The effect of the characteristics of the US health care system

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JB Donaldson Jr

BHS450 - Health Care Delivery Systems

Professor Lawanda Warthen

Case Study I: The effect of the characteristics of the US health care system

27 August 2012


In the United State of America’s healthcare delivery system there are ten basic characteristics that differentiate the U.S. health care delivery system from that of other major and developing countries. They are there is no central agency to govern it, the access to care is based on insurance, there are imperfect market conditions, some third party insurers act as intermediaries, there are multiple players in a patients healthcare, no single entity dominates, legal risks influence practices of the providers, there seems to be an automatic demand for use of new technology, new service settings along the continuum of delivery, and focus on quality. These characteristics all have key roles in a patient’s access to care, the health seeking behaviors of the US population, and the behaviors of providers within the US healthcare delivery system.

Access to health care is a vital component in the U.S. healthcare delivery system. It is defined as “the ability of a person to receive health care services” [medicaldictionary.thary.com]. This falls under the characteristic of access being based on insurance and mode of payment. Access to care relies on the payment method and in a lot of cases the coverage and type of insurance a person has. Payment in a healthcare delivery system can come from a variety of places. These payments can be submitted either directly or indirectly to the medical treatment facility by the individual patient. Other methods are the payers of health services whether it is privatized insurance companies, the employers themselves or the government. The way that a person is able to pay for medical services has a gigantic impact on what type of treatments they may or may not be privy to or chose to have. Studies and reports show that “thirty-one percent of U.S. adults reported spending a lot of time dealing with insurance paperwork, disputes, having a claim denied by their insurer, or receiving less payment than expected.” [C. Schoen 2012].When a patient’s runs into a road block in access to care he or she is less likely to receive the treatment they may need. With the high costs of health care, most people in the United States, cannot pay for a simple office visit much less a major surgical procedure out of their own pockets. Although financing can be an option for payment most of the time however this is where health insurance comes in. However, with healthcare coverage, the insurance companies can controls patients' access to such medical services. It is no secret that someone with insurance coverage will be more likely to have access to provider services which, in turn, will increases utilization of the healthcare system. If patients cannot afford to pay for medical services, either out-of-pocket or through insurance, health care providers have the option to refuse to treat them in some areas. While there are some hospitals that are required by law to provide some charity care to the poor or uninsured, in order keep a non-profit status, private practice physicians do have to abide by these restrictions. Accordingly, the absence of insurance can bar patients from receiving medical services. Having medical insurance does NOT guarantee access to healthcare services. Different kinds of insurance set conditions on when, where and from whom access to medical services will be granted, such as Health Maintenance Organization (HMO). Access to comprehensive, quality healthcare services is important for the achievement of health for all U.S. citizens.

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“Health seeking behavior refers to all those things humans do to prevent diseases and to detect diseases in asymptomatic stages. In contrast illness behavior refers to all those activities designed to recognize and explain symptoms after one feels ill, and sick role behavior refers to all those activities designed to cure diseases and restore health after a diagnosis has been made” [http://www.riao2010.org] There are many factors to consider when looking at the behaviors of a population in a community or a society that help form the basis of the health care seeking behaviors. It is a result of an evolving ...

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