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Introduction to the US Health Delivery System

Introduction to the US Health Delivery System

Sample Answer 

Introduction to the US Health Delivery System

            Traditionally, hospitals have been the main centers of healthcare provision. Hospitals would add more beds or build new wings to attract more patients. Even though these models were important in improving the provision of healthcare, they are now being done away with. This is because most of the models were only aimed at increasing volume instead of value. Currently, new alternatives of patient-centered care are being developed in which patients can be taken care of outside the hospital setting. This has led to the emergence of outpatient services such as hospice care, outpatient clinics, community health centers, home care, public health services, and mobile facilities for screening, diagnostic, and medical services. Several factors are associated with the emergence of these outpatient services which are associated with several advantages and disadvantages.

The emergence of outpatient services has been promoted by several factors. For instance, technological advancements have made it possible for minimally invasive procedures to be developed. The procedures developed as a result of technological advancements require short recovery times and are less traumatic. The fact that these procedures require short recovery times implies patients do not have to be in a hospital setting while waiting for recovery of the wounds. Also, due to recent technological advancements, physicians can carry out several procedures outside the hospital setting. They have acquired technology that can make them offer surgical, imaging, and diagnostic services outside the hospital setting. For instance, telehealth technologies have played a significant role in the promotion of remote patient monitoring. Videoconferencing tools allow for the interaction between a patient and a remote physician (Quinn et al., 2018). Such tools include software to monitor patients and biometric sensors. The use of these telehealth technologies will promote a shift from a hospital setting to outpatient care for patients with chronic illnesses.

Moreover, patient preferences have promoted the shift of healthcare from the hospital setting to outpatient care. Most patients are now demanding transparent and convenient care. More than 50% of people in the United States prefer being taken care of at home and in community-based settings to hospital settings (Schuchman et al., 2018). Being taken care of in their homes gives people control over their lives, and they also get a strong sense of independence. This is important in improving the quality of life of patients.

The shift to outpatient care is also being motivated by the fact that payers are now pushing for lower costs. There has been a rapid rise in the cost of healthcare in the United States. The national healthcare expenditure in the US is likely to be 20% of the gross domestic product by 2025 (Lyu et al., 2017). Surgery costs represent a big portion of the money paid by various insurers in the US. In addition, patients being taken care of in an inpatient setting when suffering from minor illnesses have significantly raised the amount of money paid by various insurers. To save on these costs, several payers are strongly discouraging inpatient hospital stays. Prior authorization is required for inpatient admission. This has made hospitals focus more on offering outpatient services.

The provision of outpatient services by hospitals is associated with several advantages. First, hospitals offering both outpatient and inpatient services generate a lot of revenue. Hospitals can refer post-surgical cases to affiliated units for home care follow-up and rehabilitation. Patients using outpatient services pay the hospitals, thus generating revenue for the hospitals. Since the outpatient and inpatient settings of a hospital are related, there is likely to be a smooth transition from the inpatient setting to the outpatient setting. This makes the transition to be convenient for patients.

Although hospitals benefit from outpatient services by generating more revenue, patients benefit more from outpatient services. Most of the outpatient services offered by hospitals eliminate travel, and home-based care provides home comfort (Winpenny et al., 2016). Having therapy at home offers a more useful and comfortable experience. This is because patients do not have to travel long distances going to the hospitals to be taken care of. Patients can also carry on with their daily responsibilities as they are taken care of. Besides, home-based care allows patients to do physical exercises using familiar tools. This, in turn, improves their quality of life.

However, outpatient services can also be disadvantageous. This is because some conditions require 24-hour supervision, which cannot be guaranteed in some of the outpatient care services such as home-based care. Patients who require close supervision, like those being offered rehabilitation services, are not fully supervised when they are under home-based care. In addition, patients whose conditions can exacerbate quickly cannot easily access healthcare professionals. This might lead to adverse health outcomes.

The Affordable Care Act (ACA) has played a significant role in promoting the shift towards outpatient services. The ACA requires health insurance plans to cover 10 essential benefits. Some of the essential benefits include outpatient care and preventive and wellness visits. Healthcare professionals are more likely to prescribe the essential benefits to the patients since the patients are insured for these services. Outpatient services are promoted when healthcare professionals prescribe outpatient care more. Also, preventive measures make an important component of outpatient services. Preventing measures such as regular exercise does not require a hospital setting. Therefore, by advocating for these essential benefits, the ACA encourages the use of outpatient services.

All in all, outpatient services are important in the health system. These services have been promoted by several factors, such as technological advancements, patient preferences, and payers pushing for lower costs. Outpatient services are beneficial to patients since they enjoy home comfort as they are being taken care of. Also, patients do not have to travel long distances going to the hospitals for treatment. By requiring insurance plans to cover ten essential benefits, the ACA has promoted the use of outpatient services.

References

Lyu, H., Xu, T., Brotman, D., Mayer-Blackwell, B., Cooper, M., Daniel, M., Wick, E. C., Saini, V., Brownlee, S., & Makary, M. A. (2017). Overtreatment in the United States. PLoS ONE, 12(9), 1–11. https://doi.org/10.1371/journal.pone.0181970

Quinn, W. V., O’Brien, E., & Springan, G. (2018). Using Telehealth to Improve Home-Based Care for Older Adults and Family Caregivers. Real Possibilities Public Policy Institute, 36(5), 909-917 (10).

Schuchman, M., Fain, M., & Cornwell, T. (2018). The resurgence of home-based primary care models in the United States. Geriatrics (Switzerland), 3(3), 1–10. https://doi.org/10.3390/geriatrics3030041

Winpenny, E., Pitchforth, E., Ball, S., Nolte, E., King, S., Greenhalgh, J., & Roland, M. (2016). Outpatient services and primary care : 4(15), 1–19.

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Question 


Introduction to the US Health Delivery System

Case Assignment
Please view the following videos in preparation for this assignment:

Girard, K. (2013). Health care delivery systems and occupations. Retrieved from https://www.youtube.com/watch?v=T1WpakHcjRs

Shi, L. & Singh, D. A. (2017). Chapter 7: Outpatient services and primary care. Essentials of the U.S. health care system (4th ed., pp. 167-176). Burlington, MA: Jones & Bartlett Learning, LLC. Available in the Trident Online Library.

Introduction to the US Health Delivery System

Introduction to the US Health Delivery System

Having completed the required readings and viewed the videos, you should now have a basic understanding of the characteristics and components of the United States healthcare delivery system. Healthcare delivery is no longer confined to the hospital setting. Over the past few years, we have witnessed the emergence of outpatient surgery centers, home health, hospice, etc.

For this assignment, conduct additional research as needed to address the following questions:

  1. What factors have led to care being offered outside of the hospital setting?
  2. What are the advantages and disadvantages of these settings? Who benefits the most: consumers or organizations?
  3. How has the Affordable Care Act (ACA) impacted this trend? Has it encouraged more alternative settings or put care back into the hospital setting? Explain.

Length: Submit a 3-page paper, not including the cover page and the reference list.

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