Staying healthy is essential as it determines how productive someone can be. Medical professionals and scientists conduct research in healthcare delivery and develop innovations to help people manage their health. If you are wondering, what is healthcare delivery? Continue reading this blog to learn more about healthcare delivery, models, and innovations in healthcare.

What is healthcare delivery system?

Healthcare delivery systems are the combination of employer groups, insurance companies, government agencies, and care providers who work jointly to provide healthcare to help a particular group of people stay healthy. The system helps injured or sick patients and provides preventative care to help them stay healthy.

The following are types of healthcare delivery systems;

1. Integrated delivery system (IDS)

IDS are healthcare systems that provide continuity of care. IDS provides outpatient, primary care, rehabilitation, and home health services. Providers comprise hospitals and physicians and are owned by an insurance company.

2. Exclusive provider organization (EPO)

EPO is a managed care plan that offers benefits if providers within a particular network render care. Provide care to members at a discounted rate. If a patient goes outside the network, they do not receive reimbursement.

3. Health maintenance organization (HMO)

HMO is an organization that covers health services required by plan members for permanent prepaid premiums. It uses the primary care physician (PCP) to provide patients with all primary and preventative care. PCP would refer a patient who needs any care outside the PCP practice. There are four types of HMO; group model HMO, network model HMO, Individual Practice Association (IPA) Model HMO, and staff model HMO.

To become an HMO, an organization must;

• Be providing healthcare in a geographical area
• Have a voluntarily enrolled group of people
• Agree on a set of basic and supplemental treatment and health maintenance services.

4. Preferred provider organization (PPO)

PPO is a program that contains medical providers referred to as preferred providers. The network provides many benefits to patients for services received from preferred providers. If a patient uses a provider not part of PPO, they will be responsible for the cost.

5. Point-of-service (POS)

POS is a combination of PPO and HMO. The patient can decide to receive care on POS at little or no cost or go out of the network and take care of the expenses, which can be huge. Members pay higher costs due to deductibles, increased premiums, and coinsurance.

Types of healthcare models

There are various models of healthcare delivery systems or strategies in which the healthcare delivery system operates. Some countries use a single model, while others use a hybrid of several models. Nurses are the pillar of the healthcare delivery model because of their unique role in providing care.

The following are healthcare delivery models;

1. The Bismarck model

Otto von Bismarck created the Bismarck model. Employers and employees fund their health insurance system through payroll deductions. Every employee is covered by private insurance irrespective of their health condition, and the plan is non-profit. In some countries, there is a single insurer; in others, there are multiple insurers, but the government controls pricing.

The model does not offer universal health coverage but allocates resources to those who contribute financially. The criticism of Bismarck’s model is how to provide healthcare to people who can work like the aged and the imbalance between employees and retirees. It is used in Belgium, Germany, France, Japan, the Netherlands, and Switzerland.

2. The Beveridge model

The Beveridge model was established by Sir William Beveridge in 1948 and focused on establishing national health services. The government is the single-payer and removes all competition in the market, maintaining lower costs and standardizing benefits. The national health service regulates what providers can do and change.

Funding is through taxes, and every tax-paying citizen has equal access to care without paying from pocket and receiving medical bills. The criticism of the model is that it has a risk of over-utilization, as citizens can demand unnecessary healthcare services, which could lead to higher taxes.

Another criticism is that funding during national emergencies or crises could be at risk since revenue decreases as spending increases. The model is used in the US, Cuba, Spain, Hong Kong, and New Zealand.

3. The national health insurance model

The national health insurance model employs aspects of the Bismarck and Beveridge models. The government is the single payer for medical bills; providers are private. The model involved private providers, but the fund comes from government insurance which every citizen pays.

The national health insurance model is universal and does not deny claims or make profits. The model is cheaper and simple since there is no marketing, no profits, and no motives to deny claims. The balance between public and private gives providers and hospitals more freedom without the complexity of health insurance policies and plans.

The criticism of this model is the probability of delay in treatment and long waiting lists, which are health policy issues. It’s used in Taiwan, Canada, and South Korea.

4. The out-of-pocket model

The out-of-pocket model is commonly used in underdeveloped countries with insufficient finances to create a medical system. A patient must pay their medical bill from their pocket. The rich get professional medical care because they can afford and the poor cannot afford it. In this model, the delivery of healthcare is based on income.

The model is used in rural areas of China, India, South America, and underinsured or uninsured populations of the US.

What is the primary goal of integrated healthcare delivery systems?

Below are the goals of integrated healthcare delivery systems;

1. Increased collaboration

IDS requires teamwork to reduce duplicated processes and ensure the care continuum. The efforts of members will be combined with the development of continuous and effective care. AID will ensure patient and family satisfaction.

2. Improved efficiency

IDS enhances the quality of care by reducing healthcare redundancy and waste,

3. Payer partnership

IDS improves the quality of the clinical process and patient care and reduces cost, making the hospital achieve a better influence as a marketing tool.

4. Integrated systems

Hospital systems receive enforcement and monitoring tools from programs, and the management authority will set standards for monitoring the program’s progress.

5. Improve care management

Organizations that are integrated will manage to provide improved care, and the goal is to provide the best clinical a cost outcome for providers and patients.

6. Joint continuum of care

Due to teamwork among healthcare providers, IDS ensures that patients receive the right care in the right setting at the right time.

7. Patient-centered communication

IDS enhanced communication among caregivers, patients, and family, which is the base of the patient experience. The integration stresses timely and clear communication that influences patient behavior.

8. Improving health

IDS will improve community health and increase confidence in healthcare providers and systems.

The future of healthcare delivery

Innovative healthcare delivery is essential to finding new methods to improve quality, increase efficiency, expand safety initiatives, and reduce costs. New and creative ideas improve access to care and address uninsured people. The following are healthcare innovations;

1. Health analytics

Innovation in healthcare technology, such as online appointment scheduling, where patients will be able to book appointments easily, provided they have internet access. Scheduling can be complicated due to long waiting lists and a lack of appointment availability. Machine learning and AI have created technology to predict individuals with a high risk of various health statuses, giving a more targeted approach to population health.

2. Quality and cost transparency innovation

Organizations and tools like Health grades, Leapfrog, Choosing Wisely, etc., give consumers information on cost and quality. The information helps consumers make value-based healthcare creating competition by improving quality and reducing cost.

3. Telemedicine

Telemedicine is a healthcare delivery system where patients do not have to meet the doctor in person; instead, they use phones to interact with doctors. It allows a patient to acquire medical advice efficiently at a lower cost. Since covid-19 pandemic, telemedicine has proven to be a cost-effective alternative.

4. Self-driven services

Self-driven services allow patients to decide on their care and leave to an agency. The benefit of this innovation is that care focuses on individual patients and allows them to hire providers for their needs.

5. Patient experience and technology

Research has enhanced innovations that enhance the patient experience. These innovations include; using a thumbprint to check in at the doctor’s office, medication delivery, and having a video that guides you through rehabilitation exercises in case of knee surgery.

6. Addressing nursing shortage

Healthcare organizations are working on innovations to increase nursing staff’s ability, such as increasing the number of midlevel practitioners. Technology can also help, including remote monitoring gadgets that let patients be discharged sooner and smart beds that observe patients’ movement.

Wrapping up

Healthcare delivery systems are very broad and improve with innovations as technology advances. Innovations help develop new methods to improve quality, increase efficiency, expand safety initiatives, and reduce costs. The systems work jointly to provide preventive care and treatment of injured and ill patients and help people stay healthy.

You have learned what is healthcare delivery in this blog. Now it’s time to practice providing the best healthcare delivery to patients.