Health Care Delivery Systems The structure and organization of the resources that make it possible to provide health care services to target populations is referred to as a health care system. The variety of health care systems is very wide with strong evolutionary histories tied to the governments, religious organizations, charitable organizations, labor unions, and for-profit market participants.

Five Health Care Delivery Systems

Reid set out around the world to study healthcare systems in countries across the globe. He identified five distinct healthcare delivery systems. They are as follows: (1) The Bismarck model; (2) the Beveridge model; (3) the national health insurance model; (4) the out-of-pocket model; and (5) the American model for health.

The Bismarck model. Otto von Bismarck is credited with establishing the first form of this model that is followed in Germany. Private companies and private initiatives provide the medical services and insurance coverage under this model. The insurance companies are non-profits and must enroll all German citizens unconditionally. With the exception of a very rich minority, all German citizens and people living or working in Germany under special Visas are required to sign up for health insurance coverage. Costs are control is dependent on the central role that the German government takes in determining the payments permitted for various medical and health services.

The Beveridge model. This British model is very similar to socialized medicine as most healthcare providers are government employees. In essence, the British government acts as a single-payer for all medical and health services in the United Kingdom. Patients currently do not incur any out-of-pocket costs, but the system is experiencing substantive pressure as medical and healthcare costs continue to rise.

The national health insurance model. This Canadian model functions like the system in Britain with the government acting as a single-payer for medical and healthcare. Most medical and healthcare providers are private entities, unlike in the British system where the government is a major employer for healthcare providers. Costs are relatively low, enabling the system to provide healthcare to all citizens. The waiting times for elective procedures are incredibly long, and this continues to be the major flaw in the way this system is currently implemented.

The out-of-pocket model. Most underdeveloped and poor countries follow this model of healthcare. No wide-spread private systems or public systems of health insurance exist in countries with these models. Healthcare and medical are paid for by citizens directly, hence, the reference to out-of-pocket. The ramifications of this type of system is that poor, marginalized, or underprivileged people are not able to obtain essential healthcare, and the life expectancy rates and infant mortality rates are very low as a result.

The American model for health. The model used in the United States is a composite of different aspects of the international healthcare and medical care systems described above. The American model applies to working citizens under the age of 65 in much the same way that the Bismarck model does in Germany and Japan. The primary difference is that health insurance companies in America can operate as for-profit businesses. The American model assumes operations similar to the Beveridge system for citizens who are in the military, are veterans, or are Native Americans. In these cases, the federal government acts as both the payer and the provider of healthcare and medical care services. For American citizens over 65, the American model approximates that of the Canadian single-payer system, since the federal government is essentially the insurer while medical services are delivered by the private sector. Moreover, for Americans without healthcare insurance, the closest delivery model is the out-of-pocket version experienced by people in underdeveloped and poor countries. Since people in this category are expected to pay for their medical care and healthcare services, the high costs of medical facilities and treatment puts most care out of their range -- they are forced to go without healthcare and very often go without necessary and critical medical care.

2. Leadership Effectiveness, Efficacy, and Domains

The literature identifies 13 primary attributes of effective governing boards (Adams, 2005). These attributes are as follows: (1) Trustees who are dedicated to their roles and responsibilities; (2) Power is used by the board as a group; (3) Strategic...

The trustees identified the following variables: (1) Board endorsement of additional education for trustees (92%); (2) Conducting a formal CEO performance review (91%); (3) Board composition of mostly outside independent directors (81%); (4) Chairman of the board is an outside director (80%); and (5) Regular board and trustee performance evaluation (76%) (Jaklevic, 2003).
3. Classification of Health Services System Types

Healthcare service systems can be classified according to payer / provider configurations: (1) System acts as payer; (2) system acts as payer and provider; and (3) system acts as provider. See section 1 above for explicit examples of systems in each of these categories.

4. U.S. Healthcare Governance & Responsibility

The Center for Healthcare Governance is a nationally recognized organization that functions as one of the foremost voices in hospital and health system governance. Their declared purpose is to advocate for and support health care governance that is accountable, innovative, and excellent. The center is affiliated with the American Hospital Association

The responsibilities of medical and healthcare organizations governance includes performance in the area of finance, payer relationships, quality of care, quality of services, strategic planning, and governing board quality (Adams, 2005). Boards of directors are not convened to assist staff or to perform pro forma approval of staff intentions and plans (Adams, 2005). The board must not function in a manner that confirms the board committee's own decisions (Adams, 2005). Rather the board's committees should function in a manner that serves to inform the board and increase the common level of knowledge of the options, forces, and variables of each substantive decision (Adams, 2005). This means that the board committee must not eliminate or remove difficult decisions from the board's table and the board committees must avoid assuming the prerogatives of the board proper (Adams, 2005). Effective boards of directors are responsible for the collective contemplation and deliberation of issues of importance to the healthcare system, organization, and consumers (Adams, 2005).

5. Explain healthcare outcomes in relation to systems issues and management

The primary issues for outcomes with regard to systems and management have to do with the tension between quality of care and cost of service delivery. For profit systems are at one end of the continuum and charitable systems are at the other end. Money is always a variable in healthcare systems -- if it were not, wealthy people would not elect to pay for care on a private, non-group basis. Management issues are addressed in the section on governance and leadership. All too often, boards of directors act as rubber stamps to staff initiatives and plans, or they act as agents of the shareholders. Ethics should always be paramount in healthcare -- all too often, ethical considerations are sacrificed to ensure profitability. The quality of care and the provision and access of care are well demonstrated in the international models discussed in section 1.

6. What is return on investment and how can it be utilized for quality efforts?

Return on investment or ROI is a financial ratio that reports the performance accomplished through monies invested in a firm or organization or initiative. Return on investment is used to demonstrate the benefit -- or lack of benefit -- directing resources at a particular effort. For instance, ROI is used to demonstrate the effectiveness of a marketing campaign -- the extent to which spending money on advertising, marketing, and media buy resulted in higher profit margins or more sales revenue. In the same manner, ROI can be used to demonstrate improved quality of healthcare services according to the use of resources directed at that purpose. In other words, does spending for staff training in evidence-based practice result in better patient care?

7. Best Practice Engagement of Global Health Partnerships

The following best practices have been identified by the World Health Organization for making decision about engaging in collaborative partnerships at the country level. Paramount is an overarching consideration for ensuring that a partnership or collaborative arrangement does not place additional burdens on the organization, that transaction costs are minimized by the partners, and that there is adherence to the accountability framework of the organization. The best practices principles identified by the…