Beginning a few years back, there has been a notable revolution in the healthcare delivery systems in the United States. This revolution has occurred due to the changes that have engulfed the economy and eventually has had a great impact on the health care delivery systems that are available to the citizens. Before the 1950s, acute care facilities were the most common type of delivery system and involved placing patients in healthcare facilities where they were closely monitored by the medical personnel until such a time that they were fit to leave the facility. Since the 1950s however, there was a significant decline in the number of intensive care facilities, and this came alongside an increase in the number of patients that required the services provided in the acute care facilities. The amount of surgical processes carried out in surgical centers as well as outpatient facilities has also been on the rise. As a result of this, other types of health care delivery systems were introduced in a bid to complement the decreased number of acute care facilities. They include home care, long-term care as well as the managed-care which the essay discusses in detail (Jarvis, 2001).
Types of Health Delivery Systems
Closed Healthcare Delivery System
A closed healthcare delivery system is one where the patient is able to receive all required healthcare from a strictly structured clinic model organization. The mode of payment plan in this situation is the full capitation which is payable on a per-member, per-month basis. This was the most common form of healthcare delivery system in the 1970s and 1980s, whereby the hub of infection and infection-control functions of the hospital were taken care of at the acute care facility. At the time, outpatient, home care, and long-term facilities were quite small, even unheard f in various localities. Since then, there has been tremendous growth in the gross domestic product (GDP) of the country, and a resultant change in the proportions that are allocated to healthcare delivery. Between 1960 and 2000, there was a nearly 15 fold growth in the GDP, from $526 billion which increased to almost $8, 000 billion. As a result, the fraction of GDP that was apportioned to healthcare was increased to nearly $1, 120 billion, a whopping 41 percent increase. This increase in conjunction with the newly introduced prospective payment plan focused on diagnostic-related groups caused major changes in the process of hospitalization. In the period ranging between 1975 and 1995, there was a significant decrease in the number of hospital admissions from close to 1.5 million to thereabouts 1 million. The number of patient admissions also decreased by5 percent, while the percentage of hospital stay reduced by 36 percent. Inpatient surgical procedures also experienced a decline of approximately 27 percent. The declining trends described resulted in smaller and fewer hospitals, increased and bigger ICUs, and increased severity in the population that was hospitalized. There has also been a shortage in nurses, and cut back in infection-control departments have escalated, notwithstanding the fact that statistics show nearly 2 million acquired infections from hospitals annually (Lee & Berenson, 2008).
Long-term Healthcare Delivery Systems
Since the 1950s, there has been a significant rise in the population aged 65 years and above in the United States. To date, the number has nearly tripled currently standing at 36 million from 12.2 million in 1850. The fact these individuals require specialized care, in this case, long-term care, saw a number of nursing homes number escalating in the country to 17, 208 in the mid-90s, whereas only a decade earlier, there were only 16, 091 facilities. The number of available beds also rose from around 1.2 million to an estimated 2 million. The number of facilities continues to increase as the population aged <65 years continues to grow (Jblearning.com).
As indicated, a long-term health care delivery system is the system that is charged with the responsibility of caring for the aged and sick populace. As it turns out, the care offered is long-term in nature because the patients also use the facilities as old-age care homes and do not leave until death. This shows that the care provided in the long-term care delivery systems is not only clinical in nature, but also in other areas of assistance in old age (Jarvis, 2001).
The fact that the nursing homes are not medical in nature raises some challenges in the control of infections to residents. To begin with, the facilities lack dedicated control personnel charged with surveillance, while at the same spearhead in preventing, educating as well as intervening in the control of new infections. They also lack uniform definitions or protocols of surveillance for infections that are acquired in the facilities. It is also good to note that in these long-term healthcare facilities, clinicians do not order suitable diagnostic improvements, partly due to a lack of laboratory facilities. For this reason, the patients in these facilities are not adequately evaluated for infections they may have (Jblearning.com).
Home Health-care Delivery System
As the name suggests, this health care delivery system is the system where patients are taken care of from their homes as opposed to being confined in the hospitals. In the United States, this is probably the fastest emerging division of all the healthcare delivery systems available. 1988 saw the Healthcare Financing Administration spend in the region of $2 billion for this division. Currently, the number of patients receiving healthcare from home is nearly equal to that in acute care settings at 34 million annually. Depending on the severity of the illness, the patient could be assigned a medic to be with them round the clock, or for regular visits, as may deem fit. Family members may also provide the healthcare, alongside visits to the hospital in a bid to save on costs, or also depending on the severity of the illness (Jblearning.com).
As in the case of long-term healthcare systems, infection rates and control are challenges that the segment experiences. This is due to the fact that only a few home healthcare organizations are dedicated to infection control, and also that there are no standards that regulate infection surveillance in-home healthcare systems. In addition, the regularity of visits to patients is dependent upon healthcare reimbursement systems, which may leave the patient unattended for long durations of time (Lee & Berenson, 2008).
Outpatient and Ambulatory Care
The outpatient and ambulatory care system is the type of care where patients go to the health care centers, are attended to, and then go back home. The services here do not require any confinement to the hospital, though in case of any requirements for more care, the medic informs the patient. Outpatient, usually, attends to those with minor ailments who seek consultation services and possible prescription of drugs. Ailments covered in outpatient care may include infections such as flu, dental care, well-baby clinics, ante-natal care, post-natal care, physiotherapy consultancy services, psychiatrist consultancy services among others.
Ambulatory healthcare on the other hand involves emergency services, in this case mainly traffic accident victims, fire victims, various attacks from chronic diseases such as heart disease among others, requiring immediate and quick medical attention. In such instances, emergency ambulance services are required to offer first aid to the patients and ensure that they remain alive and stable until such a time that they are presented to a health facility. After the patient has been attended to by a doctor, they may then be discharged to go home, confined in acute healthcare systems for further treatment and observation, all depending on the severity of the illness (Jarvis, 2001).
In view of healthcare, I believe that healthcare should be classified as a basic need alongside food, shelter, and clothing.
The goal of healthcare is to ensure that all persons, irrespective of background, race, ethnic group, sexuality, gender, age, or social status are able to receive timely and quality healthcare. For this reason, it should be the goal of the government and every citizen of the United States to ensure that all citizens are able to access healthcare as a basic need.
Lee, T.H. & Berenson, R.A. (2008). The Healthcare Delivery System: A Blueprint for Reform. Retrieved on 3rd March 2014 from http://www.americanprogress.org/issues/2008/10/pdf/health_delivery_ch2.pdf
Jarvis, W.R. (2001). Infection Control and Changing Health Care Delivery Systems. Emerging Infectious Diseases. 7(2); 170-173.
Introduction to Healthcare Delivery Systems. Healthcare Dynamics. Jones and Barlett Publishers, LLC. Retrieved on 3rd March 2014 from http://www.jblearning.com/samples/0763746878/46878_CH01_pass1.pdf