Traditional healthcare delivery systems required patients and healthcare providers to occupy specific roles with little room for improvisation. Within the last several years, recent reforms and policies, however, have begun to change the structure of traditional healthcare systems. Discover how healthcare delivery systems are evolving.
Traditional Healthcare Delivery Systems
Unlike many nations around the globe, the U.S. does not offer a universal healthcare program administered by a governmental agency. As The Wall Street Journal explains, the U.S. healthcare system has long centered on a fee-for-service delivery system, where private insurance companies or patients themselves pay for services received, ranging from standard office visits and lab tests to surgical procedures.
Although this traditional delivery system appears straightforward, as Julie Barnes of The Atlantic explains, that model can encourage medical professionals to prescribe as many tests and treatments as they see fit. Since the delivery process remains focused on quantity instead of quality, medical professionals may be inclined to tell patients to pursue other procedures as a form of “defensive medicine,” as Barnes asserts. As long as patients hold comprehensive insurance policies, the cost of services and treatments alone won’t prevent patients from pursuing their doctors’ recommendations.
Evolution of Healthcare Delivery Systems
Recent policy changes have set the stage for significant healthcare reform and have encouraged a shift from quantity toward quality. As a timeline from The Henry J. Kaiser Family Foundation (KFF) indicates, the first changes to the standard U.S. healthcare delivery system began to take effect in 2010. Many of these early changes involved requiring new healthcare plans to offer minimum levels of preventive coverage and creating HealthCare.gov, a consumer-focused website intended to better informed patients about their insurance and coverage options.
As the KFF timeline illustrates, major reforms have continued since 2010, and in 2014, a requirement for individuals to have health insurance came into effect. This requirement, known as the individual mandate, ensures that everyone would receive at least basic healthcare coverage. State-based health insurance exchanges also came into effect in 2014, requiring each state to offer coverage to small businesses and people. A universal application form streamlines the process, which is intended to make accessing necessary healthcare coverage easier.
President Barack Obama's Health Care Law
As the U.S. Department of Health & Human Services explains, President Barack Obama's Health Care Law, the Affordable Care Act (ACA), “puts consumers back in charge of their health care.” This health care law was intended to help patients better understand their options and make more informed choices about their healthcare. In addition to emphasizing quality healthcare procedures over quantity of healthcare procedures, the healthcare law's key features included an end to arbitrary coverage withdrawals, an end to lifetime coverage limits, and no-cost preventive care.
Medicare and Medicaid
Both Medicare and Medicaid, social healthcare programs for the elderly and low-income families, have also undergone significant reforms since 2010. As the KFF details, broader enrollment requirements, intensive premium reviews, and a quality-based repayment system for hospitals are some of the recent reforms to these two programs.
The healthcare landscape in the U.S. continues to change rapidly, especially in its delivery systems. Students of health administration degree programs and practicing health administration professionals all have the potential to help shape policy decisions that can create a healthcare system that benefits everyone.
For more information please visit USC's Executive Master of Health Administration Online program.
Resources Linked to in the Article:
http://www.wsj.com/articles/should-the-u-s-move-away-from-fee-for-service-medicine-1427079653
http://www.theatlantic.com/health/archive/2012/05/moving-away-from-fee-for-service/256755/
http://kff.org/interactive/implementation-timeline/
Sources Consulted for the Article: