A Distinctive System of Health Care Delivery

1 Chapter 1A Distinctive System of Health care DeliveryLearning Objectives To understand the basic nature of the US Health care System To outline the four key functional components of a Health care de-livery System To discuss the primary characteristics of the US Health care systemfrom a free market perspective To emphasize why it is important for Health care managers to un-derstand the intricacies of the Health care Delivery System To get an overview of the Health care systems in other countries To introduce the systems model as a framework for studying thehealth services System in the United States1 The US Health care Delivery System is a behemoth that is almost impossible for any single entity to manage and

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6 1 Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTIONI ntroductionThe United States has a unique System ofhealth care Delivery .

7 * It is unlike any otherhealth care System in the world. Most devel-oped countries have national Health insur-ance programs run by the government andfinanced through general taxes. Almost allcitizens in such countries are entitled to re-ceive Health care services. Such is not thecase in the United States, where not allAmericans are automatically covered byhealth insurance. The US Health care deliv-ery System is not a System in the true sense,even though it is called a System when ref-erence is made to its various features, com-ponents, and services. Hence, it may besomewhat misleading to talk about theAmerican Health care Delivery System be-cause a real System does not exist (Wolinsky1988, 54). The US Health care System is un-necessarily fragmented, which is perhaps itscentral feature (Shortell et al.)

8 1996). The de-livery System has continued to undergo pe-riodic changes, mainly in response toconcerns with cost, access, and quality. Inspite of these efforts, providing at least a ba-sic package of Health care at an affordablecost to every man, woman, and child inAmerica remains an unrealized goal. It ishighly unlikely that this goal will materializeanytime soon, mainly because expanding ac-cess to Health care , while containing overallcosts and maintaining expected levels ofquality, is a daunting Health care Delivery in theUnited States can be a frustrating task. To fa-cilitate an understanding of the structural andconceptual basis for the Delivery of healthservices, this book is organized according toa systems framework presented at the end ofthis chapter. Also, the mechanisms of healthservices Delivery in the United States are col-lectively referred to as a System throughoutthis main objective of this chapter is toprovide a broad understanding of how healthcare is delivered in the United States.

9 Theoverview theme provided here introduces thereader to several concepts that are treatedmore extensively in later Overview of the Scope and Size of the SystemTable 1 1 demonstrates the complexity ofhealth care Delivery in the United organizations and individuals are in-volved in Health care . These range from ed-ucational and research institutions, medicalsuppliers, insurers, payers, and claimsprocessors to Health care providers. Multi-tudes of providers are involved in the provi-sion of preventive, primary, subacute, acute,auxiliary, rehabilitative, and continuing increasing number of managed care or-ganizations (MCOs) and integrated networksnow provide a continuum of care coveringmany of the service US Health care Delivery System ismassive. Total employment in various healthdelivery settings is approximately 10 million,including approximately 744,000 profes-sionally active doctors of medicine (MDs), million active nurses, 168,000 dentists,226,000 pharmacists, and more than 700,0002 CHAPTER 1 A Distinctive System of Health care Delivery *The expressions Health care Delivery and Health servicesdelivery can have two slightly different meanings.

10 In a broadsense, they collectively refer to the major components of thesystem and the process that enables people to receive healthcare. In a more restricted sense, they refer to the act of pro-viding Health care services to patients, such as in a hospitalor physician s clinic. By paying attention to the context, thereader should be able to identify which meaning is