Health Care Delivery Systems

Introduction

A healthcare delivery system is a chain of organizations, financial and human resources providing healthcare services to the target population. The goal of any healthcare delivery system globally is to offer quality healthcare services to the customers, the patient in need (Pitts, Carrier, Rich & Kellermann, 2010). Human resources in any health institution have the first contact with health services seekers in those institutions when they come to seek health services.

This category of shareholders in healthcare delivery systems includes; nurses, medical doctors, clinicians, physiotherapists, orthopaedic technologists, pharmaceutical or pharmacists, health records personnel and specialists. All these are well trained personnel in their areas of study who ensure that they attend to patients and offer them the best services they need.

Financial resources are important in any health institution. Finance is needed to pay salaries, buy equipment, support maintenance of equipment and facilities, and to make a profit in private health facilities. Government funds public health facilities. However, healthcare seekers pay some money either out of their pockets or through health insurance providers. Religious bodies and community based organizations also finance running of healthcare services in their health institutions. Private investors build health facilities for the public to pay without any subsidies. However, health insurance providers offer health insurance products that cater for all or part of medical expenses in all health facilities (Van de Ven & Schut, 2008).

Description of my Insurance Coverage

I have healthcare insurance plan with a multinational insurance firm in the US. The type of plan is Preferred Provider Organization (PPO). The organization comprises of health facilities and medical personnel who agree, with an insurer, to offer healthcare at reduced rates to clients with membership. This insurance plan is conducted within networks of healthcare providers. The providers benefit by charging the insurance firms a charge for conducting business in their networks. There are other plans offered by my health insurance provider. These are; indemnity plan, conventional indemnity plan, exclusive provider organization (EPO) plan and health maintenance organization (HMO) plan.

Others are; point-of-service (POS) plan and physician-hospital organization (PHO) plan. This plan gives me the option to choose healthcare providers. This is not the case with Health Maintenance Organization (HMO) plan. I also have the freedom to plan on my own healthcare. The plan is quite good but for the moderately higher amounts I pay from my pockets than those in HMO plan. In addition, when I visit providers, who are outside PPO’s network, there is a lot of paperwork.

Usually, when I visit providers outside PPO’s network, I have to pay for the services then write to my insurance firm claiming to be paid back. In fact, it is regarded as the healthcare insurance plan with the most paperwork. My healthcare insurer’s representatives have to verify medical records to ascertain the condition and the amount charged. This is a verification step before they can reimburse the cost incurred.

My parents pay for my healthcare insurance plan premiums on a monthly basis. They started paying when I was 2 years old. However, I am negotiating with my new employer on how we can arrange for a comprehensive healthcare insurance plan soon. I only pay deductibles when I attend healthcare facilities outside PPO’s network.

My PPO plan covers 70% of healthcare services I am offered while I foot the 30% through coinsurance. This plan is very strict on my choice of physicians. They give preference to physicians within their network. There is an arrangement that I should have a primary healthcare physician. Because I have to pay for services to doctors outside the PPO’s network, this is a great limitation. This pushes my bills high. In addition, my healthcare insurance provider takes some time to pay my claims for services outside the network.

Process of Seeking Healthcare (From Making Appointment to Receiving All Services)

Efficient process of seeking healthcare in healthcare institutions is important in retaining customers in a healthcare facility. When the process is short, then customers feel happy and satisfied. Therefore, every healthcare facility, whether public or private, streams its process of seeking healthcare by the target population. This involves removing any unnecessary hurdles that could impact negatively on the process (Bohmer, & Lee, 2009).

Many health facilities have also adopted the internet for booking an appointment with physicians and specialists. Many facilities have also adopted the use of the mobile phone to make appointments and consultations. All these strategies are geared towards making the customer experience a lasting one. However, several factors affect the appointments and /or scheduling systems (Bohmer, & Lee, 2009). These factors are; availability of the specialist or physician, demand of the healthcare services, and the knowledge level of the secretary who gives appointments.

Annual physical examination

I go for annual physical examination every August, unless I become unwell earlier than that and there is a need for a general check-up. I ring the secretary to my primary healthcare physician who gives me an appointment. On the day of appointment, I see my physician who conducts a physical examination on me. Several tests are also done on me. These include tests on; blood sugar, arthritis, blood pressure and respiratory functions. If the tests give normal values, then I am not put under any medication by my physician.

To see a specialist, an ophthalmologist

When I have a problem with my eyes I visit my primary healthcare provider and explains my condition to my physician. The physician refers to an ophthalmologist. I book an appointment with the specialist’s assistant and wait for my day and hour. When the time comes, I go to the health facility or his clinic where he attends to my problem.

Admission to the hospital for elective surgery

Elective surgery is a procedure that is performed without a medical emergency. It is done for other reasons other than medical reasons (Pitts et al., 2010). An example is cosmetic surgery in breast implants and change of the face. Another example of elective surgery is the one involved in changing of genitals to transit from the opposite gender. The main goal of aesthetic and elective surgery procedures is to change the physical look of the patient or customer.

This is the case because there is no medical urgency attached to the procedures. When a condition forces me to undergo an elective surgery, I book an appointment with my surgeon who books me for the procedure. The number of days I spend in the hospital ward depends on the procedure performed. However, before I can undergo the procedure it has to be verified by my health insurance provider. This is another near-global feature of the PPO plan.

References

Bohmer, R. M., & Lee, T. H. (2009). The shifting mission of health care delivery organizations. New England Journal of Medicine, 361(6), 551-553.

Fuchs, V. R. (2012). Major trends in the US health economy since 1950. New England Journal of Medicine, 366(11), 973-977.

Pitts, S. R., Carrier, E. R., Rich, E. C., & Kellermann, A. L. (2010). Where Americans get acute care: increasingly, it’s not at their doctor’s office. Health Affairs, 29(9), 1620-1629.

Van de Ven, W. P., & Schut, F. T. (2008). Universal mandatory health insurance in the Netherlands: a model for the United States?. Health Affairs, 27(3), 771-781.