Question

what intermediaries exist between patients and their providers in the US? what purpose do they serve?

Answer 1

Medical care organizations (mcos), such as health maintenance organizations and preferred provider organizations, have become popular in recent decades because of their ability to lower consumers’ healthcare costs while increasing providers’ throughput. These organizations function as healthcare intermediaries or, in a technical language, as platforms in the two-sided market for medical care, with the two sides being healthcare providers looking for patients and patients looking for healthcare providers. This function currently has negative implications for the quality of medical care, but it can be utilized to improve that quality

MCO's are not just health insurers, as many take them to be. They are also, albeit less conspicuously, healthcare intermediaries. An individual pays the mco in advance for medical care that he may require in the future. The mco provides medical care to the individual when the need arises. This is how it functions as a health insurer. as a platform in a two-sided market. It is here where my account of mcos’ economically perverse incentives begins.

The mcoprovides this care by paying affiliated doctors and other healthcare providers who deliver care to the mco’s insureds. The doctors’ affiliation to this plan is contractual. They contract with the mco to set the prices it will pay them for the delivery of medical care to the mco’s insureds. The mco pays the doctors by using the money collected from the insureds (either directly or, as typically is the case, through the insureds’ employers). This is how the mco intermediates between doctors and patients — a characteristic identifying it

An effective health care system needs to coordinate medical facilities with the behavioral and economic drivers in communities that are most related to good long-term health. Intermediaries can help this to happen by providing key skills and building trust between health care institutions and community organizations and residents. Nurses are among the most important of such intermediaries. They not only provide skilled health care services, but tend to be the closest to the patient and their family caregivers, and the most aware of their broader psychosocial and health care needs.

Health care is not the only, or even the strongest, determinant of health, but it is very important. For most Americans, having health insurance— under a private plan or through a publicly financed program—is a threshold requirement for routine access to health care. “Health insurance coverage is associated with better health outcomes for adults. It is also associated with having a regular source of care and with greater and more appropriate use of health services. These factors, in turn, improve the likelihood of disease screening and early detection, the management of chronic illness, and the effective treatment of acute conditions

Private insurance is predominantly purchased through employment-based groups and to a lesser extent through individual policies. Publicly funded insurance is provided primarily through seven government programs Medicare provides coverage to 13.5 percent of the population, whereas Medicaid covers 11.2 percent of the population . Additionally, public funding supports directly delivered health care (through community health centers and other health centers qualified for Medicaid reimbursement) accessed by 11 percent of the nation's uninsured, who constitute 41 percent of patients at such health centers. Because the largest public programs are directed to the aged, disabled, and low-income populations, they cover a disproportionate share of the chronically ill and disabled. However, they are also enormously important for children.