...HCS/552 November 5, 2012 Introduction Complex health care delivery systems in the USA Describing health care delivery structure at MGH Comparing health care delivery system with SGAH Factoring licensing and regulatory requirements Quality affecting pricing Health Care Delivery Structure of MGH Decentralized model Hybrid organizational model Service‐based health care delivery structure Predominantly utilitarian authority structure Health Care Systems of the Competitor SGAH represents the hierarchical organization Centralized organizational model Mutual beneficiaries system Predominantly normative authority structure SGAH positions itself as a specialty hospital Licensing and Regulatory Effects The Center for Disease Control and Prevention (CDC) Health insurance portability and accountability act (HIPAA) Occupation safety and health administration (OSHA) Health services cost review commission (HSCRC) Licensing and Regulatory Effects Licensing and Regulatory Effects (Continued) Health Information Technology for Economic and Clinical Health Act (HITECH) Certificate‐of‐need (CON) Prospective payment system (PPS) Balanced budget act (BBA) Regulations Affecting Health Care Patient protection and affordable care act (PPACA) Recovery Audit Contractor (RAC) program Observation admit status Mandatory electronic health records Pricing and Competition Trends Hospitals positioning and differentiation...
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...Introduction to the U.S. Health Care Delivery System Introduction to the U.S. Health Care Delivery System Information Aubrey Gaines June 22, 2011 Health Care Delivery Systems BHS 450 Trident University International Dr. Leequan Ray Managed Health Care is debated on a number of aspects; nature and origin of managed care, the notion of the death of managed care and the current state of managed care in the U.S. health care system. Anyone in America, who’s used healthcare insurance through their employer, experienced managed care at some point. What is managed care and how does it affect us? The Health Maintenance Organization (HMO) ACT of 1973 required employers with more than 25 employees to offer federally certified HMO options along with indemnity insurance upon request. With the HMO ACT of 1973, employers needed them more than ever. HMOs had to instantly find a way to provide quality care at the lowest possible cost to the employer, so they engineered techniques that became known as managed care. Managed care is loosely defined as a mixture of techniques intended to reduce the cost of providing health benefits in order to improve the quality of care for a predetermined population. The intent is to decrease unnecessary cost through a multitude of mechanisms which include offering economic incentives for physicians and patients to select less costly forms of care, reviewing the medical necessity of specific services, increasing...
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...public health and health care delivery systems, we first have to have an understanding of what each of these terms mean. Public health is defined as the "science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community effort.."1 On the other hand, The Institute of Medicine in its report, The Future of Public Health in the 21st Century describes health care delivery systems as "various organizations and individuals working collectively,"2 and include clinicians, insurance plans, health care facilities and independent and corporate health care providers. In the United States, public health and health care delivery systems complement each other in several ways. One of the major way in which they complement each other is through their focus on prevention services to the communities. For instance, governmental agencies may implement programs to help improve the health of members of the communities ,such as the Woman Infant and Children (WIC) program that helps with nutrition education and provision for low income mothers and their children up to the age of five. Here we can see how public health is in place since there is the promotion of health and disease prevention among the target population. The health care delivery systems include the WIC...
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...The health care delivery system in Utah is set up much the same as many other states, from the opportunity for the community to participate in Medicaid or Medicare programs, to all sort of resources, from information on local health departments, campaigns and awareness programs, to allowing for easy access to the licensing bureau to ensure the safety and comfort of assisted living centers and nursing homes. According to health.utah.gov, growth rates in Utah for Medicaid have far exceeded the annual revenue for the last two decades. Health care costs are continuing to soar, while many people are suffering without insurance or proper care when they are in need of it most. The State of Utah has contracts with many health care organizations in which it can arrange quality care and continually improve on ways to manage health care costs, cover medical procedures, and allow opportunities for the community to be aware of how and when to utilize the benefits that they are provided, whether it be through state or government agencies, or employer’s plans. The State of Utah wants to reduce health care costs, which it can help maintain by providing out-of-network payment limitations when dealing with Medicaid, and with their budget management strategy the state makes supplemental payments to its teaching hospital. The State is also strategizing on making each Medicaid client responsible and accountable for their portion of the system, as well as replacing limits on the copayment amounts...
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...1. Explain how the medical model drives up costs in the health care delivery system? The current health care plan just treat the symptoms of diseases and is less focused on completely eliminating the problems. As the reading states this drives up the want for the best technologies and this drives up the cost of the newest and greatest technology. This technology can include new ways to make medicine, diagnose or find problems, The increase in newest and greatest also increases the overall cost and has to be made up someone were. So this cost is put on where the money is coming in. Generally this will be cost to patients. You also have to consider the ACA law which has ruined the insurance game. By raising the cost to cover the overload...
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...Health Care Organization and Delivery System Health Care Organization and Delivery System HCS/531 November 09, 2011 In the current era of technology, health care system continues to research on improvising the various ways on delivering outstanding health services to its people. In health care industry, majority of the developed countries are run by national insurance generated by enforced general taxes. Unlike in United States healthcare insurances are run by partly private and government institution ensuring individuals based on certain eligibility. Although the distinct system in the United States protrudes as one of the best health care providers around the globe, some individuals considered it as unmanageable catastrophic scheme. Additional information regarding United States health care system, the implications of its belief and values, and some models of health care delivery used in America are presented below. The health care delivery system of United States is a complicated organization involving education and research, medical suppliers, private, and government insurers, health care providers, payers, and the government. It composed an approximate number of 10 million in employment from doctors, nurses, dentists, pharmacists, administrators, caregivers, and more. The system also involves several institutions such as hospitals, nursing homes, mental health facilities, and clinical sites serving millions of people yearly...
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...American Health Care Delivery System IP5 Angela Stewart American Health Care Delivery System America’s emergency rooms see this type of critical events as a daily occurrence. Often you will find that people will go to the emergency department for care because the ER cannot refuse to care for that come to be seen. If we look into the Emergency Medical Treatment and Active Labor Act any person seeking care must receive assessment and immediate care for their ailment. Often the issue is financial, if a patient is seen at a doctor’s office co-pay or full payment is required at the time of service. With many Americans that do not carry medical insurance their ability to attend to the issue prior to it becoming an emergency is not something they can afford. At this time it is estimated that 77% of Americans are living from pay check to pay check (What percentage of Americans Live paycheck to paycheck? 2012). Without having access to a general physician to control this issue the child will end up being admitted to the hospital (Transferring patients, 2008). The Emergency department has become the safety net that catches those that fall through the cracks. If seen in the ER the individual will get the best possible care for the issue they came in for. In this case the child would be kept in the ER until they were able to clear her lungs and free her of the tightness and inability to take a deep breath. At that time the attending doctor will give a prescription for her immediate...
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...Characteristics of the U.S. Health Care Delivery System Introduction The U.S. health care delivery system can be best characterized as a loosely coordinated network of components that are interconnected. As noted by Shi and Singh (2008, p.4), “the system is a kaleidoscope of financing, insurance, delivery, and payment mechanisms that remain unstandardized but loosely connected”. The system is a combination of both government run programs (Medicare, Medicaid, Schip) private carriers such as HMO’S and other volunteer services such as the American Heart Association, American Lung Association, and a host of other organizations. The purpose of this assignment is to describe two defining characteristics (financing and delivery) of the U.S. health care delivery system and to further analyze and describe their implications on the system. Financing of Health Services As asserted by Shi and Singh (2008, p. 6), financing is an important prerequisite to obtain health insurance or to pay for health services. In the private sector, the financing of health care services for individuals is typically derived from their employers who often pay partially for such insurance in the form of fringe benefits. Employees are also given an opportunity to add other members of their families to this type of employer based insurance. As noted by Barton (2010, p.177), private insurance is estimated to cover about 67 percent of the nonelderly population and accounts for 54% of the revenues...
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...Infectious diseases remain a major cause of illness, disability, and death. Vaccination is a highly effective way of preventing certain infectious diseases since it induces protective immunity against such infectious agents. A traveler’s risk for acquiring infectious diseases is determined by various factors, including immunization status, location of travel, season, duration of exposure, occupational and recreational activities while traveling, as well as local rate of virus transmission at the time of travel. However, hand washing the oldest and still the most effective way of preventing diseases must be practiced by all travelers irrespective of which country you are traveling to. Some of these diseases include food and water borne, vector borne, blood borne, zoonosis, air borne, disease transmitted from soil and sexually transmitted diseases. Food and water borne diseases such as hepatitis A (fecal-oral route), typhoid fever and cholera, and diarrhea transmitted by the consumption of contaminated food and drink water or beverage during traveling. For example, drinking water contaminated with raw sewage, eating shell fish (such as oysters and clams) that have been harvested from contaminated water, eating raw fruits or vegetables washed in contaminated water, and swimming pools that aren't properly disinfected. Travelers must avoid consumption of potentially contaminated food, drink and drinking-water. Oral rehydration salts should be carried to combat dehydration in case of...
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...Evaluate the statement that an integrated delivery system (IDS) is the wave of the future and is critical to future organizational success. The current situation of healthcare delivery systems that are focusing on quality, patient centered approach, effective and efficient care, access to care etc are all leading to integrated delivery system approach. In future also, the healthcare systems are expected to undergo a lot of changes and challenges to improve healthcare outcomes and serve the respective community according to its needs. There is a definite and obvious scope for integrated delivery system in the future, when on one hand there would be a whole new system of PPCA and its implications and also a great number of newly insured populations to accommodate. Along with that, there would be a lot of competition among the hospitals in certain areas such as adaptation of Electronic Health records and provision of quality health services to a large number of people. Integrated delivery system would seem to help overcome many obstacles in the way because it will be helpful to avoid fragmented care and duplication of services and as a result reduce cost and increase overall health outcomes. 1. Identify the largest for-profit as well as not-for-profit health systems in the United States. Provide specific information about each, including the number of hospitals, the number of employees, and total revenue. Compare these health systems and discuss the ones you think will grow at...
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...Canadian Healthy Policy vs. United States Health Policy AHS 330 Health Care Systems: 7Q April 2, 2014 Healthcare in the United States is extremely different from the rest of the world. Over the years government and political analysts have compared and contrasted the health care systems of the United States to that of Canada’s. Despite being located on the same continent both countries have different ways of delivering health care to its citizens. Canada has a single-payer system that is publicly funded, while the United States has a multi-payer system that relies heavily on privately owned healthcare. This could be due to the differences in how many patients are cared for compared to those in America or it could be just a matter of who developed the better healthcare. However, due to the close proximity of the countries it is possible that the United States can adopt the Canadian healthcare system. According to Health Canada, Canada's publicly funded health care system is best described as an interlocking set of ten provincial and three territorial health insurance plans. Known to Canadians as "Medicare", the system provides access to universal, coverage for hospital and physician services. With this being said it is safe to assume that health care services are provided on the basis of need, rather than the ability to pay. “The Canadian Health Act contains a single national plan that is composed of thirteen provincial and territorial health insurance plans that all share common...
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...people’s lives determine their health. People who are poor are less likely to seek proper medical care, as opposed to people who are of middle-class status and above. People with more social status, money, and education have a lot of choices and control over things, such as the neighborhoods, their salaries, occupational opportunities, etc. (Jin, Shah, & Svoboda, September, 1995, 153(5)) Dennis Raphael of the CSJ Foundation for Research and Education, reinforces this concept: “Social determinants of health are the economic and social conditions that shape the health of individuals, communities, and jurisdictions as a whole. Social determinants of health are the primary determinants of whether individuals stay healthy or become ill.” (Raphael, 2008) The development of clinics has become increasingly more important since the passage of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. Politics influence clinics because when laws such as these are put in place, federal funds will follow. These acts will make healthcare more accessible to millions of people in the United States. (Hobbs, Morton, Swerissen, & Anderson, 2010). There is increasing recognition of the crisis in primary care and the relatively poor U.S. population health. Tools that can measure morbidity burden in individuals and populations will further reveal the special contributions of person focused medicine that the primary care provides. The adverse effects...
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...Obligations and Responsibilities of Kachia Local Government and Areas where Kachia LGA has failed in fulfilling its obligations and responsibilities. Obligations and Responsibilities of Communities and Areas where Communities have failed in fulfilling their obligations and responsibilities Obligations and Responsibilities of Tulsi Chanrai Foundation and Areas where TCF has failed in fulfilling its obligations and responsibilities. • On Project Activities to meet Objectives Page 20 Organization of health services Staff disposition Range of services provided at health facility Ward Health System Project Map Major health problems Essential Drugs Exemptions and Deferments Referral programme. (including Ambulance Service) Essential Equipment Health...
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...“The media is vital in conveying health information to the public, changing people’s perceptions of what’s healthy and what’s not,” William L. Roper, head of the Centers for Disease Control (CDC), said. The healthcare delivery system, however, has not kept up with phenomenal advancements in science and technology and with the proliferation of knowledge, treatments, drugs, and devices.With current advances in genomics (offering promise in diagnosis as well as, possibly, treatment), sensor technologies (offering promise in automated detection, measurement, and monitoring), nanotechnologies (offering promise in diagnosis, treatment, and control), and information and communication technologies (enabling remote delivery, telemedicine, e-health, and patient empowerment), the complexity of science and technology in healthcare is only going to increase. Sainforte, Francois and George,William W..Healthcare Delivery Systems in the United States, 2004. www.isye.gatech.edu Brandeau M., Sainfort F., and Pierskalla W. (Eds.).Handbook of Operations Research in Healthcare.Kluwer Academics, in press, 2004. Hoffman C., Rice D. P., and Sung H.Y. (1996) “Persons with Chronic Conditions. Their Prevalence and Costs”. Journal of the American Medical Association, 276(18):1473-1479. Institute ofMedicine. (2001) Crossing the Quality Chasm: A New Health System for the 21st Century.Washington,D.C.: National Academy Press. Kumar S. and C. Chandra. (2001) “A Healthy Change”, IIE...
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