The health care sector includes an array of clinicians, hospitals, other health care organizations, insurance plans and purchasers of health care services. Subsequently, the health care delivery system coordinates and ensures high-quality service delivery to the citizens. However, there are barriers that hinder the quality, accessibility and cost-effectiveness of the health care systems. This paper focuses on the barriers limiting the healthcare delivery system in the United States.
Raymond has been diagnosed with hypertension of which has been contributed by his family’s history of pulmonary embolisms and heart disease. However, he has not received consistent healthcare for most of his life since his job has not offered him an insurance cover. In addition, he does not qualify for Medicaid nor has the money to pay health insurance, healthcare, medical care services, and gas. On the hand, Emmanuel’s family has a history of type 2 diabetes. His job provides him with an insurance cover whereby he has been having annual medical and dental exams for several years. Despite the annual checkups, his blood sugar levels still remains a problem.
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Some of the barriers of the healthcare delivery system are evident in the mentioned cases. In availability of comprehensive, appropriate, timely, and quality health services when required. When Raymond was diagnosed with hypertension he expected the health care delivery system to timely offer the appropriate medical attention he required. For the years Emmanuel went for medical exams he did not get quality treatment, his blood sugar level was still high. Secondly, underinsured and uninsured are both barriers hindering health care. Raymond is hindered from accessing health care due to his uninsured status, this has made it hard for him to receive consistent and coordinated healthcare for most of his life. He is unable to pay for medical care and healthcare services. Although Emmanuel is insured he still has a burden for healthcare services, he had to pay for services of an endocrinologist and a professional dietitian.
The last barrier is the unfulfilled potential of managed care. Managed care as a theory, provides a population-based approach that stresses consistent preventive care or other related services to keep a defined group as healthy as possible. This model provides necessary funds to cater for the medical expenses of the targeted population and also monitor the quality of care provided by health providers to the same group (Awasogba et al., 2013). The population can be people suffering from chronic diseases, just like Raymond and Emmanuel. The barrier to the health care delivery is in the form of cost-containment mechanism resulted in restrictions of care, for instance, Medicaid enrollment. Raymond does not qualify for Medicaid while Emmanuel experiences poor health care services from his primary care provider (Rice et al., 2013.
The access to health insurance of both individuals can impact the healthcare outcomes in significant ways. Raymond’s accessibility to health insurance, for instance, Medicaid will provide medical coverage to meet his needs, of which he is not able to meet as his income is not substantial. Through employer-sponsored health insurances, employees are enrolled in a high deductible health plan (HDHP), which establishes a solid incentive for people to reduce consumption of health-care services. Emmanuel will no longer incur additional medical expenses due to under-insurance (Smith, 2014).
The health care system has generally been organized in the basis of a fee-for-service model where patients or the insurers pay healthcare providers and hospitals for the services offered without particular concern for price, quality or patient outcomes. Managed care and Medicare positively impact the health care delivery by reducing low-value spending by improving the management of care and delivering Medicare benefit package respectively.
References
Awosogba, T., Betancourt, J. R., Conyers, F. G., Estapé, E. S., Francois, F., Gard, S. J., ... & Pomeroy, C. (2013). Prioritizing health disparities in medical education to improve care. Annals of the New York Academy of Sciences , 1287 (1), 17-30.
Rice, T., Rosenau, P., Unruh, L. Y., Barnes, A. J., & Saltman, R. B. (2013). United States of America: health system review. Health systems in transition , 15 (3), 1-431.
Smith, J. C., & Medalia, C. (2014). Health insurance coverage in the United States: 2013 . Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census.
