|Aesthetic Medicine Today
|4 Models of the US Healthcare System
Christina Cruz Dominguez
Steven Dominguez, MD, MPH
Today we will discuss, compare and contrast the Organizational, Social, Economic,
and Public Health Models of "health care." The perspectives of health care access,
availability, delivery, efficiency, effectiveness, and quality are defined by the
perceptions of the individual or organization viewing the above named parameters.
Therefore there is not any one clear cut definition for the sampling of the four
different models of health care discussed herein.
The Organizational Model of health care in the United States is a conglomeration of
multiple informal systems that are interchangeable, yet fragmented and
uncoordinated. The basic tenant of this model focuses resources on four defined
components of medical care. The four components of medical care are the financing
of health care, health care delivery, health care personnel, and the knowledge and
technology necessary to provide health care. This informal system may be grossly
divided into five service models: 1) A system serving the employed and insured
through private non-governmental physicians and hospitals. 2) A system serving
the unemployed and uninsured through public aid facilities and programs. 3) A
system serving military veterans through government employed physicians and
Veteran Administration (government) hospitals. 4) A system serving active duty
personnel and their families through private and governmental physicians and
hospitals. and 5) The Medicare system serving all individuals over the age of 65
through private non-governmental physicians and hospitals.
All of these organizational systems coexist mutually, and yet are distinct based on the
four components of medical care outlined above. System number 2 assumes the role
of the "safety net" for primarily system number one, but also for the other three
systems. These systems deliver care through eleven services: 1) Public Health , 2)
Emergency, 3) Simple Ambulatory, 4) Complex Ambulatory, 5) Simple In-Patient
care, 6) Complex In-Patient care, 7) Long-term care, 8) Rehabilitation, 9) Dental,
10) Pharmaceuticals, and 11) Mental Health. Through this "system," the United
States has developed a health care model that is plagued with logistical problems
and errors leading to a maldistribution of quality health care and rising costs.
The Social Model of health care undertakes the general objective of achieving Equity
of Access to medical care through the following three principles: 1) Health care is a
right., 2) Resources devoted to health care are finite., 3) Health policy should be
concerned with developing just mechanisms for allocating scarce resources. The
objective of achieving Equity to Access is dependent on the values of the individual or
organization defining the terms Equity and just.
"Health care is a right" is a concept that refers to the access of health care services
and not to health itself. The availability of health care services is the issue here, not
the physical health status of the individual.
"Resources devoted to health care are finite" assumes that health care resources are
limited, and therefore a method for allocation of resources is necessary. Allocation of
resources does not imply that all individuals are entitled to the same exact health
care, but rather implies that there should be a just distribution.
"Health policy should be concerned with developing just mechanisms for allocating
scarce resources" requires criterion for defining and determining just allocation. The
criterion typically used in the Social Model includes: 1) Merit., 2) Social
Contribution., 3) Supply and Demand., 4) Similar Treatment for Similar Cases., 5)
Need., 6) Rational Model., 7) Neo-Conservative Model., and 8) Neo-Marxist Model.
The United States health care system has traditionally relied upon Supply and
Demand to justify its' Social Model, however in this era of rapid health systems
change many of the other determinants of just allocation are gaining momentum.
The Economic Model of health care emphasizes efficiency. Efficiency is founded on
three basic assumptions; 1) Resources are scarce., 2) Scarce resources have
alternate uses., and 3) Different people want different things. Hence, efficiency is
the goal instead of equity.
The Economic Model uses these three assumptions in relation to the economic
principles of Benefit, Behavior, Policy Issues, Value, Demand, and Economic
Incentives in order to reach a state of equilibrium. Simple individuals and complex
organizations use these same principles daily in conscious and unconscious, direct
and indirect decision making regarding health care services. In essence, the
Economic Model places a price on life. Placing a price on life, cannot ethically or
fundamentally be reached without application of the Social Model in order to reach
the social optimum in consumption and investment.
The Public Health Model defines its' mission as "fulfilling society's interest in assuring
conditions in which people can be healthy". The Public Health Model focuses on
society while organizing communities, private and public organizations, and the
government in an effort to fulfill core functions in assessment, policy development,
and assurance. Public Health has greatly influenced and changed the health status
of the United States through research, education, regulation, and implementation of
medical technology. The Public Health Model parallels the Organizational Model while
adopting the objectives of the Social Model. The Public Health Model produces great
results, however it is at the mercy of the government for fiscal support and therefore
does not have a political power base.
Perceptions, the window to reality. The United States health care system is not a
single model; but in fact is a multifaceted Organization Model with growing Social and
Economic Model overlap, molding and reshaping at an accelerating pace. The Public
Health Model while paralleling the Organizational Model with Social Model overlap
ignores the Economic Model, which may lead to its unfortunate demise.
What will our healthcare system evolve to given today’s legislative negotiations? Only
you hold the key. Use it by voicing your right to lobby your legislator for YOUR
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