Discussion Board 6
Health Care Systems - Part II
Managed care is a "mechanism of providing health care services in which a single organization
takes on the management of financing, insurance, delivery and payment" (Shi & Singh, 2017, p.
220). The textbook discusses the evolution of managed care in detail. Stating that in the early
1900's railroad, mining, and lumber companies located in isolated areas employed salaried
physicians to provide medical care to their worker (Shi & Singh, 2017, p. 222). Also, some
arrangements were made where companies were contracted with specific physicians and
hospitals and were charged a flat fee per worker.
The first private health insurance plan started at Baylor University Hospital in Dallas Texas in
1929 and was also based on capitalization (Shi & Singh, 2017, p. 222). The service allowed for
inpatient visits at the hospital. Larger health plans emerged in New York, California, St. Louis
and Washington in the 1940's, the plans provided comprehensive healthcare to those enrolled for
a set fee. There was a Health Maintenance Organization Act of 1973 with was passed due to the
concern for escalating costs for health care.
The law helped create growth and promoted HMO, the objective was to create 1.700 and to serve
around 40 million members (Shi & Singh, 2017, p. 224). Managed care plans grew from 27 % in
1988 to 95% in 2003. Also, conventional insurances went from 73% in 1988 to 5% in 2003. Due
to competition growing it allowed for new forms of managed plans to rise (Shi & Singh, 2017, p.
224). Private insurance enrollment and Medicare and Medicaid enrollment are all forms of
managed care that are now used.
A formal structure for a defined population, whose finance, management, scope, and content is
defined by law and regulations. It provides for services to be delivered to people to contribute to
their health…delivered in defined settings, such as homes, educational institutions, workplaces,
public places, communities, hospitals, and clinics. A health system consists of all organizations,
people, and actions whose primary intent is to promote, restore, or maintain health. This includes
efforts to influence determinants of health as well as more direct health-improving activities.
It is therefore more than the pyramid of publicly owned facilities that deliver personal health
services. It includes, for example, a mother caring for a sick child at home; private providers;
behavior change programs; vector-control campaigns; health insurance organizations; and
occupational health and safety legislation. It includes inter-sectoral action by health staff, for
example, encouraging the ministry of education to promote female education, a well-known
determinant of better health.
A health system, also sometimes referred to as a health care system, is the organization of
people, institutions, and resources that deliver health care services to meet the health needs of
target populations. There is a wide variety of health systems around the world, with as many
histories and organizational structures as there are nations. Implicitly, nations must design and
develop health systems in accordance with their needs and resources, although common elements
in virtually all health systems are primary health care and public health measures. In some
countries, health system planning is distributed among market participants. In others, there is a
concerted effort among governments, trade unions, charities, religious organizations, or other
coordinated bodies to deliver planned health care services targeted to the populations they serve.
Health care delivery continuously evolves. Managed care has made many advances since the
1900's. Improving the way patients are covered by insurances whether it is sponsored by the
employer or government funded insurance such as Medicare and Medicaid. I found an article
that discussed how health care has evolved and driving factors. Driving factors that were listed to
contribute to health care evolving are the growth in the U.S population, increase and
technologies and costs, growth of allied health care professions, increased reliance on
pharmaceutical drugs, and the rising costs of family and individual healthcare (Conklin, 2002).
Due to the health care system evolving it has contributed to less hospital admissions, out-patient
surgeries, home health care, also more emphasis have been placed on prevention and better
health related decisions are being made (Conklin, 2002). An article posted in the American
Hospital Association discussion ways that health care has rapidly changed over the last 10 years.
I found this article to be very interesting as well as informative. The article stated, safety,
effectiveness, patient centered, timely, efficiency and equitable have all been drastically
improved as the health care delivery system continues to evolve.
The article states that hospital safety has changed drastically nationwide; more than 10,000
harms have been prevented due to new safety procedures being put in place in just a span of 2
years, that were documented. Additional accountability measures have been put in place to
ensure proper effectiveness. Many hospitals nationwide are starting to or establishing 24-hour
visitation hours to allow family to engage with the patient as well as health care professionals.
Patients are now receiving quicker care when entering hospitals, for treatment.
For example, heart attack patient's intervention time approved drastically improving from a 42%
rate to 93%. Efficiency has improved due to incorporating additional safety procedures,
effectiveness, being patient centered and timely (American Hospital Association, 2014). Based
on the literature, what does the future hold? According to the article written by Thomas Conklin
the future is bright. Health care trends that are predicted for the future are, continued increase in
technology, economic recessions or expansions, cost-shifting strategies being implemented,
malpractice insurance, settlements and jury awards greater focus and witching from a private
health care model to more of a public model (Conklin, 2002). It is important that focus is placed
on continuing to improve the health care model.
"But if anyone does not provide for his relatives, and especially for members of his household,
he has denied the faith and is worse than an unbeliever" (1 Timothy 5:8, English Standard
Version). I think this verse speaks to improvement, it is important has health care evolves we
continue to improve and focus on not what will benefit us, but others.
References
American Hospital Association. (2014). Six Ways Health Care Has Changed Over the Last 10
Years. Retrieved from https://www.hhnmag.com/articles/3885-six-ways-health-care-has-
rapidly-changed
Conklin, T. (2002). Health Care in the United States an Evolving System. Retrieved from
https://quod.lib.umich.edu/m/mfr/4919087.0007.102/--health-care-in-the-united-states- an-
evolving-system?rgn=main;view=fulltext
Shi, L. & Singh, D. A. (2017). Essentials of the U.S Health Care System. (4 edition). Th
Burlington, MA: Jones & Bartlett Learning.
