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Major Characteristics of U.S. Health Care Delivery

Aisha N. Alleyne

 

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 old 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

Several external factors influence the U.S. health care system ((Shi & Singh, 2019, p. 5). Shi & Singh, 2019, p. 9). There are ten main characteristics of the U.S. health care system, which will be mentioned 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 to have more advanced technological care sought by patients and physicians (Shi & Singh, 2019, p. 11).

As mentioned 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; In the health care market, patients choose their providers, but free-market forces partially govern the 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). MCO’s 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 individuals’ inability to obtain access to healthcare due to 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 individuals’ 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 interest 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 works 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 rates, (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 are producing a substantial financial gain (Shi & Singh, 2019, p. 16). To combat this threat and protect themselves, providers engage in defensive medicine practice, which is often unnecessary and drives costs, and creates 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 well do not need a physician, but those who are sick (New King James Version, Matthew 9:12). Accountable care organizations (ACO) 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). 

ACO impact how patient care is provided, delivered, and paid so that patients can receive quality care that is patient-centered, well-coordinated, and timely care (Summers, et al. 2015, para. 5). A patients’ 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 are working together on behalf of the patients’ overall care. Patients would see that coordinated efforts with providers improve communication amongst providers, detect early diagnosis, and address preventative measures sooner.

Providers under an ACO are better able to deliver effective preventative 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 a 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.

 
 
 
 
 
 
 
 

References

Agency for Healthcare Research and Quality. 2016 National Healthcare Quality and Disparities Report: Overview of quality and access in the u.s. healthcare system. 2018.

https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/overview.html

. Accessed March 25, 2021.

Gold, J. (2015, September 14). Accountable care organizations explained. Kaiser Health News. 

https://khn.org/news/aco-accountable-care-organization-faq/

. Accessed March 25, 2021.

Jost, T. (2016, February 29). Affordability: The most urgent health reform issue for ordinary americans. Health Affairs Blog. DOI: 10.1377/hblog20160229.053330

Migneault, J. (2017, May 23). Understanding the basic of accountable care organizations. Public Payers News.  

https://healthpayerintelligence.com/news/understanding-the-basics-of-accountable-care-organizations

New King James Bible Version. (1998). Thomas Nelson Inc. (Original work published 1798)

Shi, L. & Douglas, MS (2019). Essentials of the U.S. Heath Care System (5th ed.). Jones & Bartlett Learning. 

Summer, 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. 

https://www.nationalpartnership.org/our-work/resources/health-care/impact-accountable-care

 
 

Major Characteristics of U.S. Health Care Delivery

Keshiera Jones-Sims

COLLAPSE

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The health care delivery system is one that the United States has established to be multifaceted and composed of multiple parts with the inclusion of finance, medical insurance for the patients to the providers and imbursement. This system is one that causes for the inability to meet health care needs continues to be an ongoing struggle for academics, health professionals, and politicians (Shi & Singh, 2019).

What are the two main objectives of a health delivery system?

The first objective is to be able to make sure that all of the members of the society have the capability to receive the health care services that they need whenever the need for care is necessary. The process of this difficult task is coordinated through many organizations and individuals in health care delivery (Shi & Singh, 2019, p. 2-3). When the times comes that we have to join our Lord, we will not know in advance since that is not the way that the functions and honestly no one would truly want to know. According to King James Bible Online (2021), Matthew 25:36 states “Naked, and ye clothed me: I was sick, and ye visited me: I was in prison, and ye came unto me.” This Bible verse is one that expresses that we have to take the time to care for ourselves at all times which is what He would want for us to do to ensure that we are not taken before our times. Then in Matthew 7:12 “Therefore all things whatsoever ye would that men should do to you, do ye even so to them: for this is the law and the prophets.” In accordance with the health care, each of the individuals in the world want to be looked over and cared for when we fall ill and there is no one that wants to be turned away in their time of sickness. The second objective is that it needs to provide health care that is cost effective, affordable, and meets the established requirements (Shi & Singh, 2019, p. 22).

What are the ten characteristics of the U.S. Health Care System?

            When we compare the characteristics of the United States Health Care System to that of the other countries within the world, one would be able to see the distinction between them. Shi and Singh (2019) explain that “other developed nations have centrally controlled universal health care systems that authorize health care financing, payment, and delivery to all residents” (p. 10). The health care system for the U.S. is one that has no central control and the financing is both private as well as public. There is an explanation of the effect of the private sectors growth within the article by Clarke et al. (2019) including solutions for the varying amount of trials that have opposed the health system. (p. 434).

According to Shi and Singh (2019), there have been ten essential services that distinguish the United States health care system from services provided by other countries (p.10):

1. No central governing agency and little integration and coordination

2. Technology-driven delivery system focusing on acute care

3. High cost, unequal access, and average outcome

4. Delivery of health care under imperfect market conditions

5. Government as subsidiary to the private sector

6. Fusion of market justice and social justice

7. Multiple players and balance of power

8. Quest for integration and accountability

9. Access to health care services selectively based on insurance coverage

10. Legal risks influencing practice behaviors

How is access to medical care and satisfaction improved for patients receiving care from an accountable care organization (ACO)?

            The accountable care organization (ACO) is a fresh model of the integrated delivery system that has been projected to address the incentives for pay and providing a higher quality of care for the patients “at lower cost under the new Medicare Shared Savings Program” (Shi & Singh, 2019, p. 6). There has been conducted which has proven the vitality of integrated care in the improvement of managing and health services which has provided allowance for patients to receive “the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money” (Connor et al., 2016, p. 1).

Conclusion

As previously stated, the health care delivery system is one that can be described as complex with flaws at varying levels. The established parameters have to be altered with a better formulation in order to improve the care for the patients at a better cost and to improve the situation for all. This is one where all of the individuals involved need to come to the same page and agree in order for all to be able to cross the line to get to the goal.

References

 Clarke, D., Doerr, S., Hunter, M., Schmets, G., Soucat, A., & Paviza, A. (2019). The private sector and universal health coverage. World Health Organization. Bulletin of the World Health Organization, 97(6), 434-435. doi:http://dx.doi.org.ezproxy.liberty.edu/10.2471/BLT.18.225540

Connor, M., Cooper, H., & McMurray, A. (2016). The Gold Coast Integrated Care Model. International Journal of Integrated Care, 16(3), 2. 

https://www.ijic.org/articles/10.5334/ijic.2233/

King James Bible Online. (2021).Matthew 25:36 . Retrieved March 25, 2021 from 

https://www.kingjamesbibleonline.org/Matthew-25-36/

King James Bible Online. (2021).Matthew 7:12 . Retrieved March 25, 2021 from 

https://www.kingjamesbibleonline.org/Matthew-7-12/

Shi, L., & Singh, D. (2019). Essentials of the U. S. Health Care System (5th ed.). Burlington, MA: Jones & Bartlett Learning.

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