It can be argued that the transformation of the health care delivery system from a fee-for-service system to one in which health maintenance organizations (HMOs) predominate has led to some significant health service outcome transformations. On the one hand, managed competition may give individuals and small employees the same advantages that large employers have, making health care more affordable and accessible and spreading risk among many individuals. On the other hand, as noted by the American Medical Student Association (AMSA) (2008), managed competition requires providers to accept both health and sick patients and in many instances, insurance companies are unwilling to offer or pay for high quality service or to improve technology and treatment for more unhealthy individuals.
The AMSA (2008) also argues that the transformation of the system in the United Sates has decreased the accessibility of high quality services to many different groups, particularly those workers with limited choices in terms of health care payer systems or service providers. At the same time, the Medicare and Medicaid public payer models are confronted by limited resources, thus reducing the access of selected populations to advanced care in some instances. Many different groups are underserved in the current health care delivery environment and costs of state-of-the-art care are clearly escalating (AMSA, 2008).
The American Medical Student Association. (2008). Theoretical
models for delivering health care. Available at
www.amsa.org/uhc/theories.cfm. Accessed online, February
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