Assignment 04: Healthcare Delivery Systems Directions

Assignment 04he330 Healthcare Delivery Systemsdirections Be Sure To

Be sure to make an electronic copy of your answer before submitting it to Ashworth College for grading. Unless otherwise stated, answer in complete sentences, and be sure to use correct English spelling and grammar. Sources must be cited in APA format. Refer to the "Assignment Format" page for specific format requirements. In lessons 1-4 you have learned a great deal of information on healthcare delivery systems.

This writing assignment will allow you to provide practical application of concepts learned from lessons 1-4. This writing assignment contains two parts. In the first part, you will combine the responses from lessons 1-4 questions into a Word document. Part I Lesson 1: In 250 words or more, please respond to the following question: Why is the US health care market referred to as “imperfect”? Lesson 2: Please answer the following two questions in 250 words or more: 1. What factors are associated with the development of health services professionals in the United States? 2. What are the major distinctions between primary care and specialty care? Lesson 3: Answer the following question in 250 words or more: According to the Institute of Medicine, what are the four main components of a fully developed electronic health records (EHR) system? Lesson 4: Please answer the following question in 250 words or more: Describe how some of the changes in the health services delivery system have led to a decline in hospital inpatient days and a growth in ambulatory services.

Part II: For part two of the assignment, answer the following four review questions and combine the response into a 3-4 page APA formatted paper. Provide a minimum of three sources to substantiate information provided. The four questions to be addressed are as follows: 1. Why is it that despite public and private health insurance programs, some US citizens are without health care coverage? How will the ACA change this? 2. How can healthcare administrators and policymakers use the various measures of health status and service utilization? Please illustrate your answer. 3. What were the two main aspects of the Supreme Court’s ruling in lawsuits filed against the ACA of 2010? 4. What are the main provisions of HIPAA with regard to the protection of personal health information? What provisions were added to HIPAA under the HITECH law?

Paper For Above instruction

The healthcare delivery system in the United States is often characterized as "imperfect" due to multiple systemic issues that hinder equitable, efficient, and effective healthcare provision. The term "imperfect" stems from factors such as the complex organizational structure, fragmented financing mechanisms, and disparities in access and quality of care. Unlike nationalized systems, the U.S. system comprises a mix of private and public payers, leading to inefficiencies, redundant services, and inequities. Market failures, information asymmetry, and externalities further contribute to this imperfection (Shi & Singh, 2019). For instance, uninsured populations face barriers to access, resulting in delayed treatments and higher overall costs, which exemplify market failure within the system. Moreover, the presence of profit motives and insurance company practices can obstruct coordinated care, affecting overall system efficiency. The imperfect nature also reflects disparities in healthcare outcomes based on socioeconomic status, race, and geographic location, highlighting the systemic inequities that persist despite extensive health policy efforts. Therefore, the U.S. healthcare market's "imperfect" designation captures its inability to deliver universal, equitable, and cost-effective care, emphasizing the need for reforms that address underlying systemic flaws and promote health equity (Schoen et al., 2010).

The development of health services professionals in the United States is influenced by multiple factors, including educational pathways, technological advancements, policy initiatives, and healthcare demand. Educational institutions, ranging from community colleges to universities, provide specialized training in nursing, medicine, pharmacy, and allied health fields. These programs are often regulated by federal and state agencies to ensure quality and standards. Additionally, technological innovation in medical devices, electronic health records, and telemedicine has increased the scope and competencies required of health professionals (Bodenheimer & Sinsky, 2014). Policy initiatives like the Health Professions Education Policy emphasize increasing the supply of health workers, especially in underserved areas. Furthermore, demographic shifts, such as an aging population, increase demand for healthcare services, driving workforce growth and specialization. The distinction between primary care and specialty care primarily revolves around scope of practice; primary care providers offer comprehensive first-contact and ongoing care for diverse health issues, emphasizing prevention and health maintenance. In contrast, specialty care involves focused expertise on specific organ systems, diseases, or procedures, often requiring additional training and certification. Primary care serves as the foundation of the healthcare system, whereas specialty care provides advanced diagnostics and treatments. Both are critical but differ in training, functions, and patient engagement levels (Institute of Medicine, 2001).

Electronic Health Records (EHR) systems, as defined by the Institute of Medicine, must incorporate four main components for full development: Health Information and Data, Results Management, Order Entry and Clinical Decision Support, and Electronic Communication and Connectivity. "Health Information and Data" involves collecting and managing comprehensive patient data, including histories, medication lists, and test results. "Results Management" ensures timely access to laboratory and imaging results, facilitating effective clinical decision-making. "Order Entry and Clinical Decision Support" enable providers to electronically order tests, prescriptions, and interventions with real-time support tools to enhance accuracy and safety. Lastly, "Electronic Communication and Connectivity" promotes secure sharing of information among healthcare entities for coordinated care (Institute of Medicine, 2003). The integration of these components supports clinical workflows, improves patient safety, and enhances data-driven decision-making critical for quality care.

The shift from inpatient to ambulatory services in healthcare delivery reflects technological innovations, policy changes, and evolving patient preferences. Advances in minimally invasive procedures, outpatient surgical techniques, and diagnostic technologies have made outpatient care more feasible, less risky, and less costly. Policies such as the Affordable Care Act further incentivized outpatient care through reimbursement reforms, reducing hospital stays by emphasizing outpatient surgeries and post-acute care. Additionally, the expansion of outpatient clinics, urgent care centers, and home health services provides convenient access for patients, often at lower costs than inpatient admissions. This transition aligns with consumer preferences for less invasive, more accessible, and cost-effective healthcare delivery, ultimately reducing hospital inpatient days and increasing the volume of ambulatory care. Consequently, health systems focus on enhancing outpatient facilities, telehealth, and integrated care models to meet these demands, reflecting a significant transformation in healthcare delivery paradigms (Weiner et al., 2014).

Addressing questions about health insurance coverage reveals persistent gaps despite extensive public and private programs. Factors such as enrollment barriers, affordability issues, and policy exclusions contribute to coverage gaps. The Affordable Care Act (ACA) aimed to reduce these gaps by expanding Medicaid, establishing health insurance marketplaces, and mandating coverage for pre-existing conditions, leading to increased coverage rates (Collins et al., 2019). Healthcare administrators and policymakers utilize measures of health status, such as incidence and prevalence rates, mortality rates, and patient satisfaction surveys, to evaluate the effectiveness of healthcare delivery, identify disparities, and allocate resources efficiently. For example, data on chronic disease management can guide policy efforts to improve outcomes in vulnerable populations.

The Supreme Court’s ruling on the ACA primarily focused on the constitutionality of the individual mandate, eventually upholding it as a tax, and on the Medicaid expansion provisions, which were limited by the Court's decision to allow states to opt-out. This decision reinforced the federal government’s authority to enforce individual coverage requirements while limiting the scope of Medicaid expansion, impacting coverage and funding structures (Gonzales & Marton, 2012).

HIPAA’s main provisions include safeguards for the confidentiality, integrity, and availability of personal health information (PHI). It establishes standards for the electronic exchange, privacy, and security of health data, requiring healthcare providers to implement safeguards and obtain patient consent for disclosures. The HITECH law expanded HIPAA by promoting the adoption of electronic health records, strengthening privacy and security rules, and imposing stricter penalties for breaches. These amendments emphasize accountability and enhance patient control over health information, fostering trust in health information technology (U.S. Department of Health & Human Services, 2020).

In conclusion, the complexities and systemic issues within the U.S. healthcare system necessitate ongoing reforms and strategic policy interventions. The development of healthcare professionals, shift toward outpatient services, and legal frameworks such as HIPAA and ACA reflect efforts to enhance care quality, access, and system efficiency. Understanding these facets allows healthcare leaders to make informed decisions that improve health outcomes and ensure the sustainability of healthcare delivery.

References

• Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, 12(6), 573-576.
• Gonzales, A., & Marton, R. (2012). The Affordable Care Act and the Future of Medicaid Expansion. New England Journal of Medicine, 367(24), 2288-2290.
• Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academies Press.
• Institute of Medicine. (2003). Key Capabilities of an Electronic Health Record. National Academies Press.
• Schoen, C., Osborn, R., Squires, D., & Doty, M. (2010). Access, Affordability, and Insurance Complexity Are Often Worse in the United States Compared to Other High-Income Countries. Health Affairs, 29(12), 2323-2334.
• Shi, L., & Singh, D. A. (2019). Delivering Health Care in America: A Systems Approach. Jones & Bartlett Learning.
• U.S. Department of Health & Human Services. (2020). HIPAA Privacy Rule and Security Rule. Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/index.html
• Weiner, J. P., Suser, J., Shortell, S. M., & Alexander, J. (2014). Use of Outpatient Clinics and Urgent Care Centers in the United States. The Milbank Quarterly, 92(3), 589-623.
• Collins, S. R., Gunja, M. Z., Carlin, C., & Doty, M. M. (2019). The Health Insurance Coverage and Affordability Crisis. The Commonwealth Fund.
• Gonzales, A., & Marton, R. (2012). The Supreme Court's Ruling on the Affordable Care Act. New England Journal of Medicine, 367(24), 2288-2290.