Health Care Delivery System
Health Care Delivery System
The United States has a unique health care delivery system as compared to other developed countries. The United States does not have national health insurance programs that the government is in charge of or financed through general taxes. One barrier to universal coverage of health care is the unnecessary fragmentation of the United States delivery system, which might be the central feature.(Shortell et al 1996). The health care delivery systems has several subsystems; the managed care, the military subsystem, the integrated care and vulnerable populations subsystem.
Managed care delivery system
This health care delivery system is the most dominant in the United States. It is a system that strives at achieving efficiency through integration of basic functions in the health care delivery. It controls the utilization of medical services by employing certain mechanisms. It determines the prices of the purchased services and the pay of the providers.
The primary financer of the care system is the employer or the government. The financer gives contracts to a managed care organizer (M.C.O) to give a selected health plan for the employees. The MCO thus promises to provide health care services and act like an insurance company. They contract the enrollees (members) under the health plan where they agree on the entitled number of covered health services. The enrollees thus select their preferred health providers who they will receive routine services from.
Primary care providers or general practitioners determine appropriate referrals for higher level or specialty services. Most services are delivered through contracts with providers. The employer might finance the care by purchasing a plan for the MCO, but the MCO is responsible for negotiating with the service providers. The providers are paid either through capitation where a fixed payment is made for each patient under their care or paid at a discount. The provider usually agree to discount their services to patients for a guarantee patient population and MCO network.
The health plan risks of costing more premiums than collected because they rely on the expected health care utilization cost is usually not good for the enrollees. Thus there should be a written risk to prepare the enrollee. This health plan will eventually not assume the role of insurer and be convenient for everyone entitled to that service.
Military health care delivery system
This delivery system is comprehensive, integrated and very organized. It covers treatment as well as preventive health care services. It combines medical services with public health. It is usually available free of charge to active military personnel of the United States Army, Air force, Navy and Coast guard. The uniformed nonmilitary services such as the National Oceanographic Atmospheric Association (NOAA) and the public health service also get health services free of charge.
A routine care is usually provided close to the military personnel’s place of work, either at the dispensary sickbay, first aid station or medical station. Veteran Administration (V.A) facilitates long term care to retired military personnel. It is one of the largest and oldest system which is very organized. The V.A prioritizes on the veterans who are disabled. It focusses on long term care, hospital care and mental health services. It makes sure that the department of defense get medical care, education, training, research, contingency support and emergency management.
The families and dependents of active duty free retired career military personnel’s get treatments from the hospital, dispensaries or can be covered by TRICARE. TRICARE is a program that is financed by the military and allows beneficiaries to get care from both private and military medical care facilities. Despite the military providing a high quality health care, the patient’s should be given a right to choose on how the health care services should provide for them. This will give the patients the confidence and belief in the health care delivery system.
Medical health care delivery subsystem for the vulnerable populations
The poor, uninsured and immigrants who live in an economically challenged area receive care from “safety net” providers. These “safety net” providers have health centers designed for the less fortunate. These providers are consistent with their roles thus making sure that their patients get medical services as well as their needs of vulnerable populations. Such health centers have shown tremendous improvements to the vulnerable communities who live in both rural and urban areas. (Politzer et al 2003)
Government health insurance programs such as Medicare, Medicaid and State Children’s Health Insurance Program (SCHIP) provide the vulnerable communities with health care services. Medicare is the largest source of health insurance for people who are 65 years or older and are suffering from disabilities or diagnosed with renal disease. Medicaid is the third largest source of health insurance in the United States meant for covering for women with low income, the children, elderly and persons with disabilities. It covers 12% of the United States population. (US Census Bureau. 2007)
Due to the growing population, the government took an initiative for the uninsured families and provide insurance to the children through State Children’s Health Insurance Program (SCHIP). This extends to families who have modest income but are not qualified for Medicaid. (US Census Bureau. 2007). However, “safety net” is not as secure because the availability of the providers vary depending on the community. Communities that lack safety net providers have to seek for health care from hospital emergency departments. The “safety net” providers are usually under pressure because of the growing population of poor people and uninsured persons in the community. (Shi L., et al. 2001)
Like any other community, there might be person’s with adverse conditions thus revenues from Medicaid should be accessible for the “safety net” providers to shift costs usually for those whose health care cannot be compensated to cater their private insurance. This will lead to saving more lives and better health care for the community.
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US Census Bureau. 2007. Current Populations Report. Income, Povery, and Health Insurance
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