Complexities of Delivering Health Care

Davino Jean Marie

摘要

Delivery of safe, effective, patient-centered, timely, efficient, and equitable care in a contemporary health care setting requires successful strategic integration of the various departments, programs, and procedures of the particular health care system. To achieve this goal in any health care system, the evaluation of the health system must take place. Evaluating the health care system can bring about needed change that can benefit the system while increasing the effectiveness of health care delivery for the patient, institution, and community. Evaluating health care systems includes analyzing the degrees of effectiveness, efficiency, and equity the system provides. Effectiveness describes the improvement of health in patients or populations the health care system serves. Administrative procedures, risk management programs, and epidemiological focuses contribute to the total system effectiveness. This article will review topics that are significant in delivering effective, efficient, equitable, and safe health care in a challenging, contemporary health care system. COMPLEXITIES OF DELIVERING HEALTH CARE Delivery of safe, effective, patient-centered, timely, efficient, and equitable care in a contemporary health care setting requires successful strategic integration of the various departments, programs, and procedures of the particular health care system. To achieve this goal in any health care system, the evaluation of the health system must take place. Evaluating the health care system can bring about needed change that can benefit the system while increasing the effectiveness of health care delivery for the patient, institution, and community. Evaluating health care systems includes analyzing the degrees of effectiveness, efficiency, and equity the system provides (Aday, Begley, Lairson, & Balkrishnan, 2004). Effectiveness describes the improvement of health in patients or populations the health care system serves. Administrative procedures, risk management programs, and epidemiological focuses contribute to the total system effectiveness. Efficiency depends on the health system’s available resources and the methods by which the resources are put to use. In the health care economist’s view, health care is the output attainable by production and allocative efficiency (Aday et al., 2004). Optimum production and allocative efficiency is present when strong administrative policies and procedures, practical risk management programs, and ongoing quality improvement measures and evaluations are in place. In addition, marketing functions are important in attracting patients to receive the products and services the system has to offer from production. Attending to the concerns that can make a health care system better for the population it serves can help make the system more viable in the market by producing satisfied and possibly, healthier patients. Equity involves the degree to which health disparities exist and the methods by which the health system addresses the disparities. Notably, the health care cost/quality/access dilemma is of ongoing concern. As health care costs continue to rise outside the reach of the governments and insurers, the growing concentration on quality care, preventative medicine, and equal health care access may eventually lose its momentum. The costs of implementing researched, detailed, and compliant programs may be too much for some organizations. In addition, the extreme growth of health care costs produced a net result of patients not obtaining the care they should be receiving, though others are in receipt of treatments that are either needless or out-and-out harmful or damaging (Linden, 2011). This article will review topics that are significant in delivering effective, efficient, equitable, and safe health care in a challenging, contemporary health care system. Administration: Views and Realities Approaches that emphasize operational structures or institutional arrangements arrange health systems along a single continuum from market-maximized (or mostly private) to market-minimized (or mostly public) (Anderson, 1989). On the continuum of industrialized national health systems, the United States (U.S.) is constantly changing from the market-maximized end of the spectrum toward the market-minimized end of the spectrum. In regard to market-maximized, health care is a good like other goods, resources are allocated by market prices, private and voluntary health insurance dominates, consumers exercise control over what goods to buy and at what prices, and purchasers and providers are assumed to be equally matched (Hsiao, 1992). Pressures are exerted on health care systems that are causing a focus on the quality and fair distribution of care as the people of the U.S. become more educated about health care issues. Hoangmai (as cited in Health System Change, 2005) states, “A clear hierarchy of access to care is emerging in many communities-there is growing evidence that U.S. society i

机译：在现代医疗保健环境中提供安全，有效，以患者为中心，及时，高效和公平的医疗服务，需要成功地战略整合特定医疗保健系统的各个部门，计划和程序。为了在任何卫生保健系统中实现此目标，必须对卫生系统进行评估。评估医疗保健系统可以带来必要的变化，使系统受益，同时提高为患者，机构和社区提供医疗保健的效率。评估医疗保健系统包括分析系统提供的有效性，效率和公平性程度。有效性描述了卫生保健系统服务的患者或人群健康的改善。行政程序，风险管理程序和流行病学重点有助于整个系统的有效性。本文将回顾在具有挑战性的现代医疗保健系统中提供有效，高效，公平和安全的医疗保健方面具有重要意义的主题。提供卫生保健的复杂性在当代卫生保健环境中提供安全，有效，以患者为中心，及时，高效和公平的护理，需要成功地将特定卫生保健系统的各个部门，计划和程序进行战略整合。为了在任何卫生保健系统中实现此目标，必须对卫生系统进行评估。评估医疗保健系统可以带来必要的变化，使系统受益，同时提高为患者，机构和社区提供医疗保健的效率。评估医疗保健系统包括分析系统提供的有效性，效率和公平程度（Aday，Begley，Lairson和Balkrishnan，2004年）。有效性描述了卫生保健系统服务的患者或人群健康的改善。行政程序，风险管理程序和流行病学重点有助于整个系统的有效性。效率取决于卫生系统的可用资源以及使用这些资源的方法。医疗保健经济学家认为，医疗保健是通过生产和分配效率可获得的产出（Aday等，2004）。当制定有力的行政政策和程序，切实可行的风险管理计划以及持续的质量改进措施和评估时，就可以实现最佳的生产和分配效率。此外，营销功能对于吸引患者接受系统必须提供的产品和服务也很重要。关心可以使医疗保健系统更好地服务于其所服务的人群的担忧，可以通过产生满意且可能更健康的患者来帮助该系统在市场上变得更加可行。公平涉及健康差异存在的程度以及卫生系统解决差异的方法。值得注意的是，医疗保健成本/质量/获取的困境一直令人担忧。由于医疗保健成本继续上涨，超出了政府和保险公司的承受范围，因此越来越多的注意力集中在优质医疗，预防医学和平等的医疗保健机会上，最终可能会失去动力。对于某些组织来说，实施研究，详细和合规的程序可能会付出太多的代价。此外，医疗保健费用的极端增长最终导致患者无法获得应得到的护理，尽管其他人正在接受不必要或彻底有害或破坏性的治疗（Linden，2011年）。本文将回顾在具有挑战性的现代医疗保健系统中提供有效，高效，公平和安全的医疗保健方面具有重要意义的主题。行政管理：观点和现实强调运营结构或制度安排的方法是沿着从市场最大化（或多数为私有）到市场最小化（或多数为公开）的单一连续体来安排卫生系统（Anderson，1989年）。在工业化的国家卫生系统的连续性上，美国（美国）不断地从频谱最大化的市场向频谱最小化的市场转变。就市场最大化而言，医疗保健就像其他商品一样好，资源由市场价格分配，私人和自愿健康保险占主导地位，消费者对购买何种商品和以什么价格行使控制权，并且假定购买者和提供者相等地匹配（Hsiao，1992）。随着美国人民对医疗保健问题的认识日益提高，对医疗保健体系施加了压力，这导致人们对医疗质量和公平分配的关注。 Hoangmai（如2005年卫生系统变更中所引用）指出：“许多社区正在形成一种清晰的获得医疗服务的等级制度-越来越多的证据表明，美国社会

Complexities of Delivering Health Care

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