Healthcare system in developed countries
HEALTH SYSTEM IN DEVELOPED COUNTRIES
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Introduction
·
The developed countries has a unique system
of healthcare delivery
·
The meaning of healthcare delivery in terms
of developed countries is
o
Major components of the system
o
Enable peoples to receive healthcare services
o
Provision of healthcare services to the
patients
·
Most of the developed countries have a
National Health Insurance Programmes referred to as Universal access
·
Some of the statistic of Health Insurance in US
is
o
187.4 million Americans have private health insurance
o
Health insurance can be bought from 1000
companies and 70 blue shield plans
o
540 licensed health maintenance organizations
(HMOs)
o
925 preferred providers organizations (PPOs)
Sub
Systems of Developed Healthcare Delivery
·
Managed Care Organizations
o
Seeks to achieve efficiency by integrating
the basic functions of healthcare delivery
o
Implement mechanism to control utilization of
medical services
o
Determine the price at which services are purchased
o
Primary financer of this subsystem are
§ Employers
§ Government
o
In this system two terms refers to
§ Enrollee is a member that is covered under the plan
§ Health plan is a contractual management between the Managed Care organizations and Enrollee
·
Military Care System
o
This medical system is available free of
charge to the
§ Active duty military personnel
§ Retired duty military personnel
o
This system is
§ Well organized
§ Highly integrated
§ Comprehensive
o It also gives TRICARE in which families, dependents or retired military covered under the insurance financed by active military personnel's
o
This system offers a VA (Veterans) healthcare
system which is
§ Available for retired veterans
§ Focuses on hospital, mental and long term care
§ Largest and oldest(1946) organized healthcare system in
the world
§ Provide medical care, education, training, research,
emergency management etc.
·
Vulnerable Population System
o
Particularly the poor, uninsured, minorities
and immigrants
o
Live in disadvantaged communities and receive
care from “safety net” providers
o
The safety net providers are
§ Secure
§ Forego care
§ Emergency services
§ Managing increase numbers of uninsured persons
§ Allow much cost shifting
§ Medicaid
·
Integrated Delivery System (IDS)
o
Various forms of ownership and links among
§ Hospitals
§ Physicians
§ Insurers
o
The main objective of IDS is
§ To have one healthcare organization deliver a range of
services
o
IDS is the network of organizations that
provides and arrange a continuum of medical services
Characteristic’s
of Developed Healthcare System
· Government agency involvement
· Technology is driven and focused
· Low cost
· Equal access
· Perfect Market conditions
· Social justice
· Integration
· Accountability
· Balance of Power
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