Proliferation of primary care in small city

The research being carried out is concerning the recently established primary care situated at around twenty-five miles away from the minor city with a population of around fifty thousand people. The newly created primary care has five family physicians, two nurse practitioners, two medical helpers as well as twenty medical supports. This medical supports comprise of RNs, LPNs, along with CMAs. The clinic is responsible for offering the primary care and services to the community working within and outside the city periphery. Gradually, this city had been developing to a level that it creates opportunities for new employments, education and well as a spacious living place for the future families (Starfield, 1998).  
The central city has two major care institutions. One is a tertiary care facility that is experienced in offering extended pulmonary care. The two major care hospitals mainly offer the common services like labor and delivery to expectant mothers, outpatient surgical treatment services, chronic ailments care services among others. The institutions have fully equipped laboratory and radiology ancillary bureaucracies. Up to now, the residents of this city have fully utilized the facilities within the emergency department to be treated their common diseases and conditions whenever their personal doctors weren't available (Tiem, Moseley & Dessinger, 2012).      
Factors behind the Proliferation of Primary Care in the small city
According to Centers for Disease Control and Prevention Achievements in public health, (1900), for the past 20 to 30 years, there were consistent players who were influential to the expansion of primary care in remote areas. These included the political, socio-economic, economic and social factors that facilitated the opening of the new primary care in the small towns branched from the major primary care hospitals. 
Social Factors
Tiem, Moseley & Dessinger (2012) indicated that social determinants on the health sector show the political players and the real situations of the surroundings with regards to where people were born, where they live, play, work , learn and age. These factors have ever determined the effects and the wide range of health, functionality as well as the standards of life for the healthcare primary centers practices. These factors include;
1.     The presence of the natural and artificial resources that satisfy the day-to-day demands. These include; education and work opportunities, healthful meals among others. 
2.     Varying social attitudes, values, and standards, like discrimination
3.     Vulnerability to criminal offenses, violence, and anti-social behaviors, example, the availability of waste or garbage.
4.        Nearness to social and mass media as well as the future advancements like the internet or mobile phones.  
5.     Socio-economic challenges like pervasive poverty and drought. 
6.     Availability of public security and safety, like presence of police post
Under social determinants, genetic and physical determinants are key players that influence the proliferation of new primary health care centers. For instance;
1.               The natural condition of the environment influenced by the prevailing weather condition and climate patterns
2.               The presence of housing facilities such as homes and neighborhood.
3.               Presence or absence of physical obstacles affecting specifically physically challenged people. 
4.               The vulnerability of aesthetic components like lighting, trees, and benches
5.               Good infrastructure networks such as communication and transportation connections.
 Political Factors
Policy making at local, state and federal level is affected by political influence. Either directly or indirectly, these policies affect the humanity/residents at a personal level or generally. For instance, a policy that increases the taxes on the sales of the drug mainly improves health status among the people through the reduction of the number of persons abusing the products. Some federal health policies aim at positively affecting the whole population. For instance, in 1966, the US federal policy on the Highway Safety Act and the National Traffic as well as the Motor Vehicle Safety Act was passed to guide and control the standards for both the automotive and the highways. Ultimately, the policy brought about the safety and control of motor cars by the introduction of seat belts. In return, the policies enhanced reduced rates of road accidents, injuries, and deaths (Tiem, Moseley & Dessinger, 2012).      
Mission Statement
The primary care shall be flexible, and comprehensive to produce quality healthcare practices; achieve equity and healthy life to the general public by developing accessibility to care coverage, good services, punctuality and enhanced workforce.  The guiding orientation principles include; meet the general physical, social and mental health conditions of the clients, enhance disease control within the disables, identification and diagnosing proper treatment of health status, value the quality of life by preventing death and increasing life expectancy (Audretsch et al., 2015).  
Directions the clinic shall use to develop its business
Weiss and Lonnquist (2000) say that one of the ways to make a primary care provider (PCP) be a business is by improving its operational culture. The constructive approach shapes the health measures and the resultant health care delivery structures. Through the upheld culture, the beliefs, norms, values, principles and the environment of the primary care become economically fruitful. Mainly, economic realities are an alteration that manages the spiraling cost of primary health care in the USA. The per capita income of US determined through the evaluation of general expenditure, and Gross Domestic Product (GDP) substantially applies in primary health care.   
For this upcoming primary health care center to decide what services to offer, the following economic factors shall be considered;
The growth rate of the U. S. population, especially the elderly growth rate. 
Improvements of some basic health care technological advancements and their cost considerations.
The growth rate of the experts in health care 
The rate of drug reliance as well as the allied pharmaceutical expenditure
The increasing cost for the family medical indemnity

Clinic Performance Measures

Our clinic has several performance measures derived from the goals of the primary care. The following are some of the clinic health goals;

a. The clinic focuses on adjusting health care services positively to ensure that the patients are supplied with usual as well as a continuous source of the community health care. The reason for this aim is to ensure that people are given the right health care services to improve the health performance and outcome with few disparities and expenses. The performance measure of this goal will be observed positive when the Primary Care Providers (PCPs) create an evocative and continual interaction between them and the patients. Also, the PCP should be able to offer integrated services and practices within family and community contexts.

b. The second goal of this Primary Care Center is to gain the patients' trust, enforce a well provider-patient interaction and increase the suitability of the health care offered to the community. The measures of this goal performance include enhanced health service care by providing an empirical founded preventive health services to the patients. These preventive services should prevent diseases early by identifying the early symptoms prior its development into a disorder (primary control).

It the goal of our clinic to encourage time consciousness in health care system implementations of the services. We shall be able to give a health help immediately after a threat is discovered. The performance measures for the time consciousness include; reduction of the time used by the patient in the waiting room and emergency departments (EDs). Improvements in the time spent between the health tests, identification of the problem and the treatments. This service shall be made as fast as possible.

Effects of Public Policies on Federal Healthcare Systems

Health care policies are formulated at the federal level; however, their effects are felt at the local level. Examples of these health care policies include; the Patient Protection and Affordable Care Act (PPACA), Public Health Policy and Practice (PHPP) and Affordable Care Act on the Health Care Workforce (ACAHCW). According to Schiller, Kovach & Miller (1994), these federal policies have significantly affected the development of US Health Care sector in the following ways:

a. Regarding the Affordable Care Act (ACA) health care sector in the United States has improved the traditional way of looking into the health system and fundamental forces that influence the health performance outcomes. ACA's influenced increment of the opportunities of Health Practices by expanding its access and adjustments of the health coverage. These opportunities enhance supporting transformation on the systems of the US health care department.

b. Through Affordable Care Act (ACA) following extensions and revisions, the multifaceted US health care rules and regulations have culminated in the general federal legal structure. This Act has founded the fundamental legal protections that were deficient for a long time. Ultimately, the Act has ensured affordable health medical cover right from birth to retirement age.

c. Public Health Policy and Practice (PHPP) have helped the health sector to accomplish global medical cover via a collective accountability amidst federal, personal and worker’s efforts.

d. Affordable Care Act on the Health Care Workforce (ACAHCW) enhanced fairness, improved health care's quality and made the services more affordable. For instance, the Act fought for the cost-fairness in the charges for health insurance coverage.

e. Patient Protection and Affordable Care Act (PPACA) is a significant act that improved the health-care value and efficiency by minimizing wastage. This made the health care structures to be more accountable to attend to the diverse population of the patient within the US.

f. These policies made nationwide mainly strengthen primary health-care accessibility and influences long-term amendments in the accessibility of primary besides precautionary health care.

g. Finally, these policies get involved in formulating strategic investments for public health by factoring the growth of clinical precautionary care and the public savings.

Conclusion

Differences in well-being and human services in the United States have been a longstanding test bringing about a few gatherings accepting less and lower quality social insurance than others and encountering poorer wellbeing results. This brief gives an early on outline of wellbeing and medicinal services incongruities, including what inconsistencies are and why they matter, the status of differences today, and key endeavors to address variations, incorporating arrangements in the Affordable Care Act (ACA) and their effect on wellbeing scope aberrations (Audretsch et al., 2015).

References

Audretsch, D., Lehmann, E., Richardson, A. & Vismara, S. (2015). Globalization and public policy: a European perspective. Cham: Springer.

Schiller, M., Kovach, K. & Miller, M. (1994). Total quality management for hospital nutrition services. Gaithersburg, Md: Aspen Publishers.

Starfield, B. (1998). Primary care: balancing health needs, services, and technology. New York: Oxford University Press

Tiem, D., Moseley, J. & Dessinger, J. (2012). Fundamentals of performance improvement: optimizing results through people, process, and organizations. San Francisco, CA

Centers for Disease Control and Prevention. Achievements in public health, (1900–1999) motor-vehicle safety: A 20th-century public health achievement [Internet]. MMWR Weekly. 1999 May 14; 48(18); 369–74 [cited 2010 August 27]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4818a1.htm.Pfeiffer, a Wiley imprint.