Difference in Health Care Models, Research Paper Example

Health care delivery models have evolved over time.  Starting with a basic independent practitioner model in the early half of the twentieth century, with the development of technology and the sector, health care delivery models also evolved.  This brief will look at two major changes in health care delivery: 1) The adoption of the “managed care” model in the 1980s and 1990s; 2) The adoption of the ACOs in the current environment of health reform.

The adoption of the managed care model in the 1980s and 1990s was largely a function of changes in cost and access.  As health insurance become more common after WWII, health care costs rose accordingly: Economists have estimated that prices experienced double-digit increases over the 1970s and 1980s (Ginsburg, 2004).  As a result of increasing costs, health insurers decided to implement a new model that would essentially install a “gatekeeper” (doctor), and restrict access to specialists, whose are is more expensive than that of family doctors.  While managed care was successful (perhaps more than any other health care delivery model) in stemming the upward trajectory of costs, the backlash from consumers and doctors alike was harsh: Patients did not like having access restricted; doctors thought that the focus on access potentially had an adverse impact on outcomes.

In response to the managed care model, health care delivery once again continued to open up access over time.  With this reversion, however, costs continued to increase and outcomes were also not improved.  This has led to the accountable care organization model (ACO).  While some have mistaken the ACO model as a partial reincarnation of the managed care model, the ACO has several key differences: 1) ACOs are to focus on outcomes, not cost; if access is restricted and outcomes  are not improved, the ACO would pay for that.  2) ACOs are based on a coalition of different organizations (insurers, providers, hospitals), this “mixture” in health care delivery is meant to draw upon the skills of each partner in delivering care.  No one believes that ACOs are the final stop for health reform or the most efficient health care delivery system, health care delivery in the US will continue on evolving along with the consumer preferences and ability of the medical system to respond.

Sources

Ginsburg, P. (2004). Controlling health care costs. New England Journal of Medicine, 351 (16), 1591-1593.

Luft, H.S. (2010).  Becoming accountable- opportunities and obstacles for ACOs.  New England Journal of Medicine, 363 (15), 1389-1391.