American Health Care Delivery System


According to Shi & Singh (2008), the United States of America has a health care delivery system that is, one of its own kind. It does not resemble any other delivery system in the health care in the world. This structure has for a long period been characterized as a cottage industry which has been split at the countrywide level. It has also been split at practice, state and, community levels. There exist no general policies countrywide that give guidance to the system of health care. The states make the division of responsibilities among several agencies as the providers carrying out their duties in the same society and taking care for the same patients doing their work without depending on one another (Shih, Davis, Schoenbaum, Gauthier, Nuzum & McCarthy, 2008).

The components of the country’s health care delivery system continuum include the in-patient care, the out-patient care, the long-term care, the school health care, the occupational health care, and the mental health care among others. This paper is specifically going to look at one of the components of the U.S health care delivery system and in this case it is going to be the long-term care. It is going to look at the role of the long term care in providing services and how it makes contribution to or lacks to contribute to the general health care resources management. More so, the paper is going to examine the trends in time to come and give a discussion of how these services looked at can be impacted on or require to be adjusted in order to match with these trends that will emerge.

Long Term Health Care

This kind of care has turned out on the increasing level to be a policy issue of urgency. The number of the American people who are elderly and their proportion to the overall population of the country is going up and the American people who attain the age of sixty five are living on for even a longer time. The argument over the long term health care by those people who set up policies and the public in general has flowed out in the course of the last thirty years. Increasingly, many American people together with the leaders have come to encounter a dilemma about the manner in which to meet the elderly people’s needs with the disabilities that are chronic within the country. There has been emphasis by the media about the cost concerned with the long term care and the vitality of it being designed well beforehand, the load put on individuals, and the society in general and the need to have care that is superior. There are struggles by those who formulate policies in defining the roles to be played by the state and federal governments as well as the private sector in providing funds and giving out care to the ageing population with disabilities.

The challenges ahead are;

  1. How and who is supposed to pay for the long term care?
  2. How should the designing of the services to be delivered to the elderly people be done and who is responsible for making this delivery?
  3. How should the recruitment of the personnel responsible for the delivering of the services to these people be done as well as training and maintaining this personnel?

These are the questions that are bringing in much difficulty to the long term care policymakers. Each of these questions requires to be addressed on an equal level if ever the most relevant policies have to be set up.

The issue of providing finances has captured attention periodically from the federal policy formulators from the start of the 1970s. The likely high costs coupled with the absence of the political spirit have brought about strong discussion on the obtaining of long term care and the appropriate equilibrium in responsibility of the public and private sectors.

Long term care focuses on giving help to people in order for them to go on with life in a most comfortable way possible; it requires great involvement by the members of the family as those who provide and make decisions. The families equally benefit from long term care interventions since the care given to the elderly individual who is disabled is a significant lull for the giver of care in the family (Stone & Kemper, 1989).

The long term care includes a wide range of assistance with the day to day activities that those people who are disabled chronically require for a time period that is prolonged. These basic services that are low-tech are made up in such a way that they bring down, restore or make up for loss of independent mental or bodily functioning. These services encompass “Assistance with primary Activities of day to day Living” (ADLs). These include such activities as feeding, putting on clothes, bathing or any other care that is personal. Services may as well assist with “Instrumental Activities of Daily Living” (IADLs). These includes the household activities such as preparing of the meals and carrying out cleanliness, management of life activities such as management of money, transportation, carrying out shopping activities, and management of medication.

The need for long term care come out from the medical conditions that are chronic and which comes about at birth or in the course of the stages of development like dementia, mental illness that goes on for a longer time, diabetes, among others, or that comes about as a consequence of accidents that bring about such conditions as paraplegia. This kind of care is not just an acute care’s extension. Since it goes on for a long time and mostly involves the supportive services that are low-tech, it turns out to be an essential part of the elderly individual’s life that is having a disability (Kane, Kane & Ladd, 1998).

Those individuals who require long term care as well need acute care and primary care when they fall sick but these services that are temporary concentrates on treating a sickness or bringing back a person to a condition that is better in which he or she was previously in. According to Feder & Lambrew (1996), among about five million beneficiaries of Medicare having considerable long term care requirements, the mean Medicare expenses in the year 1993 were standing at about eight thousand nine hundred and sixty dollars as compared to two thousand eight hundred and thirty five for those beneficiaries with no considerable long term care needs. The inpatient hospital care expenses were about fifty percent, about thirty percent of the expenses were for the physicians as well as the visits of the outpatient and the trained facility of nursing, and home health care took about twenty percent of the expenses.

The main strategy in the long term care is to bring together treatment and living for those people who are elderly with disabilities. There should be no undervaluing of the health care for the people who are receiving the long term care, but to bring health care in to the framework of the functions of the day to day life.

In summary, looking at the long term care, it can be concluded that this kind of care is basically concerned with the maintenance and/or improvement of the people who are elderly and having disabilities to work independently through all the possible means. More so, the long term care includes all the environmental and social needs and is thus wider than the medical representation that is dominant in acute care. In addition, the long term care is fundamentally low-tech even if it has turned out to be more complex as the people who are elderly with the medical needs that are far much complicated are set free to, or stay in, conventional long term care situation, their own homes being included. Lastly, both housing and the services are vital in the building up of the long term care policy and structures.


As the predictions of the long term care demand in the future must be analyzed with great care, it is almost not possible to project the extent, nature, and magnitude of the future supply. The services will be dependent not just on their demand but on their financing as well and also on what people are willing and ready to pay for. The make of the systems of delivery is in fluctuation, controlled care may vary in the manner in which the elderly people having disabilities that are chronic get acute and post-acute as well as long term care. Some of the people who observe raise an argument that the process of financing will go on to change. It will go on changing from the federal government to the states, families, and individuals (Cohen, 1998). As the consumers gradually reduce their reliance on the government to finance the long term care, there is likelihood to have a demand for higher flexibility in how the consumers get the services and where to obtain them.

The demand for paraprofessional long term care workers in the future and their supply is supposed to be the main concern to the makers of the policies, prospective consumers, and providers. These workers give out about eighty percent of the care in the nursing homes that is direct and more than ninety percent of the services that are direct and formal at home (Atchley, 1996). The factors bringing about a rising home care aides demand include; the growing old of the people within the population, the rising dependency of the people in the population across all the age groups on home care as the other way of nursing home placement and hospitalization, the extending in the coverage of home care through Medicaid and Medicare, and increasing preferring by many people having disabilities together with the families to which they belong for home care (BLS, 1999; Burbridge, 1993).

The nursing home aides’ demand will go on as a result of the rising pressures on hospitals in terms of finances, the building up of the post-acute care in facilities of skilled nursing and the pattern towards incorporated health and long term care systems. The greater turnover rates of the industry of home care as well as the nursing home give emphasis to the need for an increased number of workers in time to come.

Reference List

Atchley, R.C. (1996). Frontline Workers in Long-Term Care: Recruitment, Retention, and Turnover Issues in an Era of Rapid Growth. Oxford, Ohio: Scripps Gerontology Center at Miami University.

BLS: Bureau of Labor Statistics. (1999a). 1998-1999 Occupational Outlook Handbook: Homemaker-Home Health Aides. Washington, D.C.: U.S. Department of Labor. Web.

Burbridge, L.C. (1993). The Labor Market for Home Care Workers: Demand, Supply, and Institutional Barriers. Gerontologist, 33(1): 41-6.

Feder, J., & Lambrew, J. (1996). Why Medicare Matters to People Who Need Long-Term Care. Health Care Financing Review, 18(2):99-112.

Kane, R.A., Kane, R.L. & Ladd R.C. (1998). The Heart of Long-Term Care. New York: Oxford University Press.

Shi, L. & Singh, D.A. (2008). Delivering health care in America: a systems approach. Jones & Bartlett. ISBN: 76374512X, 9780763745127

Shih, A., Davis K., Schoenbaum, S., Gauthier A, Nuzum, R. & McCarthy, D. (2008). Organizing the U.S. Health Care Delivery System for High Performance, The Commonwealth Fund. Web.

Stone, R.I., and P. Kemper (1989). Spouses and Children of Disabled Elders: How Large a Constituency for Long-Term Care Reform? Milbank Quarterly, 67(3-4):485-506.

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