1. Healthcare Delivery on Micro and Macro Levels
Managed care is a healthcare plan or system that contract with health care providers and medical facilities to provide care for members at reduced costs. On the macro-level, managed care plans take into consideration on major issues such as system design and organizational structure. The funding system used by Managed care promotes efficient use of resources, such as payment using diagnosis-related groups or other care mix approaches to create an incentive to reduce length of stay and avoid excessive servicing during an episode of care (Andreou, 2011). For example, managed care providers emphasize on keeping enrollees healthy to reduce use of services and financial incentives for enrollees to use providers and procedures associated with the plan. All these can compromise the quality of healthcare provided to members. On the micro-level, managed care has changed healthcare delivery by enforcing measures aimed at reducing cost. For example, pay for performance (P4P) is a toll used in the U.S. to improve efficiency in healthcare systems by rewarding health care providers for following certain procedures. Such systems could compromise the quality of service delivered to the patient.
Emerging health care reforms have also changed healthcare delivery on both the macro and micro levels. The recent health policy legislation is one major source of growing discontent and sagging morale among America’s physicians. One specific example is the overall uncertainty surrounding the Sustainability Growth Rate (SGR) used to pay physicians under Medicare.
Integration in healthcare delivery attempts to provide all elements in a seamless range of care. Integrating healthcare has the potential of increasing effectiveness and quality care while increasing cost-effectiveness and facilitating cost effectiveness (Thaldorf & Liberman, 2007). Horizontal integration coordinates the activities across operating units that are at same stage of service delivery. Consolidating organizations providing similar level of care can help increase efficiency and quality of care due to the ensuing standards.
Vertical integration on the other hand involves coordination of the services among operating units that are at different stages of the process of service delivery to patients. Vertical integration ensures efficiency, offer seamless continuum care, and assume responsibility for health of local populations (Thaldorf & Liberman, 2007). Virtual integration of health care organizations has positive impacts to health care delivery because it allows for seamless sharing of information, which is essential for improving the health and health care of Americans. Virtual integration allows health care organizations to share new information technology to help enhance the level of service delivery.
Andreou, A. (2011). Johns Hopkins on the chip: Microsystems and cognitive machines for sustainable, affordable, personalised medicine and healthcare. Electronics letters, 47(26), S34.doi:10.1049/el.2011.3233
Thaldorf C, & Liberman A. (2007). Integration of health care organizations: using the power strategies of horizontal and vertical integration in public and private health systems. PubMed.gov 26(2):116-27.