Health Care Delivery System In The United States

507-MHA SLP MOD 1 Student’s Name Institution Part I The health insurance that I currently have is TRICARE Prime. Most of its features are similar to those of HMO. For this cover, a primary care manager (PCM) is mandatory as they help in the facilitation of referrals to specialists as well as in managing care. The PCM is a doctor who has been assigned to a sponsor and is part of the network of TRICARE providers. Therefore, once you have enrolled in a TRICARE plan, your PCM is your primary doctor. There is a TRICARE provider directory where members can choose a PCM from or they can also select one from a military treatment facility. The provision of nonemergency care by PCM is usually done through a military hospital. In the event of unavailability of military specialty care, the PCM approves care from a civilian specialist. There is a civilian provider network that is made up of health care facilities and physicians that have been contracted to provide services to TRICARE members. TRICARE is provided by the government and primarily covers military personnel on active duty and their family members (Maruthappu, Ologunde, & Gunarajasingam., 2013). Retirees and their family members who do not qualify for Medicare are also covered under TRICARE. The program seeks to provide military personnel with access to high-quality services in order to support military operations. TRICARE is administered by TRICARE Management Activity (TMA), which is accountable for the quality of care received by members. According to Green (2018), there is case management in the program that monitors and coordinates the health care options for a beneficiary in order to promote cost-effective and quality outcomes. There is also a program integrity office that develops the procedures and policies to prevent, detect, and investigate fraud related to the program. Therefore, TRICARE is provided by the government, which has several functions to oversee its implementation. It is important to note that there are several options under TRICARE including TRICARE Standard, TRICARE Extra, and TRICARE Prime. TRICARE Prime costs lowest and provides comprehensive care benefits to beneficiaries. Under TRICARE Extra, one has the option of selecting a preferred provider and is thus similar to PPO. There is maximum flexibility in choosing providers under TRICARE Standard as costlier compared to the other two. The level of coverage of my plan is 100%. This means that the plan fully covers my medical expenses. As such, I am able to visit PCM for regular checkups as well as in emergency situations. It is important to note that the approval of PCM is significant and can affect one’s medical costs. In the case one seeks care without prior approval of PCM, there is a point-of-service option that is activated, which requires one to pay an annual deductible as well as half or more of treatment or visit fees. There exi...