HCS 235 Week 2 Health Care Services Example

Four Doors Into the System: Primary, Acute, Behavioral and Long-Term Care Services Seen Through One Family's Year

[Student Name]

University of Phoenix

HCS/235: Health Care Delivery in the U.S.

Week 2 Assignment

[Instructor Name]

[Date]

The family and its year of care are composites written for a model paper; national figures come from the sources listed.

Health care services in the United States are often described as a continuum, running from prevention and primary care through acute, behavioral, rehabilitative and long-term care. That description is tidy on paper. For a family, the continuum is a series of doors, each with its own entrance rules, staff and payer. This paper follows one composite family of four, plus a grandmother, through a single year and describes the four kinds of services they used: primary care, acute care, behavioral health and long-term care.

Primary Care: The Teenager's Year

The family's 15-year-old son needed a sports physical in August. His family's employer-sponsored insurance covered it as preventive care at no cost at his pediatric practice, where a pediatric nurse practitioner examined him and updated his vaccines. In October he sprained his ankle at a Saturday game and went to an urgent care clinic, where a physician assistant ordered an X-ray, fitted a brace and sent a visit note to his pediatric practice.

Primary care is first-contact, ongoing and coordinated care for most health needs, delivered by physicians, nurse practitioners and physician assistants in offices and clinics (Shi & Singh, 2022). It is paid for mostly by private insurance for working-age families, by Medicaid and the Children's Health Insurance Program for many children, and by Medicare for older adults. Urgent care fills gaps in access, especially on evenings and weekends, but it does not replace the ongoing relationship that makes primary care effective.

Acute Care: The Father's Emergency

In January, the father, 47, woke with abdominal pain that moved to his lower right side. His wife drove him to the emergency department of a community hospital. A CT scan showed appendicitis, and he had a laparoscopic appendectomy that evening and went home the next day. The hospital billed his insurer for the emergency visit, the imaging and the surgery; the surgeon and anesthesiologist billed separately.

Acute care treats serious, short-term illness and injury in hospitals, emergency departments and ambulatory surgery centers. Most of the roughly 6,100 U.S. hospitals are community hospitals (American Hospital Association, 2024). Hospital care is the largest category of national health spending: of the $4.9 trillion national total for 2023, 17.6% of the economy, hospital care took the largest share (Martin et al., 2025). Acute care is staffed by physicians, nurses, therapists, technicians and a large administrative workforce, and it is paid by every major payer.

Behavioral Health: The Mother's Depression

In the spring, the mother, 45, told her primary care physician that she had lost interest in things she used to enjoy and was sleeping badly. A PHQ-9 screen at the visit suggested moderate depression. Her physician started an antidepressant and referred her to a licensed therapist; when her symptoms did not improve after two months, she saw a psychiatrist through a telehealth visit.

Behavioral health services treat mental illness and substance use disorders in primary care offices, outpatient clinics, community mental health centers, hospitals and, increasingly, by telehealth. National survey data estimate that 22.8% of adults, about 58.7 million people, had a mental illness in the past year (Substance Abuse and Mental Health Services Administration, 2024). Many never receive treatment, partly because of shortages of psychiatrists and therapists and because many behavioral health clinicians do not accept insurance. The mother was fortunate that her primary care practice caught the problem, because for many adults the primary care visit is the only door into behavioral health they ever reach.

Long-Term Care: The Grandmother's Fracture

The father's mother, 81, lives alone. In July she fell and broke her hip. After surgery and three days in the hospital, she moved to a skilled nursing facility for three weeks of rehabilitation, then went home with home health nursing and physical therapy visits twice a week for a month. Her daughter-in-law now stops by daily.

Long-term care covers a range of services for people who need help over an extended period, from skilled nursing and rehabilitation to assisted living, home health and custodial help with daily activities (Shi & Singh, 2022). Medicare paid for her skilled nursing stay because it followed a qualifying hospital stay of at least three days, and for her home health visits because she was homebound and needed skilled care. It would not pay for ongoing help with bathing or meals if she needed it later; that custodial care is paid mainly by Medicaid for people with low incomes and assets, or by families themselves.

Where the Family Fell Through the Gaps

The services did not always connect. The urgent care note reached the pediatric practice, but the emergency department's discharge summary for the father did not reach his primary care physician for two weeks. The mother waited six weeks for her first therapy appointment. The grandmother's discharge from skilled nursing came with a list of medications that differed from the hospital's list, and nobody noticed until the home health nurse compared them. Each gap involved a hand-off between services run by different organizations.

What the Year Cost and Who Paid

The family's year shows how payment follows the service. Employer insurance paid most of the teenager's care, the father's surgery and the mother's treatment, after the family met a $3,000 deductible that the father's emergency alone exhausted. The mother's telehealth psychiatrist was out of network, so she paid more for those visits. Medicare paid for the grandmother's hospital stay, skilled nursing and home health, with coinsurance covered by her supplemental plan. Nobody paid for the daily help her daughter-in-law now gives, which is how a large share of long-term care in the United States is provided: unpaid, by family.

What Administrators Do About the Gaps

Health administrators work on these seams: arranging electronic sharing of discharge summaries, building referral networks and telehealth options for behavioral health, and creating transition-of-care programs that reconcile medications when patients move between settings. These are administrative solutions to problems patients experience as clinical ones.

Conclusion

In one year, a single family used primary care, acute care, behavioral health and long-term care, each with its own setting, staff, entrance and payer. Understanding these services, and the gaps between them, is the foundation for managing any part of the American system.

References

American Hospital Association. (2024). Fast facts on U.S. hospitals, 2024. https://www.aha.org/statistics/fast-facts-us-hospitals

Martin, A. B., Hartman, M., Washington, B., Catlin, A., & The National Health Expenditure Accounts Team. (2025). National health expenditures in 2023: Faster growth as insurance coverage and utilization increased. Health Affairs, 44(1), 12-22. https://doi.org/10.1377/hlthaff.2024.01375

Shi, L., & Singh, D. A. (2022). Delivering health care in America: A systems approach (8th ed.). Jones & Bartlett Learning.

Substance Abuse and Mental Health Services Administration. (2024). Key substance use and mental health indicators in the United States: Results from the 2023 National Survey on Drug Use and Health. https://www.samhsa.gov/data/report/2023-nsduh-annual-national-report