The health care delivery system of the future is a complex behemoth that involves the federal and state government, a health care financing administration, the managed care organization, employers, hospitals, doctors, and patients. It will also be a health care delivery service wherein, as Kongstvedt (1997, 3) reports, “unmanaged care is no longer affordable.” The future health care delivery system will be much like our modern one. Medicare for those over 65 or those with disabilities and Medicaid for those with low or no income will continue to be the primary forms of health care financing on the federal and state levels. A health care financing administration will oversee financing. According to Wagner (1999, 4) its primary purposes will be to “regulate the use of government funds for health care” and to “prevent fraud.”
The HCFA directly oversees the managed care organizations. There are four players in the health care system linked to the managed care organizations: employers; hospitals; doctors; patients. In between these four connections there are other players who monitor and check the system, like the diagnosis related group (DRG) which acts in the following manner between the managed care organizations and the hospital: “Fundamental unit of reimbursement for impatient services; admissions are classified according to a fixed rate paid by Medicare; utilization review checks whether the services provided for a DRG are justified” (Wagner, 1999, 13).
Health policy is partly responsible for the structure and financing of the modern and future health care delivery system. Access to health care is becoming dependent on the ability to pay of the patient, at least as far as their membership in one managed care organization plan versus another. Different plans allow for access to different physicians and hospitals, provide different co-payment levels, have different stipulat
...