Custom «Health Care Delivery Systems» Essay Paper
This is an essay on health care delivery systems. A health delivery system is an organized method of conveying prevention, treatment, and management of illness by health professionals to registered individuals. The essay will define various delivery systems. It will also analyze the goals of the various delivery systems. The essay will examine the similarities and differences between then various health care delivery systems. This essay will similarly include a mission statement and in addition discuss the mission statement chosen. A mission statement is a formal, short, written statement that governs the operations of an organization. A conclusion will hence be drawn at the end of this essay.
There are two common types of health care delivery systems in the US namely; the fee-for-service (FFS) and the managed care systems such as health maintenance organizations (HMO).The fee-for-service health care delivery system is a health plan that allows the holder to pay for a particular medical service offered individually by a practitioner rather than paying as part of a comprehensive plan (Farlex, 2010). A managed healthcare delivery system is a system that controls the financing and delivery of maximum health services at reduced costs to those enrolled in a specific healthcare plan (American Heart Association, 2010). The two healthcare delivery systems are based on different goals. The fee-for-service system has multiple goals which include expanding insurance coverage, improving quality and access to care, controlling costs, good health, responsiveness to the expectations of the population, and fair financial contribution (Steinbrook, 2009). The managed healthcare delivery system has more improved goals as listed herein. They include; delivering high-quality care in an environment that manages or controls costs, delivering relevant and reliable medical care, ensuring that the most qualified practitioners deliver the service, and rendering the service in the most appropriate and less- restrictive setting (American heart association, 2010).
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Notable are the main differences and similarities attached to the two healthcare delivery systems. Both systems are only applicable to the registered members upon their subscription to a certified insurance plan. They have a general aim of maintaining and improving the health status of the insurance holders. In both, only medical practitioners are allowed to offer the healthcare. In both, service is only delivered upon request. The holders are always independent and both systems are government initiated and monitored. However, there are physical, managerial, service deliveries and cost differences between fee-for-service and managed healthcare delivery systems.
In a fee-for-service system (FFS), there is no “defined population” for which the insurance company is responsible while in a managed system, the responsibility for health is defined in a population: all of the people who are insurance holders. In a FFS, a patient can go to see any physician he wants, whenever he feels like. On the other hand, in a managed care the patient has a strong financial incentive to see only those physicians who are affiliated with the plan. In a FFS system, after paying the yearly deductible the patient will probably be asked to pay the physician’s bill up front. Later, the patient would submit a claim to be reimbursed for a certain percentage of the amount (usually 80 percent).Under managed care system; the patient will be charged a co-payment on seeing a doctor. But it is the doctor’s responsibility to file the necessary paperwork with the managed-care plan. In a FFS, the patient is responsible for finding a physician from whom he derives satisfaction and the insurances’ responsibility is limited to payment of claims. Under managed care system, the plan will consider your satisfaction from a physician and will equally participate in finding one. In a FFS system, the patient is responsible for checking a physician’s qualifications and credentials while in a managed system, the plan takes some of the responsibility of determining whether doctors are qualified when it invites them to join the network. In a FFS system, the patient refers himself to a specialist when he wants while in a managed system; the patient is referred to a specialist by his primary-care physician (Eddy, 1997).
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