Question

1. Identify the people, professionals and organizations that have something to say about how health care is delivered – and paid for – in the US. Include at least 3 of these “key stakeholders” and briefly explain their interest in the system. (Suggested responses: Consumers/patients, physicians and other health care professionals, insurance companies, federal and state government, hospital administrators, etc….)

Answer 1

There are a lot of people, professionals and organizations who can say a lot about the health care system. But the key stakeholders are as follows :

1. Patients

2. Health care providers

3. Policymakers

4. Payors

1. Patients :   Patients are the typical citizen of the country and they are the voters and sometimes taxpayers. The policy framework of the country should be established in a way to benefit patients. Patients receive health care services from providers and they are the beneficiary customers. Patients also may want to access information about their care via an electronic device.

According to their point of view they have an influence over policy making as they are the voters and also they can choose the payors. When they are ill, they are the consumers of the service. Then the patient-provider relationship becomes more powerful, and underlies the moral and ethical values of the patients and the providers.

2. Health care providers : they are the people who provide health care within the policy framework to the patients and maintain health information about them. The providers organize and coordinate patient care with other providers as care team members. According to them, they have a direct relationship with the patient and the payors in health care system. Also they are related with other health care team members while sharing their patients. Providers also must conform with the policy and framework.

Policymakers : they are the people who establish the policy framework within which the health care service to be provided for the citizens of the country. The policymakers collect the data from patients, providers, and payors to develop population-level metrics that inform their health and health economic policies. These policies are helpful to answer some questions like who is eligible to receive the care?,what care services are provided; how; where; by whom? How are services paid for? Are the services being delivered well? Are they accessible? Are the needs of vulnerable populations adequately served? What health care concerns do we need to plan for next?

Payors : Payors operationalize the financial components of the policy framework. They enroll patients as recipients and obtain care services from the providers on behalf of their patient beneficiaries. They also must take on the actuarial task of ensuring the financial sustainability of the care program. They report to policymakers and according to them minimizing the costs of funding their portfolios of care services are required to be more sustainable.