HLT 314V Week 3 Discussion 1

Review current types of health care delivery systems in the United States and contrast the current status with the reform models or revisions proposed in the readings for this topic. Select one area in health care delivery where change or reform to the current system could improve the delivery of allied health care and present your findings.

 

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Current types of health care delivery systems in the United States

Introduction

There are many ways to receive health care in the United States. Some people choose to go directly to their doctor, while others prefer to use a specialist or clinic that specializes in one type of care. Many people also have access to different types of medical insurance plans through work or through public programs such as Medicaid or Medicare Part D prescription drug coverage. These options can help you find the best healthcare plan for your needs and budget, as well as help keep costs down by helping you avoid higher-cost providers who might charge much more than lower-cost providers in your area.

Fee-for-service: Traditional way of providing health care that’s categorized by direct patient payment for each service received.

Fee-for-service: This is the traditional way of providing health care. Patients pay directly for each service received, and this can be done through insurance plans, private practice or government programs like Medicare and Medicaid.

This type of delivery system relies on the concept of “fee” being paid to providers by patients. The fee may be set as a flat amount per visit or per procedure or by using some other form of payment (such as coinsurance).

Managed care organization (MCO): Encompasses a large range of organizations and delivery systems, but most often refers to HMOs and PPOs.

Managed care organizations (MCOs) are a type of health plan that coordinates the delivery of health care services. They may be known as HMOs or PPOs, but typically include an array of different types of plans and organizations. By aggregating patient data across multiple providers and providers’ networks, MCOs can provide more efficient access to healthcare for their customers.

Health maintenance organization (HMO): Provides only services covered by a contract within the HMO network.

Health maintenance organizations (HMOs) are the most restrictive type of health plan. They often have lower premiums, but higher deductibles. HMOs are required to provide a specific set of benefits and typically do not allow you to see any other doctors or hospitals outside their network.

If you want more flexibility in your health care, then switching to an indemnity plan may be your best bet.

Preferred provider organization (PPO): A type of health plan in which you can use any doctor or hospital in the PPO network, but you’ll pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.

A PPO is a type of health plan in which you can use any doctor or hospital in the PPO network, but you’ll pay less if you use doctors, hospitals and other health care providers that belong to the plan’s network. This means that if your employer has a PPO and you need to see an emergency room physician or get treatment for major surgery at another facility not included in their network (but still within driving distance), they will likely cover it.

PPOs are often preferred by employers because they offer better access to specialists. They also tend to be cheap for employees who want this kind of coverage—you pay less out-of-pocket than with other types of plans like HMOs or indemnity plans because your monthly premium dollars go toward paying for benefits instead of being used as cash savings accounts against future medical costs (which can be difficult when dealing with chronic illness).

Point of service (POS): Combines elements of an HMO and a PPO, giving members the flexibility to choose from multiple coverage options.

If you’re interested in a POS, it combines elements of an HPO and a PPO. A POS allows members to choose from multiple coverage options, as opposed to being locked into one system or hospital network. This can be beneficial if you have an expensive condition and want access to high-quality care in order to maintain your healthiest possible lifestyle. However, some point out that if you need urgent care at night or on weekends when the office is closed, there are no options available within their network (or even within their state).

POS programs also typically charge lower monthly premiums than other types of plans do—but they may have higher deductibles and co-pays than traditional HMOs or PPOs do.

Consumer-directed health plans (CDHPs): High-deductible plans paired with a tax-advantaged account called a health savings account (HSA) or health reimbursement arrangement (HRA).

Health savings accounts (HSA), also known as “high-deductible” or “consumer-directed health plans,” are tax-advantaged accounts paired with health insurance. These accounts allow you to save money toward your medical bills, while the money in your HSA is used to pay premiums or out-of-pocket costs when they arise.

You can open an HSA if:

• You have had no coverage for at least six months before applying for an account;

• Your annual adjusted gross income is below $100,000 if single and below $200,000 if married/joint filers;

• You’re 18 years old or older (in some states).

Bundled payments: Where a single payment is made for all services related to a specific episode of care.

Bundled payments are a single payment for all services related to a specific episode of care. They are used to incentivize the quality of care and discourage unnecessary care.

For example, if you need knee surgery on both knees, your surgeon would be paid based on how quickly he or she completes the procedure. The amount that they get paid depends on factors such as:

• How long it takes them to do their work (the “time” component)

• How much time they spend with each patient (the “duration” component)

There are many types of healthcare plans available today.

The healthcare plan is one of the most important decisions that you can make when it comes to your health. It’s an investment in yourself and your family, as well as a way to ensure that you and your loved ones are able to receive top-notch care if something ever happens.

There are many different types of healthcare plans available today, but all have their pros and cons. The best way to choose the right plan for you is by considering what kind of coverage options are included with each type, how much cost will be involved with keeping those options active year after year (or month after month), how long before any potential savings kick in (if at all), etc…

Conclusion

So, what are your options? Look at each option and decide which one is right for you. If you don’t know where to start, ask your doctor or other health care provider for advice. You will want to find a plan that fits your needs and budget.