half-painted Cedar’s Mediterranean Place with the sprawling Starbucks. But across all buildings and stands one thing was the same: the hustle and bustle. 

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I saw this downtown express bus departing and couldn’t help but take a long shutter speed shot to capture the speed at which things took place on “The Ave.” The bus was jam-packed with students, residents and tourists all scrambling to get to various parts of Seattle. Then I thought to myself, “how are bus routes going to change if King County Proposition 1 were to be passed?”

So I went to this website to understand more about what the proposition is all about.  

http://seattletransitblog.com/2014/04/07/explainer-why-we-need-to-save-metro/ 

Next year, “2/3 of King County metro routes will be affected” (SeattleTransitBlog) by budget cuts. So the proposition is “a 0.1% sales tax and a $60/year car fee (with a rebate for low-income individuals) to fund roads and transit in King County over 10 years. 60% of funds raised would go to buses” (SeattleTransitBlog). 

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Image courtesy of Kevin’s Bus Rail: http://www.kevinsbusrail.com/kcmetro_gillig-40.html

If I were not to have deeply thought about that bus, the idea of researching this proposition would have never hit me. In fact, the next day coincidentally I saw rallies regarding this proposition on Red Square. Raising awareness about social issues is an integral part of the university culture. Having an politically educated student body is very important as us students will go on to determine the fate of our country. After researching about the proposition later that afternoon I went for another walk in the evening. 

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It was much cloudier yet busy during the evening time and I saw “The Ave” sprawling with students. This time around I tried to capture the hustle and bustle of pedestrians as they rushed to small restaurants to grab a quick bite and get back to their busy schedules. But I was absolutely thrilled by the reduction of cars on “The Ave” come the evening time. I expected the number of cars to increase as we went later into the evening, rather it decreased. On the contrary, I saw a good number of bikers moving along “The Ave.”

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This led me to conduct another mini research project in which I tried to find how the mode of transportation to/from and within college has been changing over time. This article by Urban Milwaukee has an explanation for how colleges have been “coaxing” students out of using cars.

http://urbanmilwaukee.com/2014/02/13/streetsblog-5-ways-colleges-coax-students-out-of-cars/

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According to the article, “104 colleges and universities around the United States provide free or reduced-price transit service to students” (Urban Milwaukee). This push for alternative modes of transportation has been extremely important in the “green movement” across the United States. There is increased consciousness about CO2 emissions and there are clearly efforts taking place across colleges in America to reduce these emissions and create environmentally sound habits among the younger generation in order to bolster the use of these alternative modes of transportation when students graduate and leave college. 

I never realized that a trip to “The Ave” could spark so much discussion about social and environmental issues such as the upcoming elections and CO2 emissions. It just goes to show that there is a deeper meaning behind virtually everything we see in our community. I guess what Lynch and Rivkin strive to do in their article is espouse that exploration of the tiny aspects of our surroundings only enhances our understanding of our society and interest in our beautiful Emerald City. 

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Oxford City and University Demographics (Assignment 1)

The Streets of Oxford

 

Oxford City is part of the Oxfordshire county and has a population of roughly 150,000 people but is said to be growing rapidly as the population in 2021 will be 165,000 (Oxford City Council). The industry there is mainly tourism as Oxford “is the sixth most visited city in the UK” (Oxford City Council). Of course, the largest public sector industry is employment and research at the University of Oxford. The annual revenue of the city is about 770 million pounds. On the whole, Oxford is a rather well educated town. About 43% of its residents have either attempted or completed a college degree whereas the average for England is about 27%. About a quarter of Oxford residents are full-time students. 

 

The University of Oxford is actually not as large as some American universities. The number of students at the University is “22,000 including 11,772 undergraduates and 9,850 postgraduates” (University of Oxford). To put things into perspective, The University of California- Berkeley has more undergraduate students, 25,774, than Oxford does total students (Cal- Berkeley), Oxford is largely diverse as about 40% of its student body is of international citizenship in countries ranging from the United States to Singapore to India. The University of Oxford gets a large sum of money from endowments of about 686 million pounds and individual colleges receive more of their own. For example, one college has an endowment of roughly 1.5 billion pounds! The University of Oxford is undeniably one of the leading universities in the world and these numbers are absolutely mindboggling

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Sources:

http://www.oxford.gov.uk/PageRender/decC/Population_statistics_occw.htm

http://www.ox.ac.uk/about_the_university/facts_and_figures/index.html

http://www.berkeley.edu/about/fact.shtml

 

First Thoughts

I am truly excited to be embarking on this journey to learn more about how the age old debate between science and humanities came to be, at one of the world’s most premiere universities! I hope to find the roots of the University of Washington Honors Program interdisciplinary academic philosophy buried within the depths of The University of Oxford, only 4762 miles away….

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