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Identify 3 constituents of integrated health care delivery systems (IDS) and describe its development. What benefits directly apply to the provision of allied health care services? What limitations exist at present that could be improved, and how so?
Integrated Health Care Delivery Systems (IDS) are critical to modern healthcare delivery. Their structure and evolution offer specific benefits to allied health care, though several limitations currently exist.
The three fundamental constituents of an Integrated Delivery System (IDS) are the providers, the facilities, and the payment mechanism (often the health plan).
Organized Provider Network: This includes the physicians (primary care and specialists), nurses, and allied health professionals who are either employed by the system or contractually bound to work together. This network ensures a standardized approach to care.
Integrated Facilities/Infrastructure: This encompasses the physical locations—hospitals, outpatient clinics, urgent care centers, and rehabilitation facilities—that are often centrally owned or managed by the system. This allows for centralized scheduling and resource allocation.
Payment Mechanism (Health Plan): This is often a prepaid health plan (like an HMO or the insurance arm of the system) that covers the patient's care. This vertical integration aligns the incentives: the system profits by keeping the patient healthy and preventing high-cost interventions (a shift from fee-for-service to value-based care).
The development of IDS in the U.S. was primarily driven by the goal of cost control and quality improvement following the unsustainable growth of the fee-for-service (FFS) model post-World War II.
Early Managed Care (1930s-1970s): Early models like Kaiser Permanente were established to provide prepaid, comprehensive care to a defined population (e.g., industrial workers), naturally linking payment to provider.
The HMO Act (1973): Federal legislation encouraged the growth of Health Maintenance Organizations (HMOs) as a means of controlling rising healthcare costs.
The 1990s and Beyond: As competition intensified and costs soared, many fragmented hospitals and physician groups merged or formed affiliations. The focus shifted from merely controlling cost to managing population health and utilizing information technology (Electronic Health Records) to coordinate