Medicine and Nursing - Other

Healthcare Delivery System in the United States

 The United States of America has a system of health care delivery that is very different than other health care systems in the world. In the United States, not every citizen enjoys the right of being health insured as this privilege does not apply automatically. The US health care delivery system cannot be regarded as a system in its true sense. Health care delivery in the United States has long been described as a “cottage industry.” It is characterized by fragmentation at the practice, community, municipality, state, and national level. The U.S. health care system is described as fragmented because people obtain health care services through different means. This fragmentation of the U.S. health care delivery system is perhaps its central feature. Although the U.S. health care delivery system has evolved, the enormous challenges of expanding access to health care services remain. Despite the federal government’s role as the single largest payer for health care, there is no national entity or set of policies guiding the health care system.

 An Overview of the Size and Scope of the Healthcare System

 The US health care delivery system is massive, with total employment that reached over 16.4 million in 2010 in various health delivery settings. The health care system consists of many organizations and individuals. These include educational and research institutions, medical suppliers and insurers, payers, and claims processors to health care providers. The US healthcare system includes three complex and integral interrelated components. The first component of this system includes people in need of health care services, also referred to as healthcare consumers. The second component consists of people who deliver health care services. These are the professionals and practitioners or health care providers. The third component of this system is the institutional component. This component includes public and private agencies that organize, plan, regulate, finance, and coordinate services, hospitals, clinics, and home-health agencies as well as the insurance companies and programs that pay for services. Besides the previously mentioned, the institutional component also includes medical education centers, the public health sector, dental healthcare providers, and supporting healthcare professions such as nursing. The quality control agencies, professional associations, and societies, licensing bodies, and companies in charge of developing medical technology and pharmaceuticals are also listed under this category.  

What are the Components of the Health Care Delivery System

 The U.S. healthcare delivery system incorporates four functional components. These components include financing, insurance, delivery, and payment. This organization of a health care delivery system is also known as the quad-function model.

 Financing

For the healthcare delivery to function well, the financial aspects have to be addressed. In the United States of America, access to health care services is limited. It can be obtained through different payment modalities. The majority of the privately insured American residents have employment-based health care plans. This means that the financial burden of the health insurance is on the employers. However, this does not mean that the employers are obliged to insure their employees. The employer has the liberty to choose an insurance plan or an insurance company. A person can also be insured through government health care programs. The access to health care is also granted to individuals who can afford to buy their own insurance plans. On the other side, there are fewer options for the people seeking health care services and who are without insurance. These options include out-of-pocket payments to doctors, the access to federally funded health centers or seeking treatment for acute illnesses at hospital emergency departments. The Emergency Medical Treatment and Labor Act of 1986 requires ‘’screening and evaluation of every patient, necessary stabilizing treatment, and admitting when necessary, regardless of ability to pay.’’

 Insurance

Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. In the United States, any program that financially supports the payment of medical expenses is considered health insurance. These programs include private insurance plans, government insurance programs or personal or out-of-pocket funds used as insurance. The term health insurance also applies to funding that covers disability or long-term nursing costs.

 Delivery

The term “delivery” refers to the provision of healthcare services by different providers. These providers include dentists, physicians, specialists and other healthcare personnel who work in private practices, hospitals or other healthcare institutions. Both suppliers and developers of medical equipment and medical research institutions are included in this category as well.

 Payment

This segment of a health care system tackles the reimbursement of healthcare-related costs to providers who delivered the services. The amount paid is determined by the insurer, and the funds originate from the collection of premiums or tax revenues. While the majority of costs are covered by the insurance provided, the patient might still be required to pay a predetermined sum before seeing a physician.

References

Ng LKY, Davis D.D., Manderscheid R.W., Elkes J. (1981). Toward a conceptual formulation of health and well-being. In: Ng LKY, Davis D.L., editors. Strategies for public health: promoting health and preventing disease. New York: Van Nostrand Reinhold.

NHS Constitution. (2013). Retrieved from: http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhs-constitution-for-england-2013.pdf

Shi L, Singh D. (2010). Major characteristics of U.S. health care delivery. In: Essentials of the U.S. health care system. Sudbury, MA: Jones and Bartlett Publishers

Shih, A. (2008).  Organizing the U.S. health care Delivery System for high Performance, Commission on a High Performance Health System. The Commonwealth Fund

Theodoropoulos, S. (2010). On the effectiveness of publicly or privately produced Health care services. University of Piraeus.

Ulrich, V. (1996). ‘Health Care in Germany: Structure, Expenditure and Prospects’, in McArthur, W., Ramsay, C. and Walker, M. (eds.). Healthy Incentives: Canadian Health Reform in an International Context. The Fraser Institute

Wolinsky, F. D. (1988). The Sociology of Health: Principles, Practitioners, and Issues, 2nd ed. Belmont, CA: Wadsworth Publishing Company

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