Healthcare delivery systems are an integral part of any organization, hospital, and society at large. It is, therefore, paramount that all health institutions indulge in setting up mechanisms that will ensure the holistic provision of healthcare services. These systems should meet the following objectives:
To ensure that all citizens have access to fundamental healthcare services. This is determined by the individuals ability to pay and if the service is available to them.
To manage the costs of healthcare so that all people can afford this basic amenity.
It is necessary to outline the key components of healthcare delivery systems. These include financing, insurance, payment and delivery. These components are usually integrated into government set ups and may prove difficult to distinguish one from the other. However, for private healthcare institutions tend to isolate these components.
Insurance, under this docket, individuals pay premiums to receive critical health services that would prove to be rather expensive should they decide to pay for it themselves. Insurance also puts together a package that the individual is entitled to; this means that he/she only receives specific services at a particular time. The insurance company normally manages the claims function and how to pay the healthcare providers.
Financing, health care is a costly affair in that a lot of components have to be catered for such as tests, equipment, procedures and duration of stay. Therefore, when money is availed, many are able to acquire insurance to pay for basic and more complex healthcare services. Most employees receive medical care as part of the perks of the job; it is catered for in their contracts. The employer caters for healthcare by contracting an insurance company, and this cover tend to be extensive, covering the employee and his/her dependents such as children, parents or even spouses.
Payment is an interesting component of the whole system as it entails how funds are reimbursed to service providers. These funds are derived from the insurance premiums paid to the insurance companies either by individuals or organizations. For instance, when an individual receives health care services and is insured, the health care provider either bills the insurance company directly or the individual is required to pay for the service immediately. Should the patient/client pay for the services themselves, he/she is entitled to file a claim with the insurance company that will see to it that they are adequately refunded. However, most insurance companies prefer to pay the amount directly to the healthcare service provider to avoid incurring other operational costs.
Delivery encompasses the provision of healthcare services and the receipt of insurance payments directly for those services (A Distinctive Scheme of Health Care Delivery, 2004). There are various types of services delivered by providers and include the supply of medical equipment, diagnostic tests, access to physicians and therapists (a unique feature to private healthcare providers).
Hospitals and large health corporations offer an array of services ad it is, therefore, essential for them to integrate these services to facilitate smooth delivery of healthcare services. Mechanisms are being put in place to enable this transition and are enumerated as such:
A patient-oriented healthcare system that assesses the flow of patients within healthcare systems. This includes incorporating healthcare workers in identifying vulnerable members of the society. This, however, attests to be a challenge for large organizations given the number of patients that they handle on a day-to-day basis
Coverage of patients in given regional areas. Specialized treatment and care are given to clients in different parts of the country to avoid duplication of services and to ensure that every client is catered for. This enhances quality service provision.
Inter-professional teams which mean that different professionals with a given area of specialization are able to work together to enable a continuous flow of care provision. This is done without the other infringing on the jurisdiction of another. For instance, this is facilitated by shared protocols when handling a patient or client. This promotes a collaborative effort and also ensures that various services are integrated into the overall system.
Measuring performances through output and indicators, for example, determining how effective immunization programs are by the number of mothers who have brought their children to the hospital or clinic. This is also aimed at maintaining or promoting cost-effectiveness, should a service render useless, then it can be dropped in a favor of a more effective one. Integrated health systems also have reward systems that can be used to identify the most efficient services provided. For instance, recognition of outstanding staff members or a point rewards system for clients.
Mergers with other institutions or healthcare provision or strategic alliances with local hospitals to offer an array of services to the large population
Automation or digitization of core services to ensure that records are easy to find and up to date. (Esther Suter, 2010).
An example of an institution that offers a wide array of integrated healthcare services is Ascension Health in St Louis in the United States of America. It is definitively one of the largest Catholic non-profit health systems in the country; it has more than 1,400 outlets based in 21 states. Some of the services provided at these centers include rehabilitation and residential care services, community health services, psychiatric care, acute and long-term care. Furthermore, it has partnered with Oak Hill Capital to form a network that provides funding for the acquisition of Catholic hospitals in an effort to provide even more services (Rodak, 2013).
(2004). A Distinctive System of Health Care Delivery. In D. A. Leiyu Shi, Delivering Health Care in America: A Systems Approach. Jones and Barlett.
Esther Suter, N. D. (2010, December 20). Ten Key Principles for Succesful Health Systems Integration. Retrieved from NCBI: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004930/
Rodak, S. (2013, May 15). 100 Integrated Health Systems to Know. Retrieved from Becker's Hospital Review: http://www.beckershospitalreview.com/lists/100-integrated-health-systems-to-know.html
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