A Principled Approach to Essential Health-Care Delivery System Reforms

The basic premise of this chapter is that we have at our disposal a wealth of evidence-based knowledge of critical health care delivery strategies that would, if implemented on a large scale, yield both a social right to health care for all citizens and favorable population health care outcomes at lower cost. This chapter provides a synthesis of this knowledge, and then identifies a limited set of very specific health care system delivery reforms that meet three evaluative criteria: equity, sustainability, and political feasibility. Equity refers to the extent to which any particular health care system delivery reform achieves a fair balance between the competing interests of different segments of the patient population and society at large. Sustainability refers to the extent to which a health care system delivery reform initiative yields favorable impacts on population health while realizing large reductions in immediate and future health care costs. Finally, political feasibility refers to the likelihood of a given health care system delivery reform in view of the competing interests of different stakeholder groups affected. This chapter offers a principled and empirically justified blueprint for the most promising health care system delivery reforms towards the fulfillment of these three ends.

Health Care System and Policy Factors Influencing Engagement in HIV Medical Care: Piecing Together the Fragments of a Fractured Health Care Delivery System

Clinical Infectious Diseases ◽

10.1093/cid/ciq048 ◽

2011 ◽

Vol 52 (suppl_2) ◽

pp. S238-S246 ◽

Cited By ~ 155

Author(s):

Michael J. Mugavero ◽

Wynne E. Norton ◽

Michael S. Saag

Keyword(s):

Health Care ◽

Medical Care ◽

Health Care System ◽

Delivery System ◽

Health Care Delivery ◽

Care Delivery ◽

Factors Influencing ◽

Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocx017 ◽

2017 ◽

Vol 24 (5) ◽

pp. 1036-1043 ◽

Cited By ~ 28

Author(s):

Julia Adler-Milstein ◽

Peter J Embi ◽

Blackford Middleton ◽

Indra Neil Sarkar ◽

Jeff Smith

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Delivery ◽

Care Delivery ◽

Policy Recommendations ◽

It Infrastructure ◽

Health It ◽

Current Health ◽

Value Based Care ◽

Abstract While great progress has been made in digitizing the US health care system, today’s health information technology (IT) infrastructure remains largely a collection of systems that are not designed to support a transition to value-based care. In addition, the pursuit of value-based care, in which we deliver better care with better outcomes at lower cost, places new demands on the health care system that our IT infrastructure needs to be able to support. Provider organizations pursuing new models of health care delivery and payment are finding that their electronic systems lack the capabilities needed to succeed. The result is a chasm between the current health IT ecosystem and the health IT ecosystem that is desperately needed. In this paper, we identify a set of focal goals and associated near-term achievable actions that are critical to pursue in order to enable the health IT ecosystem to meet the acute needs of modern health care delivery. These ideas emerged from discussions that occurred during the 2015 American Medical Informatics Association Policy Invitational Meeting. To illustrate the chasm and motivate our recommendations, we created a vignette from the multistakeholder perspectives of a patient, his provider, and researchers/innovators. It describes an idealized scenario in which each stakeholder’s needs are supported by an integrated health IT environment. We identify the gaps preventing such a reality today and present associated policy recommendations that serve as a blueprint for critical actions that would enable us to cross the current health IT chasm by leveraging systems and information to routinely deliver high-value care.

CLINICIAN-PERCEIVED CHALLENGES OF OSTEOPOROSIS CARE IN AN INTEGRATED HEALTHCARE DELIVERY SYSTEM

Innovation in Aging ◽

10.1093/geroni/igz038.2775 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S756-S756

Author(s):

Aaron T Seaman ◽

Melissa J Steffen ◽

Karla Miller ◽

Samantha Solimeo

Keyword(s):

Health Care ◽

At Risk ◽

Health Care System ◽

Delivery System ◽

Health Care Delivery ◽

Bone Health ◽

Care Delivery ◽

Osteoporosis Care ◽

Abstract The burden of osteoporosis, both on the health care system and individuals, is high. Despite this, a high percentage of patients with or at risk of osteoporosis are not identified, screened and treated appropriately. Delivering osteoporosis care to at-risk patients is complicated by a fractured health care delivery system. In this presentation, we present data from interviews with VA clinicians in order to identify challenges of osteoporosis care within the VA health care system. While clinicians reported initiating a range of bone health care delivery interventions, they identified challenges that inhibited long-term sustainability: 1) low prioritization of bone health among national and facility leadership; 2) fragmentation of clinical responsibility and care delivery; and 3) barriers endemic to the osteoporosis care delivery system. Our results indicate that, even within an integrated health care delivery system, significant coordination challenges exist.

Envisioning a Better U.S. Health Care System for All: Health Care Delivery and Payment System Reforms

Annals of Internal Medicine ◽

10.7326/m19-2407 ◽

2020 ◽

Vol 172 (2_Supplement) ◽

pp. S33 ◽

Cited By ~ 7

Author(s):

Shari M. Erickson ◽

Brian Outland ◽

Suzanne Joy ◽

Brooke Rockwern ◽

Josh Serchen ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Delivery ◽

Care Delivery ◽

Payment System ◽

How the Health Care System Can Improve Mammography-Screening Rates for Underserved Women: A Closer Look at the Health Care Delivery System

Journal of Ambulatory Care Management ◽

10.1097/00004479-200107000-00005 ◽

2001 ◽

Vol 24 (3) ◽

pp. 17-26 ◽

Cited By ~ 8

Author(s):

Nasar U. Ahmed ◽

Jane G. Fort ◽

Tonya H. Micah ◽

Yigzaw Belay

Keyword(s):

Health Care ◽

Health Care System ◽

Delivery System ◽

Health Care Delivery ◽

Mammography Screening ◽

Care Delivery ◽

Underserved Women ◽

Health Care Delivery II: Relationship of the Health Care System to Society in General

Clinical Behavioral Science ◽

10.1007/978-94-011-7973-7_30 ◽

1982 ◽

pp. 391-395

Author(s):

Frederick Sierles

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Delivery ◽

Care Delivery ◽

Relationship Of ◽

Health Care Delivery I: Quality of Our Health Care System

Clinical Behavioral Science ◽

10.1007/978-94-011-7973-7_29 ◽

1982 ◽

pp. 387-390

Author(s):

Frederick Sierles

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Delivery ◽

Care Delivery ◽

Challenges of implementing sustainable health care delivery in Nigeria under environmental uncertainty

Journal of Hospital Administration ◽

10.5430/jha.v3n6p113 ◽

2014 ◽

Vol 3 (6) ◽

pp. 113 ◽

Cited By ~ 5

Author(s):

Anyika N. Emmanuel

Keyword(s):

Health Care ◽

Health Care System ◽

Delivery System ◽

Health Care Delivery ◽

Developing Economies ◽

Care Delivery ◽

Environmental Uncertainty ◽

Sustainable Health ◽

Introduction: The increasing cost of health care in developed and developing economies has called for a change in the way health activities are implemented. Nigeria is faced with fundamental health care related challenges coupled with recent security issues. Uncertainty prevails as health system dynamics unfolds. Objectives: To explore the relationship between environmental uncertainty and health care delivery system in Nigeria. The study aims at reviewing the dynamics of health care delivery in some developed economies and Nigeria with regard to methods of adaptation of health care under uncertainty, and developing a framework for sustainable health care delivery. Methods: Databases were searched for relevant literatures using the following keywords: environmental and health uncertainty, Nigerian health care system, Nigerian primary health care, health care financing and sustainability. Other keywords used include: US, Europe and China health care dynamics, among others. Scientific databases obtained from the Internet were used including online journals, which were sourced mainly from the Google. Relationships if any were established and a framework for sustainability developed. Results: Environmental uncertainty has a multiplicity of interactions with different aspects of health care system, resulting in poor infrastructural development, inadequate government funding, absence of integrated system for disease prevention and surveillance, policy reversals, security challenges, and unimpressive health indicators in Nigeria. A framework for implementing sustainable health care delivery under uncertainty is proposed. Discussion and conclusion: Uncertainty abounds in the Nigerian health care delivery system; causing further distortion in development of the health sector. Effective mobilization of health care professionals, use of sustainable care plans by government, use of integrated medical intelligence and surveillance systems, accountability, commitment, and above all quality leadership - will minimize uncertainty factors and enhance health care performance and sustainability in Nigeria.