Current types of health care delivery systems in the United States

Out-of-Pocket Model (Uninsured): Care is paid for directly by the patient. Although the Affordable Care Act (ACA) significantly reduced this population, millions remain uninsured and rely on emergency rooms for mandated stabilization care (EMTALA).

Contractual/Organizational Structures

Within these financing models, services are typically delivered through various managed care organizations:

HMOs (Health Maintenance Organizations): Use Primary Care Physicians (PCPs) as gatekeepers and limit coverage to providers within the HMO's specific network.

PPOs (Preferred Provider Organizations): Offer greater flexibility to see out-of-network providers at a higher cost.

ACOs (Accountable Care Organizations): Groups of providers accountable for the total care costs and quality outcomes for a defined population, representing a key shift toward reform models.

Contrast with Proposed Reform Models

The current status is dominated by the Fee-For-Service (FFS) payment model, which rewards the volume of services provided (e.g., more tests, more procedures).

The fundamental reform models proposed and currently being implemented seek to shift the entire system toward Value-Based Care (VBC):

Key reform structures like Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs) embody the VBC shift by requiring integrated care, focusing on population health, and tying provider reimbursement to quality metrics and cost savings.

Proposed Reform for Allied Health Care Delivery

One area in healthcare delivery where reform to the current system could significantly improve the delivery of allied health care is Reimbursement and Recognition of Allied Health Professionals (AHPs) in Value-Based Care Models.

The Problem in Current Delivery

Under the traditional FFS model, many essential allied health services (like health coaching, nutrition counseling by Registered Dietitians, or routine physical therapy maintenance) are often poorly reimbursed or not covered at all, particularly when delivered independently of a physician's direct service. This limits patient access to comprehensive preventative and rehabilitative care.

Sample Answer

The United States healthcare system is a complex mixed model, uniquely combining elements of several international systems, which creates a highly fragmented delivery structure. The current reform movement is largely focused on shifting this structure away from volume and toward value.

Current Healthcare Delivery Systems in the U.S.

The U.S. system is not a single model but rather a combination of four distinct financing and delivery designs:

Bismarck Model (Employer-Sponsored Private Insurance): Used by the majority of the working-age population. It is financed through employer and employee payroll deductions to private insurance companies. Care is delivered primarily by private providers and hospitals.

National Health Insurance Model (Medicare/Medicaid): The government acts as the single primary payer, funded through taxation, but healthcare services are delivered primarily by private doctors and hospitals.

Medicare: Covers the elderly (age 65+) and some disabled individuals.

Medicaid: Covers low-income adults, children, and people with disabilities (eligibility varies by state).

Beveridge Model (Veterans Health Administration - VA): The government both finances the care (through taxation) and directly owns the healthcare facilities and employs the medical staff (socialized medicine).