Health care delivery systems
As the name suggests, health care delivery system refers to a well-organized means of providing prevention, treatment and management of health issues by health experts to registered persons. In this paper there are definitions of various health care delivery systems, the goals of the same and then examine the similarities and differences manifested these systems.
Health care delivery systems in place today can be categorized into two. These are the fee-for-service delivery systems and the managed care systems. To start with, fee-for-service health care delivery systems is whereby the holder pays for a specific medical service offered solely by a medical personnel instead of making payment as element of comprehensive plan. In this method for administration of medic aid program, the service provider participation is free for all service providers who by chance satisfy the requirements of state. The providers are then reimbursed depending on the amount of services that have been given. The decisions regarding policy, service coverage and the rate of reimbursement are carried out by staff of single agency of state for the administration of the Medicaid program. Administrative functions like processing of claims and disease management may be contracted though not on at-risk basis.
On the other hand managed care system is whereby finances are controlled and maximum standards of health care are provided at reduced prices to those individuals who are categorized under a certain health care plan. In this system, some part of the administrative roles related with the management of the extent of benefits of coverage is contracted to a single agency of state.
The fee-for service health care delivery system is rich of goals namely; expansion of insurance coverage, enhancement of quality and accessible health care, costs control, sound health, informed and timely response to the needs of the population and just financial involvement.
The goals for managed care system are more advanced and include deliverance of high standards of health care in a cost managed setting, relevant and dependable medic care, service delivery to the public by the most qualified personnel, and provision of services in most suitable and less constraint environment.
There are notable similarities between the FSS and the managed care systems. In both cases, the main aim is to improve health status of their attached insurance subjects. FSS and managed care systems are both only subject to registration upon getting subscribe to an insurance plan that is certified. In addition, the subjects are at all times independent and instigated and observed by the government.
In FFS delivery system, the Single State Agency operates directly with all participating Medicaid providers throughout the state. This is in terms of policies of medical care and methods of payment plus individual provider rates. The state in this case has to stick to terms and conditions stated in Social Security Act Section 19202A. Managed care systems in contrast allow the medic care providers to choose a primary plan of their choice that provide care coordination and management. Comprehensive plans like Managed Care Organizations (MCO) give a wide range of preventive, primary and acute care services. In addition, oversight responsibility is shared among the Single State Agency, the managed care plans and the providers of the plan. In managed care systems also, the contracted organizations like MCO is held accountable for improvement of patient welfare.
Another difference is, with FSS a patient is free to visit any physician of choice nay time he/she feels like but under managed care there is financial incentive that forces patients to visit physicians who are affiliate of the plan. To add on, members’ satisfaction is an important aspect that draws a difference between the two systems. With Fee-For-Service, the patients shops around so as to find a physician who he/she perceives to be providing reasonable care. Payment is limited to the responsibility of insurance plan. In contrast, managed care systems are responsible for active soliciting of customer satisfaction in terms of quality care by conducting intervallic surveys on customer satisfaction.
The key disparity between FFS and managed care systems is the capacity to hold accountable a whole system of health care providers where that system has acknowledged financial risk. The state may opt to delineate the terms and conditions for that accountability in contract with the contracted entities regarding access and quality of services.
My mission statement hereby is to be comprehensive health care delivery systems provider while engaging in quality and timely health care services within reasonable cost. The reason for this is the urge to save life in emergency cases and relieve those who are undergoing painful illness and undergoing financial constraints. There is need for quality service since it is the main aspect and this is ensured by having qualified practitioners. This is also due to the need for integrated health care systems so as to provide full care transition programs that few hospitals have in place.
References
Kronenfeld, J. J. (2003). Reorganizing health care delivery systems: problems of managed care and other models of health care delivery. New York: Emerald Group Publishing.
Reid, P. P., Compton, W. D., & Grossman, J. H. (2005). Building a better delivery system: a new engineering/health care partnership. U.S: National Academies Press.
