Romer Model of a Healthcare

Romer Model of a healthcare system: A five-Fold approach

Milton Romer's model of a healthcare system is made up of five critical components: that of the national approach to health care organization on a macro level, the management required to run and staff health care organizations on an individual basis, the economic support required for the health care programs to function effectively, and these three factors are then assessed with how the production of health services resources and their delivery is undertaken within the framework of the specific national model (Koehlmoos 2008). Romer's intent upon creating such a model was to provide a clear way of assessing the strengths and weaknesses of a healthcare system in a holistic fashion, while still giving appropriate attention to individual systemic detail. It also provides a way to compare different systems of health care, and point out strengths and weaknesses in a comparative form.

The nature of a health care system's method of organization can take many forms, including that of a Ministry of Health, as exists in the form of the National Health Service (NHS) in the United Kingdom, to the private Health Care Management organizations (HMOs) and other types of private insurers as exists in the U.S. Many systems of organization often boast a combination of the two, such as the U.S. deployment of Medicare and Medicaid for the poor and/or elderly with a system of private insurance. Although the U.S. adopts a 'hands off' approach in comparison to European methods of health care organization on a national level, health care in the U.S. is still regulated to some degree through agencies such as the Department of Health and Human Services (DHHS), the Center for Disease Control (CDC) and the Food and Drug Administration (FDA) and many others, on a federal level. Health care is also subject to state regulation, and private oversight through professional associations like the American Medical Association (AMA). Religious and charitable organizations that provide funding and places of care also play a role in the organization and oversight of the medical system. Because the U.S. system is so diffuse and decentralized in its nature, regulation and to a lesser degree financing is provided by government organizations, but services are almost always dispensed through private means, along with some private financing from individuals and organizations (Koehlmoos 2008).

In short, to provide healthcare for a large population of people in an effective fashion, a large, bureaucratic organization or system of distribution, or several organizations, are required for proper provision. A comprehensive and impersonal bureaucracy of rules and regulations fosters and maintains the second function of healthcare in Romer's model, that of the management or the planning, administration, regulation, and oversight component. Proper management ensures that regulations and legislation are enforced and procedures are carried out in a systematic, medically safe, and fair fashion. Because of the decentralized nature of the U.S. system, lower-level administration also often takes place on a private level, as does dispensing of professional qualifications and oversight of professional behavior, as in the case of the American Medical Association (AMA). Furthermore, most universities are private or receive private aid as well as public financing in the case of state-run medical schools, thus management of care is taught and passed on through private institutions.

In terms of economic support, even nationally funded systems or 'free' systems are dependent upon taxes and other forms of public aid -- health care always 'costs' in some way. Health care organizations are for-profit businesses in the U.S. And make up 34% of health care payments and costs within the national system (Koehlmoos 2008). Out-of-pocket payments make up 15%, and Medicare and Medicaid 17% and 16% respectively (Koehlmoos2008). The selling of services to hospitals and physicians dominates the bulk of money spent on care in the U.S. Of the funds allocated to health care delivery, 33% of all the money spent on health care goes to hospitals, 23% to physician services. Healthcare is the largest industry in the U.S., employing 11.9 million workers (Koehlmoos 2008).

Individual hospitals may be for profit or not-for-profit and rely upon volunteers, donations, and public funding. Out-of-pocket funding is an occasional, personal method of economic support, on a case-by-case basis, when individuals have no insurance, and private financing also occurs outside of the U.S. when some citizens seek out private health care providers in countries with the option of going to free national providers. Thus private funding and insurance through the private market, even privately-financed research on drugs and medical technology creates the financial basis of the U.S. system, and tangentially sustains many other systems. Capitalism fuels health care's continued existence in the U.S., however, and is not merely a subsidiary component. This fact also provokes occasional allegations conflicts of interest, such as when doctors who are being paid by drug companies publish their research in allegedly unbiased fashion in peer-reviewed medical journals of repute. However, most research on drugs is still undertaken by the federal government, and all drugs must be approved by the FDA.