What component systems does the report identify, especially to support the two functions ?
How were they integrated together?
How are they systems in their own right?
System Name: Med Peds-Davies 2013 Ambulatory Award
World:
The external context of the Organization in the 2013 MedPeds Davies Ambulatory winning
report is the practice of clinical medicine in a private practice setting 1.
Physicians in private practice have been providing services since the 1900s 2. Historically,
people would go to a solo practitioner in a small office with minimal resources and pay cash for
their care. Eventually, hospitals were created to assist physicians in the provision of health care
at a larger scale 2.
In the past, physicians and hospitals had a very tight relationship. Health care evolved into
two sectors within the hospital system: the physicians, who would provide care to the patients
and generate revenue, and the administrators, who would work on having the equipment and
tools needed to provide service to their communities 2,3. Later on, by the 1930s, physicians were
paid by a third party, known as “insurance”. Physicians would bill for their services and get paid
without restrictions. When Medicare began in 1965, physicians were still paid for “usual,
customary and reasonable charges”, so they were paid for any service without questioning 2. By
1982, Medicare announced that they would go bankrupt if they continued that practice, so the
system changed to Prospective Payment Systems, in which Diagnosis Related Groups (DRGs)
were implemented 2. This meant that hospitals and physicians were being paid at a fixed rate for
a particular visit and not for the series of interventions for each patient. This created major
problems, as hospitals started to limit the patient’s care by restricting hospital days and
physicians clashed with hospitals in disagreement.
In the 1990s, hospitals and some physicians began to develop joint ventures within hospitals
with the intentions of having hospital-physician partnerships following the idea that “managed
care” would prevail 2. But, as managed care declined at the end of that decade, physician-hospital
relations started to break. Physicians started to lose autonomy 2.
New technologies and more sub-specialties became available, so physicians saw an
opportunity to migrate from the hospital and provide care in an outpatient setting without the
restrictions mandated by the administrators. Medical specialties such as Family Medicine and
MED-PEDS were created with the intention of training physicians to care for all age patients in
one setting 4,5. Their focus has been mainly on prevention and treatment of acute and chronic
problems. The training for Family Medicine includes 4 years in one of the 465 accredited
programs after completion of Medical School 5. They cover areas in Internal Medicine,
Gynecology, Pediatrics, basic Surgery and Psychiatry. Family Medicine trainees have to pass a
written board exam to become board certified in their specialty 5. Med-Peds specialty includes a
4 -year training in both Internal Medicine and Pediatrics after completing medical school, with a
similar requirement for board certification as Family Medicine doctors 4.
Private practice then evolved into systems of providing health care to the patients, in the acute
and/or chronic phases of disease in a non-hospital setting 6-9. Some of the providers are still
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