Healthcare Delivery Systems Sample Paper

Health is an integral part of human life and the law also allows one to access quality health. The health of the population determines the life expectancy of a population and health outcomes. A better healthcare system leads to a better outcome and increased expectancy as most people will access timely care. Health delivery systems are practices or processes of availing healthcare services to the population (Brach & Borsky, 2020). The effectiveness, accessibility, quality, and affordability will determine if a population will adopt the health care delivery system or not. A better healthcare delivery system is measured in terms of morbidity, mortality, life expectancy, and the presence of preventive measures. Several models of healthcare delivery systems exist in the United States, aimed at both enhancing access to care and improving population health. The modes described in this paper include managed- care, self-directed services, and telemedicine. The discussion will include the similarities, differences, description of the model, and their effectiveness.

Managed-Care System

A managed care plan is based on the principle of transferring all or some vital service delivery protocols to the healthcare providers. Health maintenance organizations (HMOs), managed fee-for-service plans, and preferred provider organizations (PPO) form part of the managed-care plans. Among the fundamental components of managed care plans include promotion of health, capitation payment, reasonable pricing of services, peer review, and criteria for quality check. According to Heaton and Tadi (2021), physicians, pharmacies, hospitals, and companies offering home care do share the emerging financial risks. Peer review is important in tracking the amount spent compared with the quality of services offered.

Capitation payments help in reducing cost through payment of the prior agreed fee for services offered to the patients between the insurance company and the health care providers such as physicians. Prospective pricing and bundling of services are essential in reducing inpatient costs, thus affordability of care. This model ensures that only relevant items including correct prescription are given to the patient to help in cutting down the unnecessary cost. The principles of managed care have led to reduced inpatient services to Medicare beneficiaries, helped in redirecting services to alternate providers, lowering prices of services by HMOs and PPOs (Heaton & Tadi, 2021).

The mission of Managed care focuses on reducing the cost of care while encouraging competition and encouraging accountability of the administration (Heaton & Tadi, 2021). It focuses majorly on improving the healthcare quality thus improved services offered with a better outcome. The agreement between an insurance company and specific hospitals or doctors must be honored regardless of the number of patients that access care. This leads to reducing the cost of care and enhancing easy access to medical services. The vulnerable population including the elderly, disabled, the poor and children can be included in this model to enhance easy access to services.

Telemedicine

Telemedicine includes using technology to offer care to patients in remote settings in their homes. Electronic communication and software are used to offer remote services without patients visiting the facility (Kichloo et al., 2020). Audio and video connections can be used in the follow-up of patients, management of medications, chronic disease management, consultation, preventive care, and offering care following discharge. For example, people with chronic conditions are taught how to self-monitor their sugars and communicate to their health care providers in case of any danger signs. The healthcare providers respond to patient concerns including offering timely interventions.

Services offered through telemedicine include surveillance, health promotion, diagnostic, prompt care, and public health functions (Kichloo et al., 2020). The patient is in direct communication with the healthcare providers and the patient addresses his/her concern to the care providers. Danger signs are diagnosed and care provided early enough. Health promotion services include educating on cessation of smoking and weight loss to prevent the occurrence of heart diseases. School-going children have also benefited from telemedicine services. In case a child becomes ill in school, technology can be used to link up with healthcare providers who will provide instructions or reassure the parents.

Compared to in-person visits, telemedicine offers major advantages to both the provider and the patient. The patient, for example, will reduce travel expenses, reduced exposure to contagious disease, less time spent out of work, increased privacy, and reduced interference of responsibilities (Kichloo et al., 2020). The providers o the other hand will; offer improved patient follow-up, reduced missed appointments, improved efficiency of the office, and encourage reimbursement of the private payer. The final achievement is the provision of quality care at a reduced cost. Effective management of chronic conditions such as diabetes and hypertension reduces the incidences of heart diseases and stroke.

Telemedicine aims at offering quality care at a lower cost through timely care, increased knowledge exchange, enhanced research, and the application of science and technology in the provision of quality care. The application of telemedicine is relevant in the current situation of the COVID 19 pandemic (Kichloo et al., 2020). Guidelines offered to reduce the spread of COVID 19 include social distance, wearing the mask, washing hands regularly, and staying at home. Telemedicine offers an opportunity for the offering of services without contact thus prevent overcrowding in hospitals.

Self-Directed Care

Self-directed care services are defined by the philosophy that allows the participants to be actively involved in their care including in decision-making. According to Cook et al. (2019), such patients can assess the quality of services, evaluate the services, determine how services are offered, and decide on whoever will provide the services. Participants focus on person-centered services and offer all specialized management. Decisions are made by the participant regarding the service providers and mode of service delivery. Self-directed care falls under Medicaid services allowing patients to hire providers that will address their personal needs.

Planning for a person-centered process requires prioritization of individual needs and designing the best possible plan that suits an individual. According to Hamovitch, Choy-Brown and Stanhope (2018), factors including strength, desired outcomes, needs, and preferences guide the type of plan to be adopted. Contingency planning is necessary when assessing risks. This model ensures that more services can be offered to the patient, which in turn results in improved outcomes. Self-directed care is a common in-home care and nursing homes.

Whoever is chosen to provide care must always be present. Services offered are dictated by the needs of the patients and the directives offered. Resources required to meet the needs of the patient must be offered to enable the achievement of goals. The attention and services offered to patient leads to better health outcome.

The mission of self-directed services is to support physically disabled individuals and elderly people with independent person-centered care (Cook et al., 2019). Commitment and taking up responsibility are vital in offering quality care. Choices, inclusion, and development of community health promotion are necessary for self-directed care. This model ensures that high-quality, individualized care is provided to meet the needs of a patient.

Conclusion

Health care delivery systems are essential in determining the choices made by providers and patients. Both health care delivery systems aim at providing quality care while reducing costs. Telemedicine is an integral field that ensures remote care thereby reducing overcrowding in healthcare facilities, makes it easier for individuals to access immediate care and allows for easier remote patient monitoring. An individualized care plan, as described in this paper, is essential in ensuring better healthcare outcome.

References

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  • Cook, J. A., Shore, S., Burke-Miller, J. K., Jonikas, J. A., Hamilton, M., Ruckdeschel, B., Norris, W., Markowitz, A. F., Ferrara, M., & Bhaumik, D. (2019). Mental health self-directed care financing: Efficacy in improving outcomes and controlling costs for adults with serious mental illness. Psychiatric Services (Washington, D.C.), 70(3), 191–201. https://doi.org/10.1176/appi.ps.201800337
  • Hamovitch, E. K., Choy-Brown, M. & Stanhope, V. (2018). Person-Centered Care and the Therapeutic Alliance. Community Mental Health Journal, 54, 951–958 (2018). https://doi.org/10.1007/s10597-018-0295-z
  • Heaton, J., & Tadi, P. (2021). Managed care organization. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557797/
  • Kichloo, A., Albosta, M., Dettloff, K., Wani, F., El-Amir, Z., Singh, J., Aljadah, M., Chakinala, R. C., Kanugula, A. K., Solanki, S., & Chugh, S. (2020). Telemedicine, the current COVID-19 pandemic, and the future: a narrative review and perspectives moving forward in the USA. Family Medicine and Community Health, 8(3), e000530. https://doi.org/10.1136/fmch-2020-000530