Downloaded 1,316 times
![Slides created by: Elizabeth A. Berzas Chair and Program Director Our Lady of the Lake College Department of Health Services 7434 Perkins Road Baton Rouge, LA 70808 (225) 786-1706 [email_address] www.ololcollege.edu](https://image.slidesharecdn.com/ushealthcaresystem-overview1-100731081856-phpapp02/75/US-health-care-system-overview-1-47-2048.jpg)
More Related Content
Similar to US health care system overview 1
US health care system overview 1
- 1. Chapter 1 Major Characteristics of U.S. Health Care Delivery
- 2. Introduction The UnitedStates has a unique system of health care delivery. The US health care delivery system is complex and massive.
- 3. Introduction “ Healthcare delivery” and “health services delivery” Can have slightly different meanings,but in a broad sense, both terms refer to the: major components of the system processes that enable people to receive health care. provision of health care services to patients.
- 4. Introduction In contrastto the United States, most developed countries have national health insurance programs referred to as “universal access” provide routine and basic health care run by the government and financed through general taxes. All Americans are not “entitled” to routine and basic health care services.
- 5. Introduction 187.4 millionAmericans have private health insurance coverage, 35.2 million Medicare beneficiaries, and 31.5 million Medicaid recipients. Health insurance can be bought from: 1,000 health insurance companies 70 BlueCross/BlueShield plans The managed care sector includes approximately: 540 licensed health maintenance organizations (HMOs) 925 preferred provider organizations (PPOs)
- 6. Subsystems of US Health Care Delivery Managed Care Military Vulnerable Populations Integrated Delivery
- 7. Managed Care A system of health care delivery that: 1) seeks to achieve efficiency by integrating the basic functions of healthcare delivery 2) employs mechanisms to control (manage) utilization of medical services 3) determines the price at which the services are purchased and how much the providers get paid. Subsystems of US Health Care Delivery
- 8. Managed Care Is the most dominant health care delivery system in the United States and available to most Americans. Employers and government are the primary financiers of managed care An MCO functions like an insurance company it promises to provide health care services contracted under the health plan to the enrollees of the plan. Subsystems of US Health Care Delivery
- 9. Managed Care Enrollee refers to: a member an individual covered under the plan Health plan: a contractual arrangement between the MCO and the enrollee includes a list of covered health services to which enrollees are entitled uses selected providers usually primary care, general practioners --the “gatekeepers” Look at Figure 1.1, page 5 Subsystems of US Health Care Delivery
- 10. Subsystems of US Health Care Delivery Military The military medical care system is available free of charge to: active duty military personnel of the U.S. Army, Navy, Air Force, and Coast Guard, certain uniformed nonmilitary services such as the Public Health Services and the National Oceanographic and Atmospheric Association (NOAA)
- 11. Subsystems of US Health Care Delivery Military The military medical care system is well-organized highly integrated comprehensive covers preventative care
- 12. Subsystems of US Health Care Delivery Military TRICARE Financed by the military, and covers families, dependents or retired military
- 13. Subsystems of US Health Care Delivery Military The VA health care system available to retired veterans focuses on hospital, mental health and long-term care Is one of the largest and oldest (1946) organized health systems in the world
- 14. Subsystems of US Health Care Delivery Military The mission of the VA health care system: Provide medial care, education and training, research, contingency support and emergency management for the Department of Defense medical care system.
- 15. Subsystems of US Health Care Delivery Military The VA health care system has: over 1,100 sites 172 hospitals 206 counseling centers 40 residential care facilities 73 home health programs, and provides care to 3.6 million
- 16. Subsystems of US Health Care Delivery Military The VA: Budgets over $20 billion Employs over 182,000 Affiliates with 13,000 physicians 53,000 nurses 3,500 pharmacists
- 17. Subsystems of US Health Care Delivery Military The VA is: organized into 22 geographically-distributed Veterans Integrated Service Networks (VISN) Each VISN coordinates its own services receives federal funds
- 18. Subsystems of US Health Care Delivery Vulnerable Populations Particularly the poor, uninsured, minorities and immigrants live in disadvantaged communities and receive care from “safety net” providers.
- 19. Subsystems of US Health Care Delivery Vulnerable Populations Safety nets are not secure Provider type and availability vary Some individuals forego care and seek hospital emergency services if nearby Providers pressured to see the rising number of uninsureds Medicaid, the primary financial source for the safety net, does not allow much cost shifting
- 20. Subsystems of US Health Care Delivery Integrated Delivery The hallmark of the US health care industry: to form integrated delivery systems (IDS) IDS are various forms of ownership and links among hospitals, physicians and insurers IDS’ objective: To have one health care organization deliver a range of services
- 21. Subsystems of US Health Care Delivery Integrated Delivery IDS is A network of organizations that provides or arranges to provide a coordinated continuum of services to defined populations held clinically and fiscally accountable for outcomes and health status
- 22. No Central GoverningAgency; Little Integration and Coordination Technology-Driven and Focuses on Acute Care High on cost, Unequal in Access, and Average in Outcomes Imperfect Market Conditions Government as Subsidiary to the Private Sector Market Justice vs. Social Justice Multiple Players and Balance of Power Quest for Integration and Accountability Characteristics Of The U.S. Health Care System
- 23. Characteristics Of TheU.S. Health Care System No Central Governing Agency; Little Integration and Coordination The US system is different from other developed countries It is not centrally-controlled Central systems are less complex, less costly Has different payment, insurance, and delivery mechanisms Health care is financed both publicly and privately Look at Exhibit 1.1, page 8
- 24. Characteristics Of TheU.S. Health Care System Technology-Driven and Focuses on Acute Care The US invests in research and innovations in new medical technology Growth in science and technology helps create demand for new services, despite shrinking resources to finance sophisticated care
- 25. Characteristics of The U.S. Health Care System Technology-Driven and Focuses on Acute Care Technology has had successful interventions, but is overused This prohibits employers extending benefits to part-time workers and insurers lowering premiums
- 26. Characteristics Of TheU.S. Health Care System High on Cost, Unequal in Access, and Average in Outcome The United States spends more than any other developed country on health care Costs continue to rise at an alarming rate. Many have limited access to basic care
- 27. Characteristics Of TheU.S. Health Care System High on Cost, Unequal in Access, and Average in Outcome Access The ability of an individual to obtain health care services when needed
- 28. Characteristics Of TheU.S. Health Care System High on Cost, Unequal in Access, and Average in Outcome Access Is restricted in the US to those who: Have health insurance through an employer 2. Are covered under a government program 3. Can afford to buy insurance out-of-pocket 4. Are able to pay for services privately
- 29. High on Cost,Unequal in Access, and Average in Outcome The absence of insurance inhibits a patient’s ability to receive well-directed, coordinated, and continuous care to primary and specialty services if referred. Characteristics Of The U.S. Health Care System
- 30. Imperfect Market Conditions Under national health care programs, patients have varying degrees of choice in selecting providers true “free market” forces are virtually nonexistent. Characteristics Of The U.S. Health Care System
- 31. Imperfect Market Conditions In a free market, multiple patients (buyers) and providers (sellers) act independently. patients should be able to choose their provider based on price and quality Characteristics Of The U.S. Health Care System
- 32. Imperfect Market Conditions For the health care market to be free, unrestrained competition must occur among providers, on the basis of price and quality Characteristics Of The U.S. Health Care System
- 33. Imperfect Market Conditions A free market requires that patients have information about the availability of various services Characteristics Of The U.S. Health Care System
- 34. Imperfect Market Conditions In a free market, patients as consumers must: directly bear the cost of services received. make decisions about the purchase of health care services Characteristics Of The U.S. Health Care System
- 35. Government as Subsidiaryto the Private Sector In most developed countries, government plays a central role in the provision of health care. In the US, the private sector plays the dominant role because of American tradition, and the desire to limit government Characteristics Of The U.S. Health Care System
- 36. Market Justice andSocial Justice: Conflict Throughout Health Care Market justice and social justice are: two contrasting theories that govern the production and distribution of health care services in the United States. Characteristics Of The U.S. Health Care System
- 37. Multiple Players andBalance of Power The key system players have been: physicians administrators of health care institutions insurance companies large employers government Characteristics Of The U.S. Health Care System
- 38. Quest for integrationand accountability In the U.S., there is: a drive to use primary care as the organizing hub for continuous and coordinated health services with seamless delivery Accountability ethically providing quality health care in an efficient manner safeguarding one’s own health and using resources sensibly Characteristics Of The U.S. Health Care System
- 39. Health Care SystemsOf Other Developed Countries Most western Europe has universal access Models for national health systems: 1. National Health Insurance 2. National Health System 3. Socialized Health Insurance System Look at Table 1.1, page 16
- 40. National Health InsuranceCanada uses this system Core of care delivered by private providers Tighter consolidation of the financing, coordinated by government Health Care Systems Of Other Developed Countries
- 41. National Health SystemsGreat Britain uses this system finance a tax-supported national health insurance program: government manages the infrastructure for the delivery of medical care most medical institutions are operated by government most providers are government employees Health Care Systems Of Other Developed Countries
- 42. Socialized Health InsuranceSystems Germany uses this style Health care is financed through government-mandated contributions by employers and employees Health care delivered by private providers Sickness funds collect and pay for services Insurance and payment is closely integrated Delivery characterized by independent, private arrangements Government exercises overall control Health Care Systems Of Other Developed Countries
- 43. Systems Framework Systemsconsist of: a set of interrelated and interdependent components designed to achieve some common goals
- 44. Systems Framework Thesystems framework: explains the structure of health care services in the U.S. based on the foundations provides a logical arrangement of various components demonstrates a progression from inputs to outputs
- 45. The framework outlines:System Foundations System Resources System Processes System Outcomes System Outlook Look at Figure 1.2, page 18 Systems Framework
- 46. Conclusion The U.S.has a unique system of delivery, therefore continuous and comprehensive care is not enjoyed by all Americans it’s a patchwork of subsystems No country has a perfect system The Systems Framework is an organized approach to understanding the components of the US health care delivery system
- 47. Slides created by:Elizabeth A. Berzas Chair and Program Director Our Lady of the Lake College Department of Health Services 7434 Perkins Road Baton Rouge, LA 70808 (225) 786-1706 [email_address] www.ololcollege.edu