DLA - US organization and delivery Flashcards
Primary Care(gatekeeper or coordinator )
• Common health problems, minor interventions,
preventive measures
• Can be taken care of by general practitioner or another
caregiver
• Accounts for 80-90% of health care visits
Secondary Care
• Problems that require more specialized care, clinical
expertise
• Usually involve hospital setting for care and specific
specialties such as general surgery
Tertiary Care
• More complex and often rare disorders, requiring
extensive clinical expertise and hospital care
-Involves subspecialities
The Dispersed Model
- Multiple access points
- More fluid roles for provider
- less distinction in hosipital care
- higher value of tertiary care
what are the advantages of health care dispersion
• Flexibility and convenience
• Direct access to
specialists/tertiary care
• Autonomy in selecting services
what are the disadvantages of health care dispersion
• Higher costs involved • Tendencies toward fragmentation • Lack of organizational coherence • Difficulty of integrating care and maintainingcontinuity • Unnecessary procedures/risks of medical error
New Medical Structures
-Multi-speciality
group practice
-Community
Health Centers
Health Maintenance Organization
You receive most or all of your health care from a network
provider
Independent Practice
Associations
-• An IPA is a loose collection of private doctors who work
in their own practices
-IPA have contracts with HMO
-
Preferred Provider Organization
• The PPO payer receives monthly premiums from
subscribers and employers
• Patients are required to select physicians and hospitals
approved (“preferred”) by the payer
• Providers discount their fees or allow payer to “manage”
the care they give
Accountable Care Organizations
- Affordable Care Act authorized Medicare to initiate ACO program
- • Private insurance and employers plans have also developed ACOs
