Because the largest public programs are directed to the aged, disabled, and low-income populations, they cover a disproportionate share of the chronically ill and disabled. However, they are also enormously important for children. Being uninsured, although not the only barrier to obtaining health care, is by all indications the most significant one. Those without health insurance or without insurance for particular types of services face serious, sometimes insurmountable barriers to necessary and appropriate care.
The committee has adapted a four-level model by Ferlie and Shortell to clarify the structure and dynamics of the health care system, the rough divisions of labor and interdependencies among major elements of the system, and the levers for change.
A brief description of the model follows. Conceptual drawing of a four-level health care system. The Individual Patient We begin appropriately with the individual patient, whose needs and preferences should be the defining factors in a patient-centered health care system.
The availability of information, the establishment of private health care spending accounts, and other measures reflect an increasing expectation that patients will drive changes in the system for improved quality, efficiency, and effectiveness.
Overall, the role of the patient has changed from a passive recipient of care to a more active participant in care delivery. Unfortunately, most people do not have access to the information, tools, and other resources they need to play this new role effectively.
The level of responsibility patients and their families assume differs from patient to patient. In either case, however, patients need a free exchange of information and communication with physician s and other members of the care team, as well as with the organizations that provide the supporting infrastructure for the care teams.
Synchronous communication between patient and physician could improve the quality of care in a number of ways. Communication technologies also have the potential to change the nature of the relationship between patient and provider, making it easier for patients to develop and maintain trusting relationships with their clinicians.
Asynchronous communication also has the potential to significantly improve quality of care.
The easy accessibility of the Internet and the World Wide Web should enable all but continuous inquiries and feedback between patients and the rest of the health care system IOM, One of the fastest growing uses of the these communication technologies is as a source of medical information from third parties, which has made the consumer i.
Some of the improvements just described are available today, some are under study, and some are as much as a decade away from realization.
Thus, research is still an essential component in transforming the current system. In addition to the care team, a clinical microsystem includes a defined patient population; an information environment that supports the work of professional and family caregivers and patients; and support staff, equipment, and facilities Nelson et al.
Most health and medical services today, however, are not delivered by groups or teams. The role and needs of individual physicians have undergone changes parallel to those of individual patients. The slow adaptation of individual clinicians to team-based health care has been influenced by several factors, including a lack of formal training in teamwork techniques, a persistent culture of professional autonomy in medicine, and the absence of tools, infrastructure, and incentives to facilitate the change.
To participate in, let alone lead and orchestrate, the work of a care team and maintain the trust of the patient, the physician must have on-demand access to critical clinical and administrative information, as well as information-management, communication, decision-support, and educational tools to synthesize, analyze, and make the best use of that information.
Moreover, to deliver patient-centered care i. At the present time, precious few care teams or clinical microsystems are the primary agents of patient-centered clinical care.
All of these can, and do, prevent systems thinking by clinicians, the diffusion of evidence-based medicine, and the clinical microsystems approach to care delivery. Thus, tailoring evidence-based care to meet the needs and preferences of individual patients with complex health problems remains an elusive goal.
For care teams to become truly patient-centered, the rules of engagement between care teams and patients must be changed. Like individual care providers, the care team must become more responsive to the needs and preferences of patients and involve them and their families to the extent they desire in the design and implementation of care.
Care teams must provide patients with continuous, convenient, timely access to quality care. One member of the care team must be responsible for ensuring effective communication and coordination between the patient and other members of the care team.
The Organization The third level of the health care system is the organization e. The organization encompasses the decision-making systems, information systems, operating systems, and processes financial, administrative, human-resource, and clinical to coordinate the activities of multiple care teams and supporting units and manage the allocation and flow of human, material, and financial resources and information in support of care teams.
The organization is the business level, the level at which most investments are made in information systems and infrastructure, process-management systems, and systems tools.
Health care organizations face many challenges. In response to the escalating cost of health care, government and industry—the third-party payers for most people—have shifted a growing share of the cost burden back to care providers and patients in recent years.
As a result, hospitals and ambulatory care facilities are under great pressure to accomplish more work with fewer people to keep revenues ahead of rising costs. In certain respects, management of health care organizations is not well positioned to respond to mounting cost and quality crises.
Compared to other industries, health care has evolved with little shaping by the visible hands of management. Historically, most leaders of health care organizations were initially trained in medicine or public health.
Moreover, except in the relatively few integrated, corporate provider organizations e. These circumstances have posed significant challenges to the authority of health care management in many organizations, often creating discord and mistrust between health care professionals and health care management.
Other challenges to management include the hierarchical nature of the health professions and inherent resistance to team-based care, significant regulatory and administrative requirements e. The Political and Economic Environment The fourth and final level of the health care system is the political, economic or market environment, which includes regulatory, financial, and payment regimes and entities that influence the structure and performance of health care organizations directly and, through them, all other levels of the system.
Many actors influence the political and economic environment for health care.Hence though theses delivery systems for healthcare the patients can get the advantage of recovery systems that ensure health benefits of the patient.
These delivery systems also ensure that the best care available for them is provided and these delivery include critical health care along with general healthcare along with various other kinds of provisions also.
The resources of the health care delivery system are not balanced well enough to provide patient-centered care, to address the complex health care demands of an aging population, to absorb normal spikes in demand for urgent care, and to manage a large . The United States health care delivery system faces many issues such as rising cost of health care, increased access to services, a growing population, improved quality of .
Introduction to Healthcare Delivery Systems 1 Objectives After reading this chapter, you should be able to: Health care has now evolved into a business entity that requires strategic planning, financial management, operational control, and functional specialties to maintain its viability.
The United States has a unique system of health care delivery. For the purposes of this discussion, “health care delivery” and “health services delivery” can have slightly different meanings, but in a broad sense, both terms refer to the major components of the system and the processes that.
Integrated health services encompasses the management and delivery of quality and safe health services so that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services, through the different levels and sites of care within the health system, and.