Health care delivery system refers to the organization or combination of people, institutions and resources in order to provide health care to people. The institutions and persons that form this system include insurance companies, government agencies, employers and health care providers. The United States runs a unique health care delivery system made up of different subsystems which have developed as a result of market forces and the clamor to provide health care for a certain section of the population.
Types of delivery systems
One of the subsystem is managed care which employs measures to manage the utilization of medical services and determines the prices at which such services are purchased by patients. It is the most prevalent system in the United States which is available to majority of the public. The government or the employer is usually the source of funding in this system and contracts with a managed care organization that functions as an insurance company to facilitate provision of medical services to those enrolled in the program.
The other is the military medical care system which is available for free to actively involved military personnel of the U.S Army, Navy, Airforce and Coast Guard and certain uniformed non-military services like the Public Health Service. The highly integrated system comprehensively covers both preventive and curative services provided to the military by salaried health professionals who are themselves in the same service. Routine medical services are provided at dispensaries while long and complicated services are offered at the regional military hospitals. Retired military personnel receive long term care through Veterans Administration facilities with the disabled being given priority. The dependants and family of both active and retired military personnel also benefit from this health care from both private medical facilities as well as from the military hospitals.
The third system is that targeting the vulnerable population especially the indigent and the uninsured of minority status. Such persons who happen to live in economically and geographically marginalized areas receive medical care from safety net providers who include health centers, physician’s office and hospital outpatient and emergency departments. These safety net providers offer comprehensive services that are not confined to medical services alone but also those that enable such care. These enabling services offered by the providers to the vulnerable population include child care, transportation, outreach, language translation, nutrition and health education, case management as well as social support services. Besides the health centers, other governmental health insurance programs such as Medicare and Medicaid provide have led to reduced disparities in health care across socio-economic and racial-ethnic spectrum. This notwithstanding, the safety net scheme is not secure enough to shield all the vulnerable population who cannot afford health care. This is because their availability varies in different communities. This means that the vulnerable persons living in areas without the safety net providers have to seek alternative means of accessing health care which in most cases proves futile. These providers are also facing great pressure from the continued increase in the number of vulnerable persons and restricted funding.
The other system in the U.S Health care delivery is the Integrated Delivery System which denotes a network of organizations that seeks to provide a range of services to a certain population and consequently becomes accountable both financially and clinically for the health of such population. The aim of such system is to have a single health care organization offering medical care and represents various ownership and linkages with stakeholders such as hospitals, insurers and health professionals. The strategic positions that these stakeholders hold give birth to the different forms of Integrated Delivery Systems.
Goals and philosophies of delivery systems
The managed care system, it would appear, is premised on the philosophy of providing medical care only to the employed and those whom their financiers have made a contractual arrangement for such services. That leaves those that do not qualify to this bracket without access to medical services.
Similarly, the military system excludes civilians who form the bulk of the population. With the exception of the dependants of the military personnel and the retired personnel, other persons who cannot afford health care privately are at risk. It would seem that the goal of this system is to provide high quality medical care to the Department of Defense to ensure that security is not compromised. The system targeting the vulnerable persons seeks to mitigate the harshness caused by the lack of universal access to health care presented by the system in the United States especially to the poor. It does solve the problem but inadequately as indicated above.
Noting that the health care delivery system with all its complexity and fragmentation is inadequate and fails to ensure universal health care to all, it is imperative that measures to alleviate the problem be identified. In consonance with this, a National Health System like that of Britain is needed to ensure access to all. In this case, the government would finance a tax-supported health insurance program and operate most of the medical facilities. The health service providers would be employees of the government.
Gunderman, R. (2012). The Fallacy of Treating Health Care as an Industry. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2012/09/the-fallacy-of-treating-health-care-as-an-industry/262159/
Kazmier, J. (2008). Health Care Law. New York: Cengage Learning.
Mathews, A. W. (2011). The Future of U.S. Health Care. The Wall Street Journal. Retrieved from http://online.wsj.com/article/SB10001424052970204319004577084553869990554.html