project
Chapter 7
The healthcare industry is the fastest growing industry
in the U.S. economy, employing a workforce of nearly 20 million healthcare workers. Considering the aging of the U.S. population and the impact of the Affordable Care Act, it is expected that the healthcare industry will continue to experience strong job growth. Job growth in many healthcare sectors is outpacing that in other industries. When we think of healthcare providers, we automatically think of physicians and nurses. How- ever, the healthcare industry is composed of many different health service professionals, including dentists, optometrists, psychologists, chiropractors, podiatrists, nonphysician practitioners (NPPs), administrators, and allied health professionals. It is important to identify allied health professionals because they provide a range of essential healthcare services that complement the services provided by physicians and nurses. This category of health professionals is an integral component of providing quality health.
Health care can occur in varied settings. Physicians have traditionally operated in their own practices but they also work in hospitals, mental health facilities, managed care organizations, and community health centers. They may also hold government positions or teach at a university. They could be employed by an insurance company. Health professionals, in general, may work at many different organizations, both for profit and nonprofit. Although the healthcare industry is one of the largest employers in the United States, there continue to be shortages of physicians in certain geographic areas of the country. Rural areas continue to suffer physician shortages, which limits consumer access to health care. There have been different incentive programs to encourage physicians to relocate to rural areas, but shortages still exist. In most states, only physicians, dentists, and a few other practitioners may serve patients directly without the authorization of another licensed independent health professional. Those categories authorized include chiropractic, optometry, psychotherapy, and podiatry. Some states authorize midwifery and physical therapy. There also continues to be a shortage of registered nurses nationwide, with the most need identified in the south and west. There is also a shortage of qualified nursing faculty to teach in nursing schools, which limits the number of students enrolled in registered nursing programs. The American Association of Colleges of Nursing (AACN) is discussing this issue with policy makers.
Healthcare personnel comprise one of the largest labor forces in the United States. This chapter provided an overview of the different types of employees in the healthcare industry. Some of them require many years of education; however, some of these positions can be attained upon completion of 1–2 year programs. The healthcare industry will continue to progress as U.S. trends in demographics, disease, and public health pattern change, and cost and efficiency issues, insurance issues, technological influences, and economic factors continue to evolve. More occupations and professions will develop as a result of these trends. The major trend that will impact the healthcare industry is the aging of the U.S. population. The BLS predicts that half of the next decades’ fastest growing job categories will be in the healthcare industry. The Affordable Care Act will continue to have an impact on the positive growth for this industry. This chapter will provide a description of the different types of healthcare professionals and their role in providing care in the U.S. system insurance plans, such as indemnity plans or managed care organizations; (3) public or governmental funding such as Medicare, Medicaid, and other governmental programs; and (4) health savings accounts (HSAs). Much of the burden of healthcare expenditures has been borne by private sources—employers and their health insurance programs. Individuals may continue to pay their health insurance premiums through the Consolidated Omnibus Budget Reconciliation Act (COBRA) once they are unemployed, but most individuals cannot afford to pay the expensive premiums. As a result of the passage of the Affordable Care
Act (ACA) of 2010, the government has played a pro-
active role in developing a healthcare system that is more consumer oriented. The Act is requiring more employers to offer health insurance benefits and requiring individuals to purchase healthcare insurance if they can afford it from the health insurance marketplaces. The Act also requires health insurance plans to provide more information about their plans to their members so they can make informed decisions about their healthcare.
To understand the complexity of the U.S. health- care system, this chapter will provide a breakdown of U.S. healthcare spending by source of funds, and the major private and public sources of funding for these expenditures. It is important to reemphasize that there are three parties involved in providing health care: the provider, the patient, and the fiscal intermediary such as a health insurance company or the government. Therefore, also included in the chapter is a description of how healthcare providers are reimbursed for their services and how reimbursement rates were developed for both private and public funds.