Introduction
The U.S. is one of the countries supported by the world’s most complex Health Care Delivery System (HCDS). The system comprises professional service providers, insurance providers, and the facilities where the services are offered. The country has a population of over 330 million who depend on this complicated system (ISPOR, 2023).
Americans are estimated to pay over 1 trillion dollars as the cost of the barriers to access to healthcare by 2040 (Bhatt et al., 2023). The value was assessed by assessing the impacts of high-cost diseases such as cancer, diabetes, and heart disease. The increment in the cost of healthcare in the U.S. is worrying because most Americans cannot afford to see a doctor. For instance, in some places, the practitioners are away from the population. Therefore, this reflective report provides insights into the US HCDS after examining its purpose, population served, effectiveness, and barriers to nursing practice.
Purpose and Elements of US HCDS
The current HCDS aims to increase access to quality services and control healthcare costs within the country. I observed that the HCDS is made of the interweaving relationship between the following elements: provider mix, financial base, services provided, and the population under care. I also realized that these components ensure Americans receive the quality of care they deserve. The interaction between these elements, however, contributes to the rising cost of healthcare that negatively affects healthcare delivery.
Financial Base
Any successful healthcare system must have a strong financial ground to meet its goals. The financial base is defined as the resources needed in terms of finance and funding sources required to support HCDS. My evaluation showed that market coverage plans by private insurance companies, out-of-pocket payments, and government-financing plans dominate US HCDS.
In 2019, 50 percent of Americans were covered by private insurance provider paid by their employers (ISPOR, 2023). Apart from the private providers, 20 percent of the population was covered by Medicaid, 14 percent by Medicare, and 1 percent by other government financing plans (ISPOR, 2023). However, 9 percent of the country’s population was uninsured in the same period (ISPOR, 2023). I believe the data showed a clear disparity in healthcare financing in the U.S. Therefore; I concur that the foundation for including out-of-pocket payments, public insurance coverage, and government insurance policies within the HCDS was because of its inability to support universal healthcare coverage.
Population Served
The Healthcare Delivery System is the backbone of any functioning country. From my assessment, between 2010 and 2020, the U.S. had a population increase of 7.4 percent (National Library of Medicine, 2022). From the same study, I also noticed that between 2010 and 2020, the median age in America increased from 36.9 to 38.2 years, which was accounted for by older people who lived longer (National Library of Medicine, 2022). The majority of older people suffer from old age and lifestyle diseases, which require constant medical attention.
Despite the system’s aims to serve the population equally, I identified a gap that led to the underserving of the American population. ISPOR (2023) indicates about 9 percent of Americans do not have any health insurance coverage. I believe the basis for excluding the 9 percent was that employment-based groups predominately purchase private insurance coverage, and individuals purchase a small portion. On the other hand, the public cover policies provided by the government mainly targeted the aged, disabled, and low-income population.
Provider Mix
The USHCDS relies on multidisciplinary professionals to ensure every person receives the required medical services. Provider mix refers to the various medical professionals involved in patient care. The medical professionals in the system include doctors, advanced practice registered nurses, mental health practitioners, pharmacists, and registered nurses, among other practitioners (Reibling et al., 2019).
From my observation, the rationale for including a provider mix in HCDS was to ensure patients receive care that meets their needs. This aligns with the system’s goal of access to quality healthcare for all Americans. They collaborate to ensure they deliver the necessary aid a patient may need.
Services Provided
Another key element of the HCDS in the U.S. is the services provided under this system. It refers to all the medical services a patient would receive under the system. Some of the services I identified in the HCDS were primary care, preventive care, mental health services, and treatment of illnesses and injuries (Wagner, 2021). Preventive care services refer to the healthcare services that target preventing illnesses. In contrast, treatment services refer to the medical services offered to patients aiming to relieve patients from illnesses such as heart disease, flu, cancer, and injuries. From my perspective, the rationale for including preventive care in the HCDS was its criticality in staying healthy as it detects problems before they manifest and become difficult to treat.
Projected Healthcare Needs in the U.S.
The rising population in the U.S. indicates an increase in the country’s healthcare needs, especially primary care. Jain (2022) projected that between 2022 and 2026, the median incidence rate for primary care demand is estimated to rise in the country by 1.7 percent. Jain (2022) further reported that the estimation indicates that Americans are projected to do at least 1.2 primary care visits per year, which is 0.1 higher than in 202. I agreed with the author, as this can be attributed to the rise in chronic diseases such as metabolic and heart conditions in the U.S. (Ostrominski et al., 2023). Ostrominski et al. (2023) demonstrated a steady rise in Americans with heart, renal, and metabolic conditions. The study approximated that in every four adults in America, one has a heart, renal, or metabolic condition (Ostrominski et al., 2023). Therefore, from the assessment, I concurred that primary care will rise, especially for people suffering from the abovementioned condition.
Effectiveness of US HCDS
The US HCDS can be evaluated by looking into various factors contributing to its effectiveness. A study by Commonwealth Funds investigating healthcare system performance ranked the U.S. last at position 11 (Jacob, 2023). It involved a comparison of HCDS of developed nations such as the United Kingdom, United States, Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, and Switzerland. The evaluation was based on various metrics, which included access to care, care process, administrative efficiency, equity, and healthcare outcome (Jacob, 2023). In the care process segment, the report indicates that the U.S. ranked second (Jacob, 2023). This segment included preventive care, safe care, coordinated care, and patient engagement.
In my opinion, the US HCDS’s unfortunate performance resulted from poor access to care and a lack of transparency in the system. This was supported by a report published on Peterson-KFF, where America was rated as the lowest country with the ease of access to healthcare, leading to high amenable mortality and premature deaths (Telesford et al., 2023). Through the assessment, I also realized rampant fraud and cover-ups are other factors affecting US HCDS’s effectiveness.
One of the notable frauds within the system is up-coding, which becomes a problem between providers and insurance providers (Telesford et al., 2023). This negatively impacts the quality of care as the policyholders are stuck in between as the government leaves the market forces to control the industry. The providers may charge highly for a procedure; similarly, the insurance provider may also charge high premiums from the policyholders but become rigid at the time of payment, making the HCDS less effective in delivering care.
Barriers to Advanced Nurse Practice in Current HCDS
Based on the assessment of the HCDS, one barrier to advanced nursing practice is the limited scope of their work. I observed that the current system denies N.P.s the opportunity to prescribe medication and diagnose and treat patients. It is estimated that about 80 million Americans in 2020 lived in regions with a shortage of healthcare practitioners (Lalitha et al., 2021). I agree that Advanced Nurse Practitioners can fill this gap as they have the requisite skills, training, and education for the job (Lalitha et al., 2021).
However, this barrier can only be overcome when the state actors initiate the processes of changing the policies that restrict the nursing practice (Lalitha et al., 2021). The process will need resources such as professionals from different fields to form a committee that will look into nurses’ training to ensure that it incorporates all the necessary before allowing them to have a full practice (Lalitha et al., 2021). The timeline for the process can be one year, as it will require the committee to look into nursing practice across states to develop recommendations. Giving the nurses autonomy to practice fully through institutional support will greatly increase access to care and lower the country’s healthcare cost.
Conclusion
The US HCDS aims to ensure all Americans have access to quality care. The system consists of such components as provider mix, financial base, services, and population. These elements ensure the system operates smoothly to ensure people receive care. The system, however, is faced with challenges such as a limited scope of operation by other professionals, such as N.P.s, leading to a shortage of practitioners and a rise in cost.
References
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