Health Care Delivery in the United States – Health System Example

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"Health Care Delivery in the United States"  is an engrossing example of a paper on the health system. Reason for the Case There are many reasons as to the case. First, Mary has uncoordinated care from at least six doctors thus varying treatment protocols. Secondly, Mary is at the age where she has a rapidly decreasing mental function and the lack of coordination frustrates her thus endangering her life. Thirdly, the mixing of drugs that may affect other drugs is also life-threatening to Mary. Fourthly, the cumbersomeness of repeated tests, redundant workups, and conflicting workups tire Mary who is 86 years old.

Lastly, the financial burden put by repeated tests, redundant workups, and unnecessary drugs is slowly draining Mary financially. Summary of the Case A Medicare beneficiary named Mary suffers from Alzheimer’ s disease, diabetes, coronary heart disease, asthma, and hypertension. Her doctors are uncoordinated and thus each uses their own personal treatment protocol and drug prescription.   Mary’ s doctors and numerous practitioners advise her according to their own personal assessments without consulting each other on what direction to take with their patients. This has led to confusion, repeated tests, redundant and unnecessary workups, more fiscal spending, the mix of drugs that react with the other drugs she is using and overall low-quality health care for Mary.

Being 86 years old, this confusing, expensive and life-threatening medical care is becoming too much for Mary and her health as she also is the stage where her mental function is at rock bottom. Relevant Medical Care Organization Principles and Theories, Laws and Policies In the case of Mary, there are several relevant medical care organization principles and theories, laws and policies that may appeal to her.

They include: - Bundled payments/bundled care- this is a type of payment where a patient makes a single payment to healthcare providers on a pre-determined cost for the treatment of a given condition (Kovner, Knickman & Jonas, 2011). Medicare- this is a type of payment or public social insurance where health insurance is paid to people above 65 years old or handicapped younger people. Payer mix- this is a word used in the medical books on payments made by private insurance, government insurance and patients paying cash. For example Medicare, indemnity insurance and Medicaid (Kovner, Knickman & Jonas, 2011). Pay for performance- here is where patients give more money than the needed fee to motivate the caregivers into giving quality treatment. Fee for service- it is where patients pay only for the service done by the caregivers and nothing else (Kovner, Knickman & Jonas, 2011). Integrated delivery system- this is a group of health providers who come together to provide health services to a given community and are liable for the responsibility of medical outcomes (Kovner, Knickman & Jonas, 2011). Specialty care- where a patient receives specialized medical services by a physician who specializes in the condition, mainly after referral. Patient-centered medical home- this where a patient receives a coordinated treatment through a primary physician to the other caregivers (Kovner, Knickman & Jonas, 2011). Analysis The above-named principles are relevant to the resolution of Mary’ s case.

Bundles' payment will be to Mary’ s advantage since she will only pay once for all the diseases she has. This reduces the financial constraint she would have accrued if she did not use the bundled payment option. Secondly, Mary qualifies for Medicare since she is 86 years old and Medicare caters for people aged 65 and above.

This option allows the national insurance to pay her healthcare bills. Thirdly, Mary can decide to take on the option of payer mix and use Medicaid as holders of this card only pay 65% of the needed bill. This will totally reduce the medical cost to help reduce the frustrations. Fourthly, Mary knows her health is more important than money. Therefore, in order to receive quality treatment Mary should use the pay for performance. Fifthly, since Mary has numerous ailments meaning she goes to health centers regularly, she should consider using a fee for service options.

This option is good for her because she will not have to pay other fees like consultation or patient books fee but only for the service rendered. Sixthly, the integrated delivery system works better and efficiently than hospital-based doctors because it is a private business. Therefore, reputation in terms of results is their main concern. Mary should check this option as it is a better solution to her ailments.

Seventhly, specialty care is a very good option for Mary since she will receive treatment for her condition from a physician who specializes in that ailment. No more blind treatment by any practitioner. Finally, the patient-centered medical home is the best option for Mary since she really needs coordinated treatment as this is the whole reason for the case. The primary physicians will advise the other practitioners on how to proceed with treatment and thus reduce frustrations and repeat of tests and workups. Recommendations There are many recommendations that can help alleviate Mary’ s present situation with health centers. Mary should take into consideration a plan that will ensure she is not drained financially.

For example, she should consider taking up Medicare where the national insurance pays for people aged 65 and above. She is 86 and has many ailments and at her age, she cannot work and generate enough money for her medical cover. Therefore this is a good deal for her. Mary should also think about her un-coordinated treatment and choose a coordinated treatment process. She can choose a patient-centered medical home as she will deal with one primary physician who will then give directives to the other practitioners.

In addition, she should consider a specialty treatment where she will only deal with a physician dealing in that given condition rather than treatment by any physician. Mary should also seek special treatment from people who care about their jobs and thus will work hard and carefully on their patients, unlike hospital-based doctors who are salaried by the governments. These are the integrated delivery system that will be responsible for any wrong outcome in the medical process.


Kovner, A. R., Knickman, J., & Jonas, S. (2011). Jonas & Kovner's health care delivery in the United States. New York: Springer Pub.
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