Integrated Health Delivery System - Essay Example

Integrated Health Delivery System Introduction Health care system is a very important system of any nation because health is what makes a nation different than others. In any nation if we see funds are allocated to different systems such a way that health and security system gets the most and it is made sure that do not feel deprived at any point which makes it clear how important health care system is. In the last few decades along with making health care system a best health care provision facility, it is also tried to make it a good income source for the country. Money that is spent on health department is considered to be a kind of investment now and along with keeping a check on whether health related needs are getting satisfied or not? a check is also kept on which way it will be more productive for the country to have it modified. There are two major system operating these days managed care system and integrated health care system. Health maintenance organization is an example of the first one and physician hospital integrated delivery system is an example of the second one. Now different research studies have shown that both these systems have their importance at different levels and they have been viewed as inevitable, desirable, and even compatible (Author, 1993., shortell, 1996). At some places these two systems have been merged together and have been said to be managing care and integrating the delivery of the care which is still acceptable to most of the management coordinators. Now in order to be more precise we describe integrated health care system in a bit more detail. This is a system in which health is taken as one unit rather than considering it as heart a different unit, brain a different one and stomach even a different one. While treating heart the rest of the body has to be taken into consideration and then according to the needs, treatment and expected outcome has to be taken into account. “In the last two decades there has been a significant emergence of multi- hospital networks (MHNs) in the health sectors of all industrialized countries. Such networks seem to represent an organizational choice, which provides interesting opportunities to cope with cost and quality issues stressing the health field”. (Lega, F. 2005). Having integration in health care system is good for consolidating the system, having a good control on the disease process itself and bringing out more financial benefits out of it for a country. Consolidation Consolidation is defined as any transaction that involves delegating the key decision-making rights of two or more hospitals to a single board. The universe of consolidation thus includes full asset mergers, holding companies involving substantially all of the operation of multiple hospitals and any other “active parent” relationships it excludes les formal relationships such a point marketing agreements for particular services (e.g., Cardiac care, oncology and academic affiliation. Consolidation can further be classified as mergers or acquisition depending on the characteristics of the hospitals involved. An acquisition joins two or more parties that are asymmetric with respect to the size or services offered and mergers bring together parties that are roughly more or less the same size with the same services” (Huckman 2005). If we talk about integration then any big or small center which provided any type of health care services can be merged together and they can work in harmony towards achieving the same goal with good share of their expertise. “With integrated system we can develop a framework that will help companies systematically decide whether they should ally with or acquire potential partners” (Huckman, 2005). Consolidation is a term that is not being used very often but in simple words we can say that this is a type of assistance for each other working together and sharing experiences for the benefit of human beings as a whole rather than just considering an open heart surgery at bigger center of cardiology for a coronary event or treating a heart attack as a minor heart burn at a smaller center just because the thinking process was not broaden enough to take that into consideration. When these centers of different level merge together and share their activities or in other words have a labor division they can work the best way than working individually as separate units. This has a simple concept behind it that it is like joining hands together for carrying out an important task or achieving something together than doing it alone. These hands can only join each other when the concept of integration is there to put them together with a specific role for everyone towards an assigned goal. Disease process Having integration in health care system is like broadening the concept of looking at a disease from different angles and treating a person as a set of systems working together with dependence on each other rather than a system individually which is never the functional story in real. Health care system is effective or not can only be decided on the basis of two things one whether it is covering everyone equally or not? And the second one is that is it satisfactorily taking care of the ones it is covering or not? now if patients are seen by an orthopedic surgeon or rather a chronic pain management team and they start prescribing pain killers which can potentially lead to gastric ulcers are going to be even more harmful for someone already suffering from a bad gastric or duodenal ulcer or taking another example of a cardiology unit where a patient comes with an acute coronary syndrome and is taken immediately for an emergency angiogram without knowing the status of his/her kidneys, this will make the already compromised kidneys suffer even further so these are the things which can be taken care of if an integrated approach is followed while providing patients with health care facilities. If we are just managing the disease or targeting an organ as the case mostly is in managed care system then “such assumptions may not be warranted. Critics of managed care correctly argue that HMOs lack the full incentive to perform disease management activities, since their enrollee base is likely to turn over within 5 years”. (Lawton, R. 2001). Providers further argue that manage care organizations can not perform disease management since they would then subject hospitals and physicians to one HMOs particular protocols and care paths that might conflict with another HMOs care management tools. (Bodenheimer, 1999., Cassak, 1996., Haris, 1996). Patient always wants to be considered as an individual and never wants to be treated as an owner of one organ system if he/ she is being seen for one complaint by a doctor they come back complaining that their issues were not entertained. We take an example of a scenario that a patients gets admitted to the floor of psychiatry, the patient is on anti psychotic medications without having a metabolic work up done. Metabolic abnormality is the most common side effect of antipsychotic medications. Now the usual protocol in psychiatry is to check these patients for their behavior, mental state and their medication everyday but what is the blood sugar level like? What is the blood pressure like are all questions to be answered and here even if this hospital is maintaining a basic chart of vitals and these baseline labs on routine basis and these labs turned out to be abnormal and they need to be seen by a medical specialist then what should be done should this unstable patient be sent out to another hospital for having a medical check up done? This is going to be very risky both for the patient, medical specialist and even other patients around there. The best in such circumstances will be to have a medical facility on floor and should be called in for a consult and the patient should be assessed in the presence of a psychiatrist and a nursing staff. Another scenario even worse than this will be having a patient with chronic dementia on psychiatry floor with a bad bed sore which needs to be dressed and assessed daily by someone in general surgery so what can not be done if the system is not an integrated system and is just a managed care system? These are all concerns about providing a patient with a quality mental or physical health care with broaden concept which only comes through having an integrated approach towards the patient. Similarly some systems have implemented computer based patient support systems that host discussion groups and personal stories enabling patients to gain greater confidence more holistic approach and perceived self control in their health care and improve patients comprehension of health care information. (Advisery board, 2002). Such support systems are believed to reduce inappropriate care and improve quality. (Center, 1999). “Integrated health care approach empowers the patients and gives them incentives to coordinate their health information and serves as their own gatekeeper”( Lawton, 2002). Impact on economy There have been different studies on assessing the impact of converting health care system from managed care system to integrated health care system. Studies have been done with horizontally as well as vertically integrated system most of them have shown this modification of system has a negative impact on the economy. On the other hand in a study “Star noticed that comprehensive prepayment for health services as achieved through HMOs significantly increased efficiency and reduced health care costs.” (Bazzoli, 2004) If we look at a territory which has a number of tertiary hospitals, a number of primary health care units, a huge number of doctors personal clinic where they sit in their private timing, and even a number of home care facilities there will be a number of ways health care is getting in the access of the seekers but if all these hospitals and health care centers are converted into something like one or two tertiary care hospitals may be one primary care hospital for each sub area of that territory and the number of private clinics and these home care services delivery are prohibited then patient will have a bit of a problem accessing these few points because they might be located at a distance from the patients but will be minimizing on the average amount these patients will be spending. Here we are looking at the income of these health care facility points but if we go back and see these centers have been consuming money for their construction and maintenance along with running it. Even if this intervention is getting expensive for a country the motive from health care management should still be not to try raising the income of a country but to provide a good health care to the nation. “It has generally been found that integration fails to improve hospital’s economic performance”. (Lawton, R. 2002). There are different ways to integrate health care system like any sort of discussion, meeting, watching videos, listening to lectures or even seeing a case by multiple doctors with different views are all the ways to facilitate the work to be integrated and this all leads to patient’s satisfaction. Having a good understanding of a patient’s of his/her medical condition reduces the burden of that disease both on the patient and a nation dramatically. Once one knows the diagnosis, pathophysiology, treatment and prognosis clearly they can decide for something better suited for them according to their affordability but if these private consultations and small health care units are taken into account then these practices are very expensive for the patients and might be a source of income for the ones carrying out private practices but not the government as such. Conclusion Integrated health care system in simple words is a system which provides the patient with the best health care facility while keeping it less expensive for them. This is a system that leaves the patients with an understanding of their disease and even their body. Health is a very important parameter of calling a nation prosperous and successful if the health care system of a nation is not satisfactory nothing in that country can be good. In order to provide a country with a healthy health care system it has to be an improving system on day to day basis, it has to be reasonably affordable for the patients and it should not drown a country’s economy. Consolidating a system and particularly health care system is like making this system more precise, concise and increasing acceptability which increases the authenticity of it so obviously. For health care system cost, accessibility and quality have always been an issue and a challenge for every developing and developed nation and an integrated system of health care delivery is a very simple answer to it. “Results from a study of 36 large integrated health care organizations suggest that financial performance is adversely affected by the scale of investment in integration but not necessarily by the timing or sequencing of the investments made. The results also suggest that some integration strategies have more detrimental effects on financial performance than do others. Finally the results show that centralized integrative structures appear more financially successful than are less centralized structures.”(Burns, 2005) Health care provided through integrated system is less costly, highly accessible in terms of affordability and is a high quality tested and proven care. There have been studies which have shown contradicting views regarding this integrated system but majority of the studies have agreed upon the efficacy of this system and have open the forum for implementing this system widely. Designing a health care provision network for an area should be planned the way that there should be an optimal number of tertiary care hospitals depending on the area covered and the population taken care of. The primary health care centers should just be the attending and collection points where patients for further interventions should be identified and should be sent to the tertiary care hospital. Home care provision should only be provided to the ones that can not come to hospital due to disability and that should be also be done in the form of a team and not a single person to maintain the quality of service. There should still be a report of the problem to the concerned person to make sure that the problem has been taken care of the appropriate way and no issues have been over looked. References 1. Advisory Board Company. The Grand Alliance. Washington, DC: Author, 1993 2. Advisory board, “Computer based support helps underserved breast cancer patients,” advisory board Briefing 20 August 2001, www. Advisery.com (22 April 2002) 3. Bodenheimer, T. (1999). ” disease management- promises and pitfalls”. New England Jounal of Medicince 340 (1999): 1202-05 4. Burns, Gimm, and Nicholson (2005) "The Financial Performance of Integrated Health Organizations" Journal of Healthcare Management. Vol. 50, No. 3, pp. 191-211. 5. 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