Question

HEALTHCARE SYSTEMS AND CARE DELIVERY MODELS ANALYSIS 1

Healthcare Systems and Care Delivery Models Analysis

HEALTHCARE SYSTEMS AND CARE DELIVERY MODELS ANALYSIS 2

Summary of the organizational leadership and governance structure

The Nevada State government do not have a completely government controlled and

regulated healthcare system since in the United States, the government has not selected and

implemented a specific health system to use. According to Knickman, & Kovner, (2015) in the

entire United States, the healthcare system is managed by private businesses and some federal

and state health programs. The Nevada State government plays an important role in determining

how private insurance companies and healthcare provider run the out of pocket model of health

care. The same government is in charge of controlling the Medicare and Medicaid federal

government program that benefit the specific intended individuals in the market.

One leadership and governance structure, it is the state government that offers leadership

to stakeholders. The government through the 2010 Affordable Care Act (ACA) regulates the

insurance premiums charged by private insurance companies for various healthcare coverages.

However, the insurance companies’ owners and healthcare providers are also major players in

settling at acceptable premium fee based on the cost of healthcare within the country (National

Center for Health Statistics, Center for Disease Control, & Prevention 2017). This is to mean that

the government is the leading body while as insurance companies and healthcare providers are in

the same level within the structure. It is the consumers that are in the lower level since they have

to abide with state laws in place as well as agreement between the insurance companies,

healthcare providers and the government in both state and federal levels.

HEALTHCARE SYSTEMS AND CARE DELIVERY MODELS ANALYSIS 3

Analyze and critique of the major service lines and offerings

The out of pocket model of healthcare that Las Vegas makes use of, there are a lot of

benefits and challenges surrounding the system. Through the system, consumers are able to

receive healthcare services based on their affordability state and this is something that has

classified healthcare in Las Vegas into classes (wealth, average income earners, low income

earners, and poor people). It is challenging to notice that the quality of healthcare is hence

determined by the quality of services a client is able to pay for. The insurance companies in the

same spirit have different levels of premiums that also determine the quality of services that a

client should receive. As noted by Gotanda, (2019) healthcare in Nevada has been considered

costly due to the use of out of pocket model. This is because members of public are compelled to

pay a certain amount monthly to maintain their medical insurance covers which are paramount

when it comes to accessing medical services.

All the same, the presence of the out of pocket model of healthcare has empowered

service providers to make sure that services are available. This is because in Las Vegas, people

are required to have a medical insurance cover in order to access medical services. This comes as

an assurance to healthcare providers that the services they offered would be paid by the private

insurance company insuring the patient. Sadly, the consumer does not have power in regards to

services offered by the insurance and service providers since these are agreements that

consumers are never involved but required to comply with to access services.

Demonstrate an understanding of how organizational leadership and behavior drives the delivery of health services.

In Nevada, the organizational leadership and behavior has the power to drive the delivery

of health services. The behavior and actions of healthcare providers in the private and public

HEALTHCARE SYSTEMS AND CARE DELIVERY MODELS ANALYSIS 4

sector and that of insurance companies are determined by how the state leaders’ handles health

related issues. According to Knickman, & Kovner, (2015) whenever state healthcare officials

heading ministry of health have shown seriousness in the quality of services people are offered,

the behavior of service providers have been noted to improve tremendously. This is because the

state government has the power to charge individuals and entities interfering with healthcare

service delivery or violating healthcare laws and policies put in place.

Additionally, it is the organizational leadership that has the power to make policies and

implement them. This is to mean that when quality and reliable decisions are made and

implemented to the letter, it means that other stakeholders have no option but to act according or

have their operating licenses revoked. With such strict measures in place, the services providers

in the medical and insurance sectors have been compelled to act in the best way possible, offer

quality services, and make sure that service delivery is consistent. Moreover, with quality

leadership, whenever an issue arises, it is addresses instantly and amicably and this is something

that has promoted and sustained quality service delivery.

Discuss strategies and competencies that managers and leaders utilize to create policy, procedures, and design service lines and care delivery models

In Nevada there are a lot of strategies and competencies that state government has been

used when creating policies, procedures and designing of service lines as well as service

delivery. One of the main strategies used is hiring professionals for instance individuals with

legal background and have experience in designing laws. The professionals are nonetheless

guided by the constitution in order to derive at policies that are legally acceptable and benefit the

members of the public indiscriminatively. The sector also highest professionals in

implementation of policies that maintain a close follow up to ensure that companies in the

industry do not take advantage of their positions to exploit consumers.

HEALTHCARE SYSTEMS AND CARE DELIVERY MODELS ANALYSIS 5

In regards to line of service designing, it is the specific individuals offering services that

are granted the privilege to come up with the design that suits their work style. This is something

that makes line of service highly flexible and designed in a manner that suits the individuals

offering the services for the benefit of the consumer. The medical providers and insurance

companies are also incharge of designing the service delivery models. This is because each

organization has its structure which the state government does not interfere with. Hence, it is the

service providers that devices a plan through which services would get to consumers in the most

convenient and reliable manner.

Nonetheless, it has been noted that the consumers has a say on the model of service

delivery the services providers opts to embrace. This is because the healthcare industry in

Nevada is for profit and this means it is highly competitive. Organizations in the sector are

compelled to embrace strategies that would maintain their relevance in the market and increase

competitive edge. Engaging consumers has been used by healthcare providers and insurance

companies as an effective strategy to understand the market hence helping in creating a method

of service delivery that suits the target market.

HEALTHCARE SYSTEMS AND CARE DELIVERY MODELS ANALYSIS 6

References

National Center for Health Statistics, Center For Disease Control, & Prevention (2017). Health,

United States, 2016, with chartbook on Long-term trends in health.

Gotanda, H. (2019). The Effects of the Affordable Care Act Medicaid Expansions on Out-Of-

Pocket Spending, Healthcare Utilization, and Health Outcomes. University of California,

Los Angeles.

Knickman, J. R., & Kovner, A. R. (2015). Health care delivery in the United States. New York,

NY: Springer Publishing.