The four components of the healthcare delivery system are finance, insurance, delivery, and payment, each acting as a continuum affecting the individual’s access to healthcare (Denisco, 2021). Fortunately, although for-profit hospitals and clinics may have issues with some clients paying bills, profit margins are maintained due to third-party providers and insurance payments (Denisco, 2021). However, most clientele needs more medical coverage because the Direct Process Improvement (DPI)plan site is a nonprofit clinic. Hence, the clinic services, medical supplies, and overhead are paid primarily through donations or reimbursements from Medicare or Medicaid. Thus, the two components of the healthcare delivery system which may have the most substantial impact on the DPI include finance and providers.
Stakeholders often indirectly affect provider care in massive hospital conglomerates (Denisco, 2021). For example, some insured patients may require prior authorization from the insurance provider before receiving certain medications or diagnostics. Insurance companies may receive discounts for referrals to companies or service providers, thus directing utilization. However, in a nonemergent situation, providers accept payments and provide care once the deductibles are met. Unfortunately, the financially insecure patient may not have the luxury of receiving nonemergent care due to financial constraints, and the impoverished nature of their current existence limits care options; with the DPI’s setting offering services that mitigate the exorbitant healthcare spending that their lack of primary prevention access imposes.
In part, many financially insecure patients are unaware of the availability of Medicare or Medicaid benefits (Denisco, 2021). Medicare and Medicaid are financing services allowing patients to receive care at a subsidized or cost-free rate. For diabetic patients, these services enable them to obtain diagnostic and preventative treatment, decreasing the probability of adverse outcomes. Hence, as portions of the DPIs intervention is to initiate medical nutrition therapy, including dietician referral, financing is one of the healthcare delivery components that will vastly affect its implementation.
Clinic social and community health workers tirelessly advocate for patients to receive the financing needed to increase the likelihood of provider services, the second component of the four processes of the healthcare delivery process affecting the DPI (Denisco, 2021). Although clinicians at the DPI site are volunteer workers, laboratory, vision, dental and podiatrist screenings may require costs not covered by the clinic. For example, the MNT strongly encourages lipid and glycemic values. Fingerstick glucose and Hba1c services are provided in the clinic; however, the patient lipid panels must be outsourced to local labs with free services. This healthcare delivery factor will ultimately affect the DPI process, as some patients do not qualify for government insurance (finance) and need the means to pay for the delivery services. The DPI will not prescreen for the ability to pay for MNT services; therefore, delivery and finances may affect the implementation of the intervention.
Denisco, S. M. (2021). Advanced practice nursing: Essential knowledge for the profession (4th ed.). Jones & Bartlett Learning.
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