Description

Topic: Major Characteristics of U.S. Health Care Delivery

Prompt: First, what are the 2 main objectives of a health delivery system? Next, what are the 10 characteristics of the U.S. health care system? How is access to medical care and satisfaction improved for patients receiving care from an accountable care organization (ACO)?

first response

The two main objectives of a health care delivery system are that it must allow all citizens access the health care services and that all of the services must be cost effective and meet certain standards of quality. Within the health care delivery system, there are subsystems that address certain population. For example, the subsystems are managed care, military medical, special populations, and long term care. “Managed care strives for efficiency by integrating basic functions of health care delivery and seeks to control (manage) the utilization and cost of medical services.” (Shi & singh, 2019). I am a soldier of the United States Army so I am very thankful for military medical services. These services are available for soldiers and their dependents, at free of charge. We have access to primary care doctors, specialties, and others at private and military medical care facilities. I have seen the importance of these services, not only for myself but for other service members, to be some of the greatest parts of being in the military. For example, I was hospitalized for over two weeks and had surgery last year and it did not cost me a dime. If it was not for these services, I would have had an extremely high medical bill that I would not be able to afford. There is, also, the Veterans Administration which is available to retired veterans who have served in the military. The Veterans Administration provides care and services with a focus on hospital care, long term care, and mental health services. The special population subsystems focuses on people who do not have adequate resources or are poor, uninsured, a minority, or live in disadvantaged communities. A major part of the special population is the use of Medicare and Medicaid. Medicaid is the third largest health insurance source in the United States by providing insurance to nearly 19% of the United States population.

The ten characteristics of the United States health care system are that there is, “no central governing agency and little integration and coordination, technology driven delivery system focusing on acute care, high cost, unequal access, and average outcome, delivery of health care under imperfect market conditions, government as subsidiary to the private sector, fusion of market justice and social justice, multiple players and balance of power, quest for integration and accountability, access to health care services selectively based on insurance coverage, and legal risks influencing practice behaviors.” (Shi & singh, 2019).

In 1973, the Health Maintenance Organization Act of 1973 was created. The purpose of this act was to create interest by consumers and providers and to make health care delivery accessible. This Act helped immensely in the delivery of health care and clinical integration of health care. Access and satisfaction has improved for patients receiving care from an accountable care organization because they have options. According to the article named, “Accountable Care Organizations”, it states that “Restructuring the clinical organizations and integration of care among individual physicians, as well as among physicians, hospitals, and other health-care providers, has been identified as essential to health-care quality and efficiency at both the individual and population levels.” ( (Burke, 2011). Another way access and satisfaction has improved is that there are new and different forms of insurance. The providers must work together to improve quality of care and reduce the costs of care. In the journal article, “A Framework for Describing Health Care Delivery Organizations and Systems” it discusses the different elements and domains of the health care delivery systems. It states, “In 2001, the Institute of Medicine observed that health care has traditionally been provider and payment centered and that a shift in paradigm was critical to the survival of the US health care system.” (Pina, et al., 2015). This has changed the systems by focusing on the patient and giving the patient a voice. This has changed the outcomes of patients and their care.

second response

When we evaluate healthcare systems around the world, there are many pros and cons of how different countries deliver healthcare. The system in the United States is no different. There are many things that we do well and other areas where we can improve. The system is constantly evolving to overcome new challenges that can consist of technology advancements, funding advancements, and reform measures such as the Affordable Care Act. The primary objective of the U.S. health care system is “to provide cost effective health services that meet quality standards to a nation” (Shi & Singh, 2019, p.22). Additionally, “health care delivery in the U.S. is characterized by a patchwork of subsystems developed through market forces or based on the need to care for certain populations. These components include managed care, the military medical care and VA systems, the system for vulnerable populations, and the emerging IDs.” (Shi & Singh, 2019, p.23). When combined, the overall objective of the U.S. healthcare system is to provide affordable and quality health services to all populations.

As mentioned, every health system in the world is different. Shi and Singh in Essentials of the U.S. Health Care System explain that the U.S. system is identified by ten key characteristics. No central governing agency, technology driven system which is focused on acute care, high cost, unequal access, average outcomes, delivery of health care under imperfect market conditions, government as subsidiary to the private sector, fusion of market justice and social justice, multiple players and balance of power, quest for integration and accountability, access to heath care services selectively based on insurance coverage, and legal risks influencing practice behaviors. Some of these characteristics can be strengths such as the balance of power, the ongoing quest for integration, and the advancements in technology. However, the other characteristics can highlight areas of needed improvement such as high costs, access limitations based on insurance, and legal risks which influence provider decisions.

A study published by the National Institutes of Health evaluated the changes in patient experiences before and after the implementation of accountable care organizations (ACOs). The study found three areas where ACOs created improvements when compared to the control group. First, “reports of timely access to care and their primary physicians’ being informed about specialty care differentially improved in the ACO group” (McWilliams, et al., 2014, p.1). Second, “Among patients with multiple chronic conditions and high predicted Medicare spending, overall ratings of care differentially improved in the ACO group as compared with the control group” (McWilliams, et al., 2014, p.1). Third, “Differential improvements in timely access to care and overall ratings were equivalent to moving from average performance among ACOs to the 86th to 98th percentile (timely access to care) and to the 82nd to 96th percentile (overall ratings)” (McWilliams, et al., 2014, p.1). Overall, the study found that ACOs can improve patient satisfaction. Additionally, coordinated care and timely access to care can be associated with improved overall patient care and better treatment outcomes.

An additional study evaluated the benefits and barriers of ACO implementation with Rural Health Clinics (RHCs). A comparison was drawn between RHCs that joined an ACO and RHCs that chose to not join an ACO. According to the study, improved population health and improved patient care are both benefits of the ACO. “One fundamental goal of ACOs is that they will improve the health and wellness of a defined population… This goal is promoted by increasing the emphasis on preventive care provided by primary care services and coordinating services across levels of care” (Ortiz, et al., 2014, p.3). Additionally, the study noted, “the cost savings would be achieved by emphasizing preventive care, increasing operational efficiencies, and reducing hospital readmissions. Thus, ACOs may contribute to meeting America’s challenge of providing cost-effective care to growing numbers of chronically ill” (Ortiz, et al., 2014, p.3). Improved access to preventative and primary care will greatly benefit the patient population that the ACO serves.

Providing quality and cost-effective healthcare to a population the size of the United States is not an easy task. Galatians 6:9 states, “So let’s not get tired of doing what is good. At just the right time we will reap a harvest of blessing if we don’t give up” (NLT). This biblical principle can be a reminder to all of us as we overcome and adapt to challenges in our personal, professional, and academic lives. As our healthcare system adapts to the implementation of ACOs, it will require providers and organizations to accept new ways of coordinating healthcare to benefit the patient.