GBAM/501 Read Me First

Read Me First
HCS/235 Version 5 / 1

Read Me FirstHCS/235

Week Three

Introduction

Health care services in the United States are provided by numerous public and private organizations and a variety of professionals and paraprofessionals. This week’s readings and activities address the components of the health care system, identify the providers and services available in the system, explore medical education, and discuss the workforce and healthcare management from an industry perspective.

The organization and management aspects of health care delivery in the United States are different than in other countries. Health care in many other developed countries is centrally planned and controlled by the government. In the United States, health care planning occurs at many levels, and health care delivery is primarily decentralized and controlled by the public and private sectors. Legislative attempts at the federal level to place more control on the planning of health services have been less successful than legislation regulating specific components of the system such as privacy and confidentiality.

The Organization of Health Care Delivery

The mix of public and private sectors in health care delivery in the United States has resulted in a fragmented health care system with numerous stakeholders and an essential need to work collaboratively to prevent gaps and overlaps.

During Week Two, we explored the idea of stakeholdersin financing health care. Those individuals and entities with vested interests in the quality and functioning of the healthcare industry include all types of health care providers, professionals, and workers as well as patients. Private, not-for-profit, public, and volunteer organizations and facilities also have an important role and investment in the health care system. The following are a few examples of key components in the U.S. health care delivery system.

Public Health

Public health agencies are often considered the health care safety net in the organization of the health care delivery system. They are also the agencies that focus on disease prevention in populations rather than treatment of disease in individuals. Some public health agencies provide primary care such as family planning, prenatal care, and treatment for sexually transmitted diseases to individuals.

Community health centers also assist by filling in health care service gaps. The health centers provide primary care to individuals, but their focus remains on population health. Community health centersare federally and state funded, provide care on a sliding fee scale, collect from third-party payers such as Medicaid and Medicare when available, and provide services to patients in a selected geographical area such as the inner city or a rural community.

Hospitals

Hospitals comprise one of the largest components in the United States health care system. Hospitals can be public or private institutions and for-profit or not-for-profit (Williams & Torrens, 2002). They can be rural, urban, teaching, community, regional, or specialty. Hospitals employ the largest proportion of health care personnel and consume a large percentage of all health expenditures.

Public hospitals are owned by the government. Federally owned hospitals are often targeted to specific groups such as Native Americans and veterans. State-owned hospitals include some mental health institutions.

For-profit hospitals provide an investment to their owners or shareholders. National investor-owned hospital corporations have increased in size over the years by purchasing public and not-for-profit hospitals in financial difficulty. For-profit hospitals provide less indigent care, are usually not as involved in education and research, and are more likely to select patients based on ability to pay.

Voluntary Health Agencies

There are many health agencies in the private sector that play an important role in health care. These agencies are referred to as voluntary agencies or nongovernmental organizations. Examples include the American Heart Association and the American Cancer Society. Voluntary agencies are usually disease-specific and provide education, counseling, and referral rather than direct health care services. They are an essential segment of the health care system and instrumental in influencing health policy.

Health Care Workers

Health care professionals such as physicians, nurses, pharmacists, social workers, nutritionists, and more comprise another group of stakeholders in the nation’s health care system. Nurses are the largest group of health care professionals and the majority work in hospitals. Others work in clinics, schools, health departments, and other settings.

Another growing segment of health care workers are paraprofessionals with specific skillsthat fill important gaps in delivering health care services to patients. Examples include laboratory, radiology, and pharmacy technicians and nurse’s aides. Specific technology-related roles are also emerging to address the increasing function of technology in health care delivery.

Finally, with the expansion of electronic health records (EHRs)and the concept of meaningful use—use of EHR data to improve health care processes and outcomes---as well as renewed focus on patient-centered care, new health administration positions are emerging that demand new skill sets, such as health informatics, workflow or business process design, and quality improvement.

Health Care Workforce and the Health Care Industry

Health care workers are the foundation of the health care delivery system in the United States. Nearly 70% of health care expenditures are attributed to the 10.5 million health care workers (California HealthCare Foundation, 2004). Health care is the largest industry in the United States (U.S. Department of Labor, 2004).

Current issues in the health care system influence the availability and practice of health care professionals and paraprofessionals. Licensing, certification, regulations, staff shortages, litigation, changing technology, scope of practice, and personal safety are just a few. The shortage of health professionals and the need to reduce costs have led to the development of other categories of health care workers.

Medical Education

To sustain a well-trained, high-quality workforce, often extensive medical education is required to obtain and maintain the clinical skills to provide medical care in the United States.Physician educationincludes a rigorous combination of academic, clinical, and continuing education, as well as licensing and credentialing (Barsukiewicz, Raffel, & Raffel, 2010).

After earning a 4-year degree in a related field, such as biology, medical students continue into their undergraduate medical education--2 years of academic coursework followed by 2 years of clinical rotations. Then, students take the United States Medical Licensing Examination (Barsukiewicz, Raffel, & Raffel, 2010). The next step is a year-long internship that includes supervised clinical training; this year is followed by graduate medical education (GME), where students must apply for a residency program. General practitioners complete a 1-year general residency; physicians wanting to specialize go on to an additional 3- to 5-year specialty residency. Thus, the total medical education, not including an undergraduate degree, is 7 to 12 years.

Physicians may then choose to become board-certified in their specialty by passing a qualifying exam. While certification is voluntary, as opposed to licensure, many hospitals and insurance companies require board certification for employment or for participation in a network (Barsukiewicz, Raffel, & Raffel, 2010).

Nurses and other health care providers also require education that is usually academic and clinical in nature; however, much focus has been on physician education, chiefly because this extensive education is not inexpensive. The average medical school debt, in 2004, ranged from $100,000 to $140,000 (AAMC, 2005).

While patient care revenue used to cover about 80% of residents’ training costs, because of the increased cost of patient care, a large portion of this education is now paid for by government programs—Medicare is currently the largest payer of GME (Barsukiewicz, Raffel, & Raffel, 2010).

In conclusion, the health care delivery system in the United States includes a variety of distinct componentsthat contribute to the system’s organization and structure, each with important functions. Collaboration and partnership among sectors and the various components is essential for a well-managed and functional health care system that is properly trained and meets the needs of its citizens.

This week in relationship to the course and the program

By now, you have increased your comprehension of how health care agencies and providers contribute to the overall organization and management of the U.S. health care system. Through your readings, you moved beyond the evolution of the health care system to an understanding of how the organization and management of health care delivery in the United States differs from other countries and of the importance of partnering with stakeholders for a functional system. Information on health care workers as a resource and a cost to the delivery system is provided.

Hints for a reading strategy of the assigned materials

As you read, focus on the functions and roles of the various components in the health care system. Recall the barriers you or your family have experienced in seeking health care services. To more fully understand how the U.S. health care system differs from other health care systems, search the University Library for “health care delivery in XXXX,” where XXXX is a country of your choice.

Some questions to ask as you hone your critical thinking

As you review this week’s information, consider the following questions:

What can the United States’ health care system learn from health care systems in other countries?
If you currently work in health care, what specifically can you do to nurture partnerships and collaboration among stakeholders?
What roles, if any, should the federal government have in health care planning? Explain.

Summary

Through this week’s learning activities, you are exposed to the complex organization and management of the health care delivery system in the United States. You learn that numerous entities have a stake in the overall system. Knowledge of the organization of health services is essential to identify overlaps and gaps. Future health care managers and administrators can maximize limited resources by partnering or collaborating with other stakeholders in the community to reduce duplication of services and fill critical gaps in health care.

References

AAMC. (2005). Medical educational costs and student debt. Retrieved from

Barsukiewicz, C., Raffel, M., & Raffel, N. (2010). The U.S. health system: Origins and functions.(6th ed.). Mason, OH: Cengage Learning.

California HealthCare Foundation. (2004). California workforceinitiative. Retrieved from

U.S. Department of Labor (USDOL). (2011). Health care. Retrieved from

Williams, S.J., & Torrens, P.R. (Eds.) (2002). Introduction to health services (6th ed). Albany, NY: Delmar.