health and policy
Lola2230
9781284151619_SLID_CH04.ppt
Chapter 4
Overview of the United States Healthcare System
Chapter Overview
- Provides a general understanding of how the healthcare system works in the United States
- Focuses on
- Healthcare finance
- Healthcare access
- Healthcare quality
- Comparative health systems
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Healthcare Finance
- In 2016, the United States spent $3.3 trillion on healthcare services, representing 17.9% of GDP.
- Estimated to reach 19.7% GDP by 2026
- National health expenditure projected to grow 5.6% from 2017 to 2026
- Increase driven by increase in prices for medical goods and services and increases in spending due to Baby Boomer population
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Healthcare Finance: Insurance
- When ACA signed into law in 2010, 16.3%/49.9 million individuals uninsured
- By 2016 uninsured rate dropped to 8.8%/28.1 million
- Changes to ACA expected to result in increase in uninsured again
- Most people in United States obtain insurance through their employer
- Health insurance acts as an intermediary between patients and providers
Healthcare Finance: Direct Service
- Federal, state, and local governments fund programs that directly provide care to individuals.
- FQHCs
- HIV/AIDS programs
- Family planning programs
Healthcare Access
- Access refers to ability to obtain needed services.
- Key barriers to access
- Lack of health insurance
- Inadequate health insurance
- Insurance coverage limitations
- Workforce issues
Health Care Access: Uninsured and Underinsured
- Key characteristics
- Poor, low education, non-native, racial/ethnic minority, location, age, gender
- Problems with being uninsured
- Less access to care, less timely care, less likely to follow treatment recommendations due to cost
- Underinsured do not have financial resources to cover the gap between what their insurance covers and their medical bills
- Safety net providers serve many uninsured and underinsured
Healthcare Access: Insurance Coverage Limitations
- High cost-sharing
- Co-payments, deductibles, premiums
- Reimbursement and visit caps
- Service exclusions
Safety Net Providers
- Serve disproportionately high numbers of uninsured, underinsured, and publicly insured patients
- Public and private hospitals, community health centers, family planning clinics, and public health agencies
Healthcare Access: Workforce Issues
- Provider shortages
- Especially primary care and public health
- Problem exacerbated by influx of newly insured individuals under the ACA
- Uneven distribution of providers
- Significant problem in rural areas
- Several ACA provisions address these workforce issues
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Healthcare Quality
- The United States spends more per person on health care but often ranks poorly on preventive and primary care healthcare measures.
- IOM focuses on six areas to improve quality.
- Safety, efficacy, patient-centeredness, timeliness, efficiency, and equity
Comparative Health Systems
(1 of 2)
- Three common types of healthcare systems
- Publicly financed, privately delivered national healthcare system (Canada)
- Publicly financed and delivered national health systems (Britain)
- Socialized insurance system with mandatory contributions and private delivery (Germany)
Comparative Health Systems
(2 of 2)
- Type of health insurance design relates to key issues for patients
- Affordability
- Differences in access by income level
- Waiting lists/wait times
- Choice
- Complexity of interacting with insurance system/paperwork
- Patient satisfaction
