health care system

The health care system consists of clinicians, insurance companies or it’s plans, employer groups, health care facilities; such as a hospital, a network of organizations that are combined to facilitate the care to the individual or population with health care. The health care system, when it comes to insurances is challenging for me to understand. I was a case manager and would submit plan of cares for patient’s authorizations and there were always challenging and upsetting moments. The way the U.S has the health care system set up can be confusing.

The deliverance of the health care is either via private – owned groups, healthcare networks, HMO’s and PPO’s. The types of facilities that provide health care are private practices, hospitals, US Government health facilities, academic medical centers, psychiatric hospitals, nursing homes, long term facilities, rehab facilities, and any other approved medical facility.

The United States has the highest costs for health care than any other country. “Health care costs were about $3.3 trillion dollars in 2016. For decades, the amount of money spent on health care has increased more than the overall economy has grown (Roger I. Schreck, 2018)”. The health care debt increases due to nonfunded population. If people cannot afford healthcare insurance, most likely won’t be able to pay for their health care costs. The Affordable Care Act in 2014, helped minimize the amount of population uninsured. The financing aspect is either through private voluntary or public programs.

The U.S Department of Health and Human Services is the primary agency that manages the U.S health care system. The list of the organizations that fall within the HHS agency are: Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, National Institutes of Health, Health Resources and Services Administration, Agency for Healthcare Research and Quality, Food and Drug Administration, Center for Medicare and Medicaid Innovation, Patient Centered Outcomes Research Institute, National Academy of Medicine, and Joint Commission.

The sustainability methods include system integration and care coordination. “In 2011, the U.S. Department of Health and Human Services released the National Quality Strategy, a component of the ACA that lays out national aims and priorities to guide local, state, and national quality improvement efforts, supported by an array of partnerships with public and private stakeholders (The Commonwealth Fund, 2019)”.

Quality patient care and their health outcome is how many (if not all) facilities are reimbursed by CMS. I believe the outcome would be greater if health care focused on preventative and accessible care. Cost of health care services needs to be regulated. The type of response of being proactive rather than reactive is the best step. I do not fully understand the health care system, and I took courses for clinical case management. The courses consisted of heath care insurances and the many topics that were asked in this discussion. If I do not fully understand with that background, it might be challenging as well for someone who does not have the same background. I do hope reforming the health care system will mean a greater outcome.