SLP Healthcare Delivery System in the US


The US is one of the countries that offer good health services. The government has continued to enact regulations that ensure that every citizen has access to quality healthcare services. The previous administration came up with a health care program, the Obamacare which was a remedy to the low-income earners. Today, the country reports the highest percentage of individuals under health care cover. There are several types of health insurance covers designed to meet the needs of every US citizen. The plans vary according to factors such as percentage coverage and the need for a primary doctor. People have the responsibility to ensure that they get the right health insurance services for them and their families. Examples of health insurance plans include Point of Service, Health Savings Account, Health Maintenance Organization, Indemnity, Exclusive Provider Organization, and Preferred Provider Organization. The will discuss my preferred type of insurance, which is the Health Maintenance Organization.

The Point of Service is the plan that outlines a network of health care providers where the subscriber is privileged to pay less. Otherwise, to visit a specialist, there is the requirement of getting recommendation from the primary doctor. The second plan is the Preferred Provider Organization, which allows the user to pay less on the health provider network outlined. In addition, subscribers are allowed to seek services outside the company network of service providers when referred, though, at an extra cost (Doshi et al., 2016). Third, there is the Health Maintenance Organization. It compels subscribers to seek services only from the doctors who are contracted by the company. The program may also participate in wellness and prevention. The fourth plan is the Exclusive Provider Organization, a plan that allows its subscribers to seek services from its network of health service providers. Otherwise, emergency services can be sought out the network.

I preferred to use the Health Maintenance Organization plan due to the features associated with it. The plan offers services with which I am comfortable. While settling on my preferred insurance type and company, I had to put certain factors into consideration. First, it was necessary to consider the reputation of the company (Nyman & Trenz, 2016). The image of the company and how it has served its customers has much to portray about the reputation of the company. Secondly, it was necessary to look into the cost of the plan. I had to take a plan that I could easily afford. Since the plans require premiums that are submitted on a monthly basis, the plan had to be within my financial capability.

Thirdly, it was important to analyze my health status and find out my future medical needs. There individuals who may be certain with regular medical attention due to their conditions. For example, a cancer patient is likely to go for specialized medical care. Fourth, circumstances may force the subscriber to cost-share with the insurance company. Therefore, I had to find out the amount I was willing to cost-share in case there would be the need (Doshi et al., 2016). In that regards, I considered items such as a copayment, coinsurance, and deductibles. The next factor to consider when selecting a health insurance plan is whether an individual needs regular prescriptions. In case the subscriber intends to take regular prescriptions, choosing a plan that accommodates that would be the best option. Lastly, a subscriber considers if the doctor is included in the network.

My preferred plan, which is Health Maintenance Organization offers a wide variety of services to the clients. The plan was initiated in 1974 through the federal legislation. The plan provides clients with wide range of preventive services. Through the plan, the subscriber has to choose a primary care physician who would be responsible for most the needs. The client has the privilege of identifying the best and most convenient PCP for them. Otherwise, the plan compels the user to visit only the listed health care providers. A notable disadvantage is that users have less flexibility to have hospitals and physicians of their choices. HMO has a minimized co-payment. The client is required to pay monthly premiums and gets numerous health services in exchange. The plan does not only cover subscribers but also their families.

Some of the available services include x-rays, laboratory tests, surgery, therapy, hospital stays, and emergency care. The insurance service providers usually enter into agreements with hospitals and health care professionals to offer the services to their clients. Subscribers to the insurance policies are, therefore, limited to the doctors and health care providers that are in agreement with the health insurance company. There are exceptional cases to the limitations. For example, emergency care is covered from any physician or health institution. In each visit, the subscriber is, however, required to pay a small co-payment. Otherwise, the cost of using HMO services is relatively small. The health insurance companies have the mandate to provide the care services due to the regular premiums submitted monthly (Nyman & Trenz, 2016). As a result, they have preventive programs that ensure that ensure that health problems may be handled at earlier stages without letting them worsen. Some of the preventive cares include immunization, office visits, physicals, check-ups, and mammograms.

HMO has notable characteristics that make it unique. Subscribers pay relatively lower premiums. The definition of its services enables users to have good financial planning so that they do not get overburdened by huge health bills. Secondly, users have to opt to work with the selected institutions and professionals in the network (Buss & Van, 2014). That promotes an effective relationship between the user and health service providers. Next, the plan engages in preventive programs. The plan has a long-term initiative to monitor the health of their clients. Preventive measures not only impact on the health of clients but also help the insurance companies to avert possible health expenses that are avoidable.

In conclusion, the US is one of the advanced countries that are successful in providing its citizens with quality health care services. The government has set a favorable environment that facilitates the provision of health services to everybody (Doshi et al., 2016). There have been constitutional introductions that have promoted the growth the industry to make health care services accessible to every American citizen. There are types of insurance coverage plans available according to the needs of everybody. My preference is the HMO which comes along with lucrative offers. Some features make me prefer HMO owing to the earlier discussed factors considered when choosing a plan. For example, the plan has affordable premiums that fall within my financial ability. Otherwise, one limitation of the plan is the lack of flexibility in selecting health care institutions and professionals.