Health Care Delivery Systems in the United States

Health Care Systems
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Health Care Systems
The need for healthy communities is a concern that stakeholders, including caregivers, experts in medicine, and political class, seek to address. The U.S. government is committed to ensuring its millions of citizens have access to quality health care (Ratna, 2020; Mjåset et al., 2020). Therefore, the country has embraced a complex healthcare delivery system that best serves the interests of intertwining relationships between patients receiving care, payers, and providers. Although the U.S. healthcare system is defined by a constant state of evolution, today, one can explain it by two types of designs, including preferred provider organizations (PPOs) and Health Maintenance Organizations (HMOs) (Moattari & Mohit, 2023). This current review examines the similarities and differences between PPOs and HMOs, defining the systems and identifying key goals, subjects, barriers, opportunities, future impacts, and the role of nursing. 
Definition and Description of the Delivery Systems
HMO is an organization that arranges and provides coverage of designated health services for a prepaid premium. The premium is often fixed and relates to services the target group needs. This delivery system could further be divided into a staff, network, individual practice association, and group model. Following the HMO, a primary care physician act as the gatekeeper, providing preventive and primary care to patients (Moattari & Mohit, 2023). These professionals refer patients to and coordinate care needed outside their scope. However, other than emergency care, any care not administered or coordinated by the primary care physician is not covered under HMO. On the other hand, PPO is a system that establishes contracts with medical care providers. In this case, the contracted providers are the preferred caregivers. PPO facilitates dispensing care at a discount through these contracts. Patients will have an enormous financial responsibility if they utilize providers not part of the PPO network. 
Both systems provide treatment to the injured and sick. They are meant to offer preventive care to communities nationwide to improve quality of life. Preventing illnesses is perceived as a perfect approach to cutting costs within the American healthcare system. The systems prevent diseases by engaging professionals who various insurers fund to implement specific programs. The designs further attempt to cut costs for the healthcare system and individuals by constantly making necessary adjustments. They acknowledge the need for every person’s well-being by serving as organizations that provide resources and develop guidelines for helping patients. The two systems are also similar in their constitution. They include all resources, people, organizations, and institutions that help various groups of citizens stay healthy. 
Goals/Philosophies of the Systems
A significant goal of PPOs is to create a network of participating caregivers. The system does this by contracting doctors, nurses, and hospitals. It holds for a low cost of health care services. Therefore, it encourages patients to utilize contracted ...