Introduction to the U.S. Health Care Industry
History
The US health care industry is a little unique when compared to other developed nations. Over the years, in the US, it is only insured Americans who have been able to access basic and routine healthcare services on a continuous basis. It therefore goes that the healthcare insurance schemes that provide these covers are privately owned. However, The Patient Protection and Affordable Care Act in 2010 (ACA) seeks to provide a universal coverage which shall be manned by the Government. As much as it aims at expanding healthcare services to all affordably, cost implications remain a major challenge.
Characteristics of the industry
- The US Healthcare Industry is both complex and massive. It is characterized by
- Lacks a central governing agency
- Little integration and coordination
- Technology driven delivery system focusing on acute care
- High in cost and unequal in access
- Delivery of healthcare under imperfect market conditions
- The government is a subsidiary to the private sector
- Fusion of market and social justice
- Access to health care services based on insurance coverage
- Legal risks influence practice behaviors
The four subsystems:
Managed care (MCO)
This system seeks to achieve efficiency through the integration of the basic functions of health care delivery. It employs mechanisms that manage the utilization of medical services and determines the prices at which the services should be bought. It functions more or less like an insurance company.
Long term care (LTC)
It comprises of medical and non- medical care which is given to people who are critically ill or disabled including support services. LTC is offered separately by insurers but it is not popular because premiums are a little costly.
Hospital care
This entails medical services offered to patients at a medical facility or hospital premises. This is usually covered by insurance generally by most Medicare hospital indemnities.
Outpatient care
This is the medical treatment or care that does not necessarily require an overnight stay in a hospital facility, and is normally administered in a medical office.
Professionals
- Physicians
These include Medical doctors who are licensed by the National Medical Board Exam, the Doctors of Osteopathy who are approved by the American Osteopathic Association and occupational Medicine physicians
- Registered nurses
They receive training from colleges and graduate from an approved nursing school and granted a license after a board examination.
- Physician assistants
They practice under the instructions of the lead physicians
- Other healthcare professionals
They include licensed vocational nurses and medical technicians. They work under supervision by senior medical staff except minor cases like giving first aid.
Settings
Delivery systems are being set in place to ensure an effective health structure to promote proper integration between the medical service providers and the patients. This ensures accountability from both ends to ensure positive results.
Opportunities/challenges
- Maintaining public trust
Having the confidence of the public has been an uphill task.
- Dealing with regulations
The regulation of the private sector becomes hard since the system is uncoordinated
- High costs
It has been a big challenge to make Health Care affordable since most insurers charge exorbitant premiums.
Health policy
The government plays an important role in the implementation of policies in the healthcare systems in the country. Restructuring of the health care delivery system to advance the quality and significance of care is vital to address escalating costs, poor quality. Improvements ought to develop admittance to the right care at the correct time and in the right setting. The system ought to keep individuals fit and inhibit common, preventable worries of diseases and illnesses to an abundant rate as conceivable.
References
Shi, L., & Singh, D. A. (2010). Essentials of the U.S. health care system. Sudbury, Mass: Jones and Bartlett Publishers.
Jonas, S., Goldsteen, R. L., Goldsteen, K., & Jonas, S. (2013). Jonas' introduction to the U.S. health care system. New York: Springer Pub. Co.
