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Related Concept Videos

Introduction To Health Care Delivery System01:18

Introduction To Health Care Delivery System

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The healthcare system is constantly changing and complex. Various services are available from different healthcare providers, but gaining access to these services has become challenging for people with limited healthcare insurance. Uninsured people present a challenge to healthcare because they frequently postpone or forego treatment.
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
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Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
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Primary Healthcare Services01:30

Primary Healthcare Services

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Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
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Issues And Trends In Healthcare Delivery System01:29

Issues And Trends In Healthcare Delivery System

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The issues and trends in healthcare delivery are constantly changing. The COVID-19 pandemic is one recent issue that wreaked havoc on healthcare systems, causing a shortage of healthcare workers, high demand for medicines and supplies, and increased medical expenditure due to a lack of insurance. Other issues include rising healthcare costs and care fragmentation.
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
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Preventive Healthcare Services01:30

Preventive Healthcare Services

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Preventive healthcare services keep people healthy via frequent check-ups, screening, and counseling. They primarily aid in disease prevention rather than treating an acute or chronic illness. Preventive treatment also keeps individuals productive and energetic, allowing them to work well into their retirement years. Examples of preventive care services include:
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Secondary Healthcare System01:11

Secondary Healthcare System

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Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
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Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
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A Pathway To Consumer-Driven Universal Coverage.

Avik Roy1

  • 1Avik Roy ( aroy@freopp. org ) is president of the Foundation for Research on Equal Opportunity, in Austin, Texas.

Health Affairs (Project Hope)
|March 3, 2020
PubMed
Summary

The Affordable Care Act (ACA) individual market faces challenges making coverage costly for many. Strengthening this market could expand health insurance access and sustainability for diverse populations.

Keywords:
Affordable Care ActConsumer-Driven Health ReformFair Care ActFederal health plansHealth insurance exchangesHealth policyIndividual marketsMedicaidMedicare AdvantageNongroup MarketPremiumsPrivate health insuranceUninsured

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Area of Science:

  • Health Policy
  • Healthcare Economics
  • Insurance Markets

Background:

  • The Affordable Care Act (ACA) marketplaces have not met enrollment expectations.
  • Regulatory changes have increased coverage costs for individuals above 150% of the federal poverty level.
  • Existing market structures present barriers to affordable, personalized healthcare options.

Purpose of the Study:

  • To identify strategies for strengthening the individual health insurance market.
  • To explore pathways toward more affordable and personalized coverage options for all nonelderly Americans.
  • To assess the potential for a more robust individual market to improve healthcare sustainability.

Main Methods:

  • Analysis of ACA regulatory impacts on market costs.
  • Examination of Massachusetts health reform and Medicare's private insurance programs.
  • Policy review of market-oriented health reform principles.

Main Results:

  • ACA regulations have inadvertently raised costs for a significant population segment.
  • Specific populations, including those with pre-existing conditions and in non-Medicaid expansion states, face affordability challenges.
  • A strengthened individual market could offer a more sustainable alternative to the current system.

Conclusions:

  • Reforms drawing from the ACA and Medicare's private insurance programs can foster a consumer-driven path to universal coverage.
  • Personalized, market-based solutions are crucial for expanding access to affordable healthcare.
  • The individual market holds potential for greater sustainability and broader coverage expansion.