According to Longest and Darr (2008) the health service system is a dynamic force (p. 302). In the late twentieth century, the health service organizations (HSOs) and health systems (HSs) underwent some serious changes. The increase in health care cost in the United States is evidenced by both per capita expenditures, and also by measuring health care expenditures in relationship to the Gross Domestic Product (GDP). Some of the important changes that occurred in health services delivery in the 1980s and 1990s include a rise in health care cost, specifically in hospitals, competition from other health care organization, such as managed care like preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point-of-service …show more content…
Some of the changes included new medical and surgical procedures, like increase in pharmaceutical prescription, joint replacements, medical devices such as CT scanners, electronic health records (EHR), and transmission of information (Terry, 1994). Although these new changes improve health care services, the high cost, however, affect both people and businesses. Another change that occurred in the early 1990s was the number of Americans enrolled in a health maintenance organization (HMO) (Gold 1991). The number enrolled grew tremendously from 36.5 million to 58.2 million. Some of the changes that occurred during the decade among HMOs: “the rapid growth of for-profit HMOs; the rapid growth of network and individual practice association (IPA) models; the growth of mixed-model HMOs; product diversification; industry consolidation at the national and local levels; the decline of community rating methods; altered payment arrangements with physicians; increased patient cost sharing; declining hospital use; and increased use of clinical guidelines” (Gabel, 1997). Furthermore, in the 1980s and 1990s customers had high expectation for quality services due to Increase in deductibles and copayments. In conclusion, the health care system has not only undergone some drastic changes in the past two decades, and it will continue to evolve. All the changes forced health care organization to take some type of action; and the action taken by a health care system seeking correction and balance has been to look for ways to contain costs by adapting (CQI) continuous quality
According to Harry A. Sultz and Kristina M. Young, the authors of our textbook Health Care USA, medical care in the United States is a $2.5 Trillion industry (xvii). This industry is so large that “the U.S. health care system is the world’s eighth
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
For decades, one of the many externalities that the government is trying to solve is the rising costs of healthcare. "Rising healthcare costs have hurt American competitiveness, forced too many families into bankruptcy to get their families the care they need, and driven up our nation's long-term deficit" ("Deficit-Reducing Healthcare Reform," 2014). The United States national government plays a major role in organizing, overseeing, financing, and more so than ever delivering health care (Jaffe, 2009). Though the government does not provide healthcare directly, it serves as a financing agent for publicly funded healthcare programs through the taxation of citizens. The total share of the national publicly funded health spending by various governments amounts to 4 percent of the nation's gross domestic product, GDP (Jaffe, 2009). By 2019, government spending on Medicare and Medicaid is expected to rise to 6 percent and 12 percent by 2050 (Jaffe, 2009). The percentages, documented from the Health Policy Brief (2009) by Jaffe, are from Medicare and Medicaid alone. The rapid rates are not due to increase of enrollment but growth in per capita costs for providing healthcare, especially via Medicare.
Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA: Stanford Business, 2010. Print.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Despite the established health care facilities in the United States, most citizens do not have access to proper medical care. We must appreciate from the very onset that a healthy and strong nation must have a proper health care system. Such a health system should be available and affordable to all. The cost of health services is high. In fact, the ...
Niles, N. J. (2011). Basics of the U.S. health care system. Sudbury, MA: Jones and Bartlett.
The Iron Triangle of Health Care is a concept developed by William Kissick, the father of Medicare, in his 1994 book, “Medicine’s Dilemmas: Infinite Needs Versus Finite Resources”. In his book Kissick describes three health care issues which are the primary concerns of all health care systems and that operate in a dynamic and complex relationship: Cost, Quality, and Access. The Triangle is Iron because it is generally difficult to have a low-cost, high quality, wide access health care system, Kissick (1994). Within the triangle it is generally assumed that if quality increases, then costs must increase as well, Kissick (1994). In this paper I will discuss this triangle and the relationship of the three aspects. Also I will discuss how each one dramatically
The U.S. healthcare system is very complex in structure hence it can be appraised with diverse perspectives. From one viewpoint it is described as the most unparalleled health care system in the world, what with the cutting-edge medical technology, the high quality human resources, and the constantly-modernized facilities that are symbolic of the system. This is in addition to the proliferation of innovations aimed at increasing life expectancy and enhancing the quality of life as well as diagnostic and treatment options. At the other extreme are the fair criticisms of the system as being fragmented, inefficient and costly. What are the problems with the U.S. healthcare system? These are the questions this opinion paper tries to propound.
It is hard to imagine life without health insurance. If you have any type of medical problem that requires attention, and you have appropriate health care insurance, you can be cared for in the finest of private hospitals. You can get great treatment and your ailments, depending on the severity, can be treated as soon as possible. Doctors, physicians and surgeons are willing to put out a big effort if they know that they are dealing with patients who are insured and have the money to go under extensive medical treatment. But imagine life without such luxuries. For example, what happens if a relative requires much needed surgery, but does not have health insurance to cover the procedure? What happens if a lack of medical insurance prevents you or your family from seeing a doctor, which could result in health problems that had not been identified but could have been treated before they became life threatening? These scenarios may seem far-fetched, but these types of situations happen to people who lack health coverage everyday. There is a true story about a patient who was insured and diagnosed with treatable cervical cancer. Unfortunately, she lost her job and with it her insurance. She was then unable to see her private doctor, and was turned away from other hospitals because ?cancer treatment is not considered an emergency in a patient who can?t pay? (?Help for D.C.?s Uninsured?). The woman later died at her home without ever being treated. This example raises the question, since when are people with less money less deserving of health care or appropriate treatment?
In this essay, we will discuss the structural outline as well as characteristics that make-up the U.S. health care delivery system. The health care delivery system has two main objectives which are to provide a cost-effective method that holds a particular standard of qualities, as well as accessibility to all U.S. citizens (Shi & Singh, 2017). Confronted by difficulties to lessen costs and expand service delivery, the U.S. health care system have need of transformational modification (Ellner, Stout, Sullivan, Griffiths, Mountjoy & Phillips, 2015). In addition, to the need for transformational change, monetary issues plays a big role in the inability to invest in social goods such as education and infrastructure.
The United States health care system is one of the most expensive systems in the world yet it is known as being unorganized and chaotic in comparison to other countries (Barton, 2010). This factor is attributed to numerous characteristics that define what the U.S. system is comprised of. Two of the major indications are imperfect market conditions and the demand for new technology (Barton, 2010). The health care system has been described as a free market in
Healthcare current dynamics involves good decisions that create better healthcare for citizens. These dynamics allow healthcare providers to strategically plan for better opportunities to advance with providing the best healthcare. Also, this may include the needs of what all patients’ desire when it relates to healthcare. Furthermore, the changes that has taken place in healthcare today, has created quite a stir in the US. For an example, preventive measures have been implemented for women in many areas like having screenings with mammograms, or even with prenatal care. In many cases, diseases like breast cancer have been detected for healthcare providers to treat
Health care is described as the maintenance or restoration of health by the treatment and prevention of disease, especially by trained and licensed professionals. Health care generates significant costs for the industry itself and for patients. There are many economic factors that can, and do affect health care costs. Actual costs affect the patients as well as various areas of health care, some of which include insurance companies, and government health care programs. Therefore, economic factors such as Hospital Acquired Conditions and Medicaid Managed Care have a great impact on the potential for profit and loss of many hospitals, insurance companies and managed care organizations.