Major Characteristics Of U.S. Health Care Delivery ✓ Solved

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Major Characteristics of U.S. Health Care Delivery Aisha N. All

What are the two main objectives of the health delivery system? The United States health delivery system is fragmented and unique, complex and massive, which results in unaffordable and inaccessible health care (Shi & Singh, 2019, p. 1-2). Universal health care is not provided to Americans, leaving many individuals unable to access the U.S. health care delivery system (Shi & Singh, 2019, p. 1-2). Health care reform has increased access to quality care and has expanded coverage; Quality care and affordable health care represents the U.S. healthcare delivery (Shi & Singh, 2019, p. 5). Many other factors directly impact the quality and access to health care.

Improving quality care in the U.S. health care delivery demands better coordination of subsystems of health care delivery, services amongst providers and facilities to enhance quality care and address disparities (Agency for Healthcare Research and Quality, 2018, para. 3-4). Subsystems of the U.S. health care system include delivery of services to specific populations within the U.S. health care system (Shi & Singh, 2019, p. 3). Additionally, there are direct links between quality of care and racial disparities within communities of color that impact quality care (Agency for Healthcare Research and Quality, 2018, para. 27). Such disparities include significant wealth and income gaps between poor communities and the wealthy (Jost, 2016, para. 4-8). Since health care costs are not distributed evenly, health care affordability has been an enormous problem within the U.S (Jost, 2016, para. 4-8).

Health care reform measures such as the Affordable Care Act have made healthcare affordable for lower-income Americans (Jost, 2016, para. 11). James 5:14 provides, “Is anyone among you sick? Let him call for the elders of the church and let them pray over him, anointing him with oil in the name of the Lord” (New King James Version, James 5:14). Providers should pray for the Lord’s power to provide healing to patients.

The ten characteristics of the U.S. health care system include several external factors influencing the U.S. health care system (Shi & Singh, 2019, p. 5). There are ten main characteristics of the U.S. health care system, which will be elaborated below.

Contrary to other developed countries that are less complex and controlled universally, the U.S. health care system does not have a controlled centralized health care system. They are privately and publicly financed with varied insurance, payments, and delivery mechanisms (Shi & Singh, 2019, p. 11). The U.S. health care delivery system is driven by technological and scientific developments due to an increased demand for more advanced technological care sought by patients and physicians (Shi & Singh, 2019, p. 11).

As outlined earlier, health care in the United States is costly, with residents having limited access to services due to inequities coupled with intermediate care compared to health care services rendered in other developed countries (Shi & Singh, 2019, p. 11). Access to health care in the United States is limited to those who (1) have employer-based health insurance, (2) are covered under a government-sponsored health care program (including coverage under the ACA), (3) can buy insurance with their own funds, (4) can pay for services privately, or (5) can obtain services through safety net providers (Shi & Singh, 2019, p. 11).

Insurance coverage does not guarantee that individuals will not face barriers to access (Shi & Singh, 2019, p. 11). In the health care market, conditions are imperfect; patients choose their providers, but free-market forces partially govern health care (Shi & Singh, 2019, p. 12). A healthcare free market consists of buyers and providers who are sellers. However, the patients choose the provider that includes managed care organizations (MCO), Medicare, or Medicaid (Shi & Singh, 2019, p. 11).

MCOs in the free-market form alliances because consolidation of buying power is in their hands. A free health care market among providers based on price and quality of services will not exist (Shi & Singh, 2019, p. 11). In the United States, the government is considered a subsidiary of the private sector. The government pays the difference after the private fills in the gaps left unaddressed by the private sector (Shi & Singh, 2019, p. 15).

In the United States, the private sector plays a dominant role (Shi & Singh, 2019, p. 15). In the United States, market justice and social justice have contrasting ideas regarding how health care services are distributed (Shi & Singh, 2019, p. 15). Social justice relates to the community’s well-being, and an individual’s inability to obtain access to healthcare due to a lack of financial resources is a social justice issue (Shi & Singh, 2019, p. 15). Market justice puts the responsibility of health care distribution on market forces in a free economy, and medical benefits will be distributed according to the individual’s ability to pay (Shi & Singh, 2019, p. 15).

One main concern is where smaller companies provide insurance, but employees cannot afford to pay; these employees cannot obtain government assistance for health care because their income does not fall below the eligibility guideline (Shi & Singh, 2019, p. 15). The concerns relate to social justice and market concerns that the ACA addresses in reform measures (Shi & Singh, 2019, p. 15).

There are multiple players in the U.S. health care system, including the government, physicians, administrators of health institutions, insurance companies, and large employers who all have an economic interest, and such interests can collide (Shi & Singh, 2019, p. 15). These opposing interests prevent one entity from dominating the health care system, which is an advantage (Shi & Singh, 2019, p. 15). However, conflicting interests create barriers to creating a comprehensive, streamlined health care reform system, a challenge (Shi & Singh, 2019, p. 15).

Primary care must be comprehensive and coordinated health care services for medical homes and health homes for patients (Shi & Singh, 2019, p. 15). For this framework to be practical, the patient-provider must work in tandem to improve a community’s health; however, the provider must be accountable for providing quality care while the patient takes responsibility for their health (Shi & Singh, 2019, p. 15-16).

Access to health care services is based on whether an individual has insurance via private or government assistance. Uninsured individuals have limited medical care options, and they will either (1) pay providers a higher out-of-pocket rate, (2) obtain care from safety net providers such as Medicaid, or (3) obtain treatment for their acute illnesses at emergency departments (Shi & Singh, 2019, p. 16).

When uninsured individuals utilize the emergency room in this manner, the cost of emergency room care shifts to patients with the ability to pay for services – and includes taxpayers (Shi & Singh, 2019, p. 16). Private providers are prone to litigation and medical malpractice claims because society views medical litigation claims as producing a substantial financial gain (Shi & Singh, 2019, p. 16).

To combat this threat and protect themselves, providers engage in defensive medicine practices, which are often unnecessary and drive costs, creating inefficiency (Shi & Singh, 2019, p. 16). Such defensive medicine includes ordering additional diagnostic tests, scheduling additional appointments, and creating huge case documentation (Shi & Singh, 2019, p. 16).

How is access to medical care and satisfaction improved for patients receiving care from an accountable care organization? Matthew 9:12 provides, “Those who are well do not need a physician, but those who are sick” (New King James Version, Matthew 9:12). Accountable care organizations (ACOs) can provide a way for physicians to provide comprehensive medical services for ill patients. Essentially an ACO operates as a network of “doctors and hospitals that share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending” (Gold, 2015, para. 6).

The primary care physician is at the heart of each patient’s care and vital to the structural framework of an ACO (Gold, 2015, para. 6). ACOs impact how patient care is provided, delivered, and paid so that patients can receive quality care that is patient-centered, well-coordinated, and timely (Summers et al., 2015, para. 5). A patient’s access to medical care and satisfaction is drastically improved because all of the providers responsible for each patient’s care are working in tandem to streamline and optimize the quality of care (Migneault, 2017, para. 4).

To accomplish this, a provider should use data and best practices to decrease duplicative medical services, closing the medical care gaps for patients (Migneault, 2017, para. 4). Patients who receive services through an ACO may be more willing to engage in preventive care when providers are viewed as working together on behalf of the patients’ overall care. Patients would see that coordinated efforts with providers improve communication among providers, detect early diagnoses, and address preventative measures sooner.

Providers under an ACO are better able to deliver effective preventive care when services are coordinated across the care continuum (Migneault, 2017, para. 4). ACOs include specialists, post-acute providers, and private companies. This eliminates the rigidity of patient referral patterns similar to HMOs’ patterns, thus increasing patient satisfaction by not having to seek referrals from a provider before seeing a specialist (Gold, 2015, para. 23).

Patient satisfaction is further improved because although patients would often be referred to other hospitals within the ACO, patients would still have the choice to seek care out of network without incurring additional costs (Gold, 2015, para. 17). These options prevent unnecessary burdens and less stress for patients navigating the health care system.

Paper For Above Instructions

The U.S. health care delivery system is characterized by its complexity and fragmentation. It incorporates numerous parties, including government agencies, private insurers, and healthcare providers, which often leads to inequities in access, quality, and cost of care (Shi & Singh, 2019). Understanding the objectives and characteristics of this system is vital for improving health outcomes and ensuring that all individuals receive the care they need.

One of the primary objectives of the U.S. health care delivery system is to ensure that all members of society have access to necessary healthcare services when needed. This can be especially challenging given the system's structure and the financial barriers many face. Additionally, a second objective is to deliver care that is affordable and effective while meeting established health care standards (Shi & Singh, 2019, p. 22). This dual aim of accessibility and cost-effectiveness is crucial for enhancing the overall efficiency of health care delivery.

Notably, there are ten main characteristics that define the U.S. health care system. Firstly, there is no centralized governing body overseeing the entire healthcare system, which hinders the coordination and integration of services. Instead, care is delivered through various private and public funding mechanisms (Shi & Singh, 2019). Secondly, the U.S. health care system is heavily influenced by technological advancements, which have driven the development of acute care models (Shi & Singh, 2019).

Furthermore, the complexity and cost of care in the U.S. lead to unequal access and variable outcomes. Limited access is primarily determined by insurance coverage, making it essential for individuals to have appropriate insurance to obtain the care they need (Shi & Singh, 2019). Additionally, the market forces at play within healthcare often result in imperfect conditions, where competition may not yield better care or prices for patients.

The presence of both market justice and social justice in the U.S. health care system adds to its complexity. Market justice suggests that healthcare services should be distributed according to an individual's ability to pay, whereas social justice promotes access to healthcare as a community responsibility, wherein all individuals should receive necessary care regardless of their financial situation (Shi & Singh, 2019). This dichotomy often generates debate on the direction and reform strategies necessary to achieve equitable healthcare.

ACOs represent one approach that aims to overcome some of these challenges by fostering coordinated care among healthcare providers. ACOs consist of networks of physicians and hospitals that share accountability for care delivery and costs, emphasizing the importance of teamwork in patient management (Gold, 2015). By enabling health professionals to collaborate, ACOs can enhance the patient experience and promote access to preventive care. This collaborative environment is structured to facilitate communication among providers, thereby improving the timeliness and quality of care received by patients (Summers et al., 2015, para. 5).

Moreover, ACOs incorporate data and best practices into care models, reducing redundancies while also closing significant gaps in service delivery (Migneault, 2017, para. 4). This coordinated effort enables patients to have a more streamlined experience while also encouraging proactive health management. Patients enrolled in ACOs may experience better access to specialists and the freedom to seek care outside of the network without incurring excessive out-of-pocket costs, ultimately improving overall satisfaction (Gold, 2015).

In conclusion, the U.S. healthcare delivery system is multifaceted and impacted by numerous factors that influence access, quality, and cost. Pursuing strategies that strengthen coordination, such as ACOs, can significantly enhance patient care and improve satisfaction levels. As the landscape of healthcare continues to evolve, understanding these dynamics is fundamental in advocating for better health outcomes within the society.

References

• Agency for Healthcare Research and Quality. (2018). 2016 National Healthcare Quality and Disparities Report: Overview of quality and access in the u.s. healthcare system.
• Gold, J. (2015, September 14). Accountable care organizations explained. Kaiser Health News.
• Jost, T. (2016, February 29). Affordability: The most urgent health reform issue for ordinary Americans. Health Affairs Blog. DOI: 10.1377/hblog.053330
• Migneault, J. (2017, May 23). Understanding the basics of accountable care organizations. Public Payers News.
• Shi, L., & Singh, D. (2019). Essentials of the U.S. Health Care System (5th ed.). Jones & Bartlett Learning.
• Summers, L., de Lisle, K., Ness, D., Kennedy, L., & Muhlestein, D. (2015). The impact of accountable care: How accountable care impacts the ways consumers receive care.
• Clarke, D., Doerr, S., Hunter, M., Schmets, G., Soucat, A., & Paviza, A. (2019). The private sector and universal health coverage. Bulletin of the World Health Organization, 97(6).
• Connor, M., Cooper, H., & McMurray, A. (2016). The Gold Coast Integrated Care Model. International Journal of Integrated Care, 16(3).
• King James Bible Online. (2021). Matthew 25:36. Retrieved from King James Bible Online.
• King James Bible Online. (2021). Matthew 7:12. Retrieved from King James Bible Online.

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