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IS4D: Health Delivery Models

Page history last edited by editor 7 years, 7 months ago
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Model Evaluation Frameworks
Health Financing Models

Health Delivery Models

 

Health Delivery Models

 

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Health Delivery Models
Programs that reduce fragmentation and informality of health care delivery and that may enable financing, regulation, training and new business models.
Franchise A group of providers that operates under the same brand, but where outlets are operator-owned and services are standardized by a central franchisor.
Chain A group of providers that operates under the same brand, but where operators are paid employees of a sponsoring organization.
Network A group of providers that are loosely joined to deliver services to specific population groups. Each provider is a separate entity and retains its own branding. Membership in the network may entitle the provider to payments, patient volume, central services, or training
Cooperative A group of providers that affiliates with one another in order to improve efficiencies. May share services such as supply chain and financial management.
Professional association An organization that seeks to further a particular healthcare profession, the interests of individuals engaged in that profession, and the public interest. Often entrusted with maintaining control or oversight of the legitimate practice of the profession.
Integrated delivery system An organization that delivers a full continuum of care (prevention, primary care, secondary care, tertiary care, ancillary services, etc.). Some integrated models also incorporate financing by collecting prepaid premiums to cover the cost of care for members.
Health Financing
Programs that mobilize funds for health care and align provider incentives to increase access for targeted groups of patients or to support select health interventions.
National (social) health insurance A health insurance scheme sponsored by government that pools resources, spreads risk across a broad population, and expands coverage.
Micro/community health insurance Health insurance packages sponsored by communities that pool funding from individual contributions of community members.
Private health insurance Health insurance products offered by private companies for purchase by individuals or employers.
Vouchers Subsidized coupons distributed to a target population which may be used to purchase specific health goods and/or services from approved providers.
Contracting Programs where a government entity selects and pays one or several providers to deliver specific health services to specific populations. Contracts sometimes replace what were previously government-provided services.
Cross subsidization Programs that charge full-fees for services to patients that are able to afford them and use the profits to subsidize services for the poor.
Regulating Performance Programs that set standards and enforce or incentivize higher quality care or increased access for target populations.
Licensing, accreditation, and quality enforcement Programs and policies that give credentials to select providers based on having met certain quality, structural, and managerial standards. Also, any program that mandates specific clinical practice guidelines, and/or monitors providers over time to ensure quality.
Pay for performance Programs or policies that incentivize quality by rewarding providers financially for meeting pre-established targets for the delivery of health care services.
Incentives or mandates for expansions of access Government policies that create incentives or requirements for private organizations or professionals to serve underserved populations or provide high-value services (e.g., tax breaks for facilities in rural areas, requirements that a certain portion of clients fall below the poverty line, requirement that facilities must treat patients with medical emergencies regardless of ability to pay).
Other policy or regulation Programs and policies that incentivize quality and provide consumer protection by standardizing medical and institutional practices, regulating insurance packages and coverage, placing limitations on marketing, etc.
Changing Behaviors Programs designed to change the behavior of individuals involved in health care transactions by educating patients about what kind of care to seek or providers about how to deliver higher-quality services.
Social marketing Programs that aim to change consumer care-seeking behaviors through marketing/advertisement techniques. These are often used to encourage patients to seek and purchase particular products or to promote quality networks or franchises.
Consumer associations Organizations that act in the interest of consumers to promote quality, safety, fairness, and responsiveness.
Provider training Programs that seek to improve the quality and/or efficiency of services by training health care workers and/or building the internal capacity of organizations.
Other health awareness/education Programs that create social awareness and educate the public about specific health topics such as disease prevention and treatment, healthy behaviors, correct use of pharmaceuticals, etc.
Enhancing processes Processes, technologies, or products that facilitate increased efficiency, lower costs, higher quality, and/or improved access.
Information and communications technology Programs that utilize technology to enable remotely delivered care, communication, and exchange of medical information (e.g., telemedicine, call center, cell phone technology, biometric system, etc.).
Innovative operational processes Programs that improve quality, reduce costs, or enhance efficiency of services through new business or care processes (e.g., high-volume/low-cost operational models, process standardization, shifting of tasks to less-trained personnel).
Mobile Health Programs that utilize various models of transportation to deliver services to rural and remote populations. (e.g., ambulance services, health worker transport, traveling clinics/products, etc.)
Supply chain enhancements Programs that reduce costs and improve efficiency of supply chains that move medical products from manufacturer to retailer.
Innovative medical products and equipment Programs that design, manufacture, and sell new products such as rapid testing kits, nutritional supplements, or other medical supplies, that reduce costs, improve quality, or enable remote care.

 

 

 

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