Health care encompasses the maintenance or improvement of physical and mental wellbeing by diagnosing, treating and ameliorating disease, illness or injury through trained and licensed professionals.
Some may argue that healthcare should be allocated on an efficient and equitable basis, rather than efficiency alone. Others hold fairness to be of greater significance than efficiency in allocating healthcare services.
Primary Care
The committee defines primary care as the daily healthcare that patients receive from clinicians, including screening, diagnosing and treating illness or injury. Clinicians who offer this care typically treat multiple health problems at once without regard to disease or organ systems – acting as advocates between their patient relationships with larger health systems.
The committee does not accept the view that primary care clinicians function as gatekeepers, believing this narrow view limits clinicians’ scope of action and could negatively affect patient outcomes. Instead, a more inclusive definition of primary care allows for more in-depth discussions of clinical practice, training opportunities and research issues.
Hospital Care
Hospitals offer 24-hour care from skilled medical professionals who are always accessible. People suffering from serious health conditions or recovering from accidents may require hospitalization for short periods before being released home or transferred to another community-based health care setting such as nursing facilities.
Hospitals also bear a responsibility to serve their local communities by offering charity care, donating funds or services and offering facilities for doctor training, health-care professional education and research.
Hospitals are required to conduct a community health needs assessment every three years and develop an action plan, and use the results of these evaluations as the basis for Medicare disproportionate share hospital (DSH) payments.
Specialty Care
Health care providers specialize in treating specific types of medical conditions. In collaboration with primary care providers, these specialists work to ensure individuals receive the most suitable and effective treatments available for their ailments.
These specialists assist with developing, monitoring and coordinating care for complex chronic medical conditions such as cancer. Oncologists work directly with individuals to oversee their cancer treatments and closely track progress.
Studies demonstrate the power of specialty care to both improve outcomes and decrease costs for patients with complex conditions, who typically suffer from multiple chronic health conditions that require intensive monitoring and management. Value-based payment models offer another avenue for providing high-quality, cost-efficient healthcare delivery.
Outpatient Care
Outpatient, or ambulatory care, refers to healthcare that does not require you to stay overnight in a hospital setting. Outpatient services may be offered by co-owned facilities that are associated with hospitals as well as independent clinics that may offer them.
Due to advances in medical techniques and technology, more procedures are now performed as outpatient care rather than hospitalization, making outpatient care more accessible to patients through neighborhood clinics, urgent care centers and specialty treatment centers. Students interested in health care careers should explore both inpatient and outpatient environments before choosing one as the ideal workplace environment.
Managed Care
Managed care health insurance plans provide cost savings through contracts with medical providers and facilities that create a network that members can utilize for healthcare services.
Consumer advocacy organizations express concern that managed care plans do not provide enrollees with enough quality choices and that narrow networks restrict beneficiary choice and access to high-quality care. They further express worry that managed care plans blend cost-cutting objectives with patient-care goals, creating intermingled financial incentives which compromise quality care delivery.
Many managed care plans employ utilization review techniques such as preadmission screenings, surgical second opinions and ongoing reviews of high-cost cases to detect duplication, waste or unnecessary services. Such programs have had mixed success rates.
Health Insurance
Health insurance is a form of risk management that covers some or all of a covered person’s medical and surgical expenses for an affordable monthly premium. Individuals can purchase health insurance on their own, through their employer, association or government – including traditional fee for service plans and managed care plans.
When comparing policies, make sure you ask about all of the items and services covered under each plan, their deductible amount and cost-sharing arrangements such as co-payments and co-insurance that may apply. It’s also smart to get familiar with how long a provider has been operating as well as its history within their market as well as any consumer complaints filed with MID.