The US health system does not operate in a rational and integrated way.

 The US health system does not operate in a rational and integrated way.

The US health system does not operate in a rational and integrated way. It is more

of a chaotic relationship between payers, fi nancers, insurers, and delivery systems.

There is also a blend of private and government providers and payers that make it

even more complicated. Some of these include:

• A large array of healthcare settings where medical care services can be

delivered

• An unstructured payment collection system among providers and insurers

• A vast number of insurance agencies, managed care organizations (MCO), and

other types of insurers

• Multiple payers making up their own rules for insurance and pricing of services

• Too many consulting firms offering expertise and healthcare services

This fragmented and uncontrolled healthcare system has some unique challenges

as well. Some of these are:

• Duplication and overlap of services

• Provider ineffi ciencies and a waste of resources among providers

• Inconsistencies and inadequate healthcare services

• The largest healthcare system in the world (too large to be controlled by a single

force)

• Inadequate controls of patient care quality

The US healthcare system has some unique characteristics that make the system

good in some instances of healthcare but very complicated and confusing to manage.

These different characteristics include governance of the system, third-party

payers, technology, and patient care quality.

Medicine and Business: A Practitioner's Guide
Author(s): Ronald V. Bucci (auth.)
Publisher: Springer International Publishing
Year: 2014
ISBN: 978-3-319-04059-2,978-3-319-04060-8