Guide to healthcare delivery systems in the United States

Delivery systems in healthcare ensure patients receive appropriate medical care in medical centers, hospitals, clinics, and other healthcare facilities. 

This structured framework allows medical providers to effectively manage their facilities and ensure better coordination of services to provide quality medical care.

Let’s learn more about healthcare delivery systems and the various types.

A healthcare delivery system comprises all the medical services and activities that directly or indirectly impact patient care from institutional and individual medical providers. 

A healthcare delivery system has four main components:

The payers

These public and private entities provide financial coverage for medical services and allocate funding resources to institutions in the healthcare system. These include insurance companies and government-funded programs like Medicare and Medicaid. 

The providers

Medical providers are the people and institutions that provide healthcare services to members of the public. 

Medical providers in the healthcare system include physicians, nurses, therapists, specialists, and pharmacists.

The facilities

These physical locations support healthcare service delivery, enabling providers to supply medical care. Healthcare system facilities include hospitals, clinics, rehabilitation centers, and nursing homes.

The patients

Patients are those who seek medical care from doctors or healthcare facilities. 

Healthcare delivery systems help practitioners provide efficient, reliable medical services to patients and address underlying community health problems. 

It allows easier adoption of new care practices and the latest medical technologies. 

Here are some reasons why healthcare delivery systems are essential:

Health promotion

Healthcare delivery systems enable medical providers to raise awareness and teach the general public ways to avoid common health problems. 

Providers organize and run health education programs to encourage healthier lifestyle choices, vaccinations, and regular check-ups, promoting the general public’s well-being.

Treatments for illnesses

Healthcare delivery systems provide access to medical services and treatments, improving health outcomes. 

Healthcare providers treat various medical conditions and offer continuous care to help patients manage their conditions. 

Healthcare facilities also identify patients requiring specialized care, transferring them to facilities that best serve them. 

Preventative health

The saying ‘prevention is better than cure’ is more true in healthcare than in any other field. 

Delivery systems in healthcare offer critical public health services, such as vaccinations. These reduce the burden of preventable conditions and the spread of infectious diseases. 

Health screenings identify potential health risks and diseases early, allowing timely intervention.

Emergency response

Healthcare delivery systems provide immediate medical attention and life-saving interventions during emergencies and accidents. 

They ensure medical facilities integrate emergency preparedness into their operations, enabling coordinated responses to health issues.

Delivery systems in healthcare help medical providers: 

• Respond to emergencies quickly

• Perform quick patient transfers

• Allocate medical resources

• Offer quick training to first responders

These all allow for better emergency management.

Delivery systems in healthcare depend on the country’s available resources and patient needs. 

Healthcare delivery systems in the United States have different levels depending on the complexity of medical cases, specialties, skills, and equipment required. 

Healthcare providers at these levels provide medical services like diagnostics, evaluation, and treatment. They may also refer the patient to the next level of healthcare for their specific needs.

We can categorize the levels of healthcare delivery as follows:

Primary care

Primary care addresses most of a person's medical needs throughout their life, including physical, social, and mental well-being. It’s the first level of healthcare a patient receives when seeking medical services. 

Most patients see a primary physician or other medical professionals like a pharmacist or physiotherapist. Who they see depends on their medical needs and their local healthcare system.

Primary care physicians should have broad knowledge since they see many diverse patients, including people of all ages and all geographic and socioeconomic regions. 

The primary care physician: 

• Diagnoses and treats the common health conditions in their area of expertise

• Assesses the urgency of a medical condition

• Refers patients to other specialists when needed

Primary care benefits healthcare delivery by providing easy access to medical services and better treatment outcomes, decreasing hospital visits and hospitalization.

Secondary care

Secondary healthcare providers specialize in specific medical fields, such as cardiology, orthopedics, dermatology, and neurology. 

They have advanced training and expertise in diagnosing and treating complex health conditions in their area of specialization. They handle patients who require treatment beyond the scope of primary care. 

Medical conditions that need secondary care include pneumonia, diabetes, cancer, and thyroid disease. 

Secondary healthcare services may include planned surgeries, rehabilitation services like physiotherapy, or specialist clinics like renal and cardiology.

Tertiary care

Tertiary care is highly specialized healthcare that involves complex and advanced diagnostics, treatments, and procedures performed in state-of-the-art medical facilities. 

Medical specialists in these facilities can access purpose-built equipment like advanced intensive care units and diagnostic support services. 

Primary and secondary care medical practitioners can refer patients to a tertiary care center. These centers offer treatment on an inpatient basis, although some medical services have an outpatient option. 

Tertiary care includes: 

• Cancer management

• Cardiac surgery

• Neurosurgery

• Plastic surgery

• Transplant services

• Severe burns

• Advanced neonatology

• Palliative care

Quaternary care

Quaternary care is an extension of tertiary healthcare, providing highly advanced solutions to specific medical conditions. 

Select national and international medical centers offer quaternary care services, so it’s not widely accessible. 

Quaternary care caters to patients with rare or complex health conditions and involves specialized surgeries, uncommon diagnostic procedures, experimental medicine, and novel treatment methods. 

It also has a larger catchment area, attracting patients countrywide and worldwide.

New delivery systems are constantly changing how people interact with the healthcare system, making it essential for patients to stay informed on new developments. 

These systems give patients more freedom of choice for their healthcare, allowing for lower costs, efficiency, and ease of use. 

The new types of delivery systems in healthcare include:

Managed care

Managed care plans are insurance agreement plans with predetermined medical facilities, healthcare providers, and doctors to offer healthcare services to plan members at lower costs. 

These healthcare providers form the plan's network, and the cost of care depends on their rules. 

Here are some common managed care plans:

Health maintenance organizations (HMOs)

The plan offers preventative care for a monthly or annual fee and only provides services within its network. 

Insurance companies must contract providers to benefit from the HMO network. You choose a physician within a specific geographical area to oversee your medical care.

Preferred provider organizations (PPOs)

The plan allows a patient to choose any healthcare provider without restriction. 

However, PPO services are typically more expensive than HMO services. They still pay some of the cost if you receive care outside the network.

Point of service (POS)

The plan lets patients choose between an HMO and a PPO whenever they need medical care. The patient can select a primary healthcare provider and still receive care outside the network.

Concierge services

Concierge services require a monthly or annual payment for medical care instead of varying fees like other medical providers. 

It’s essentially a private practice where doctors can charge a retainer fee to provide patients with complete access to the medical services they offer. 

Concierge medicine creates a closer relationship between a physician and the patient, allowing quicker and more personalized care. The system also has decreased costs and provides better access to services that a patient may lack with traditional insurance.

Self-directed services

Self-directed services are under Medicaid, allowing patients to make decisions regarding their healthcare instead of leaving the choices to an agency. 

It allows patients to choose the healthcare provider within their budget that they are most comfortable with.

Telemedicine

Telemedicine is an innovative healthcare delivery system that doesn’t require patients to see their doctor physically. Instead, patients can interact with their physicians remotely via video or phone. 

The system gives patients quick access to their healthcare providers, and patients can also receive medical messages and appointment reminders. 

Telemedicine is cost-effective for patients and physicians since it does not require office space or equipment. This significantly reduces medical costs and provides care to patients who usually cannot afford it.

The primary challenge in healthcare delivery systems is the shortage of qualified physicians and human resources specialists. 

Epidemic and chronic diseases also directly impact the healthcare system and can cause a strain on a country's healthcare resources.

Healthcare delivery costs are the expenses associated with providing healthcare services to patients.

Administrative costs are expenses incurred in administering and managing healthcare services.