Question

Do you feel that the U.S. is a dispersed or regionalized model of care? Why or why not?

Answer 1

I feel that the US model of care is a dispersed model of care .The  reasons for the same are discussed below:

In a dispersed model of care,the patient has the right to choose his/her primary consultation from either a primary care physician or a specialist depending upon his/her health problem except for few limitations laid down by the complex insurance schemes which require the patient to see a primary care physician first.The specialists are dispersed in the community and the major hospitals and the patient can get treatment directly from the specialist without having to go to the primary care physician( unless insurance scheme requires the same).There is no order of hierarchy of referral that has to be followed from the primary care physician to the specialists to the tertiary specialist in the US model of care [which is typically the feature of a regionalized model of care as existing in UK United Kingdom] and hence the US model of care is a dispersed care model.

In a regionalised model of care,the patient has to first see the primary care physician(unless critical emergency) and only on his referral, the patient consults the specialist. If determined by the specialist that the patient still needs further specialized care, he is referred to the tertiary care specialist/ the tertiary care hospital in the area. It is a pyramidal model of healthcare delivery .The primary care physicians are responsible for the main bulk of health care and form the base of the pyramid followed by the specialists who take care of the complicated medical/surgical conditions treated in the hospitals which form the middle of the pyramid with the decreasing number of trained super specialists at the tertiary care centres treating most complex conditions, forming the top apex of the pyramid.

The features discussed above do not exist in the US model of care which is more of a dispersed model where the speciality care specialists are dispersed in the community and speciality care is available for the patient as primary care.The patient gets to choose to get care from the primary care physician or the the treating specialist in the community in this model.The US model of care follows a diamond distribution with a few primary care physicians/small nursing homes/local hospitals at the base and a few highly specialised tertiary care centres at the apex with the central bulk  being formed by specialist hospitals and specialist doctors delivering competitive quality patient care.

The advantage of the US dispersed model is that it allows easy specialist care access to the patient while the disadvantages are the costs involved,long waiting periods and the lack of personalized holistic comprehensive attention which the patient can get from the primary care physician.The advantages of the regionalized healthcare model of care are the low costs ,less waiting time and personalized comprehensive holistic medical attention, that a patient gets from his primary care physician and structured smooth system of referrals while the disadvantages are the long waiting period for the conditions which require direct specialist care and intervention on urgent basis on account of having to follow the ladder of referrals.

Summary: I conclude that the US model of care is a dispersed model due to the availabilty and access to the specialist care in the community for the patient without having to compulsarily follow tiers of referral as in regionalised model of care.