Assigment 1

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Chapter01-UnderstandingHealthSystemsTheOrganizationofHealthCareintheUnitedStates.pdf

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Chapter 1

Understanding Health Systems:

The Organization of

Health Care in the United States

Reference Table 1.1

The Development of Health Care

• 1850-1900:

– Epidemics of acute infections due to unsanitary

living conditions.

• 1900-1941:

– Development of scientific medicine and the

beginning of governmental and societal

intervention.

Reference Table 1.1

The Development of Health Care

• 1941-1980:

– Shift from acute illnesses to chronic illnesses

• Classic model of illness

– Development of health insurance, and the

explosion of medical technology.

Reference Table 1.1

The Development of Health Care

• 1980-present:

– Chronic diseases now include illnesses related

to environmental hazards and working

conditions, a rapid growth in costs due to

technology, and an increase in governmental

influence.

Social Organization

• 1850-1900:

– No formal structure.

• 1900-1941:

– The development of local hospitals and health

insurance plans.

• Mid 1960’s:

– Implementation of Medicare and Medicaid

insurance programs.

Three Perspectives on

the American Health Care System

1. Public policy perspective

2. Management strategy perspective

3. Clinical/patient perspective

Public Policy Perspective

• U.S. health care system is comprised of five

individual sub-systems:

1. Employment-related system

2. Poor and uninsured system

3. Veterans Administration system

4. Worker’s compensation system

5. Active duty military system

The Employment System

• Covers approximately two-thirds to three-

quarters of the total American population.

• Finances one-third of health care

expenditures.

• Collection of private employers providing

health insurance in the private sector.

The Poor and Uninsured System

• Local governments supported by taxes and

individual incomes are the sources of

financing.

• Services are provided by safety-net

providers and local hospitals in the public

sector.

The Poor and Uninsured System

• Individuals who qualify for state Medicaid

programs may obtain care in the private

sector.

The Veterans Administration System

• National system operated by the federal

government.

• Financed by federal tax revenues.

• Coverage is only available to military

veterans based on length of service or

service-connected disability.

The Workers’ Compensation System

• Care is provided to individuals who suffer

from injuries or illnesses related to work

environments.

• Insurance benefits include direct financial

support for living expenses and health care.

• Both the employer and the employee share

the cost of the insurance.

The Active Duty Military System

• Care is financed and provided entirely by

the military system for active-duty

members.

• Private insurance is provided to cover

dependents.

• Dependents may receive care from

hospitals and physicians in the private

sector or within the military system.

Management

Strategy Perspective

• In the 1980s

– Employers began to demand that insurance

companies constrain the rising costs of health

insurance premiums.

• Employers began utilizing managed care

policies to reduce their costs.

Management

Strategy Perspective

• This resulted in a major shift from a

“provider-controlled” health care system to

a “payer-controlled” system.

The Clinical Perspective

• How patients obtain care

• Basic service components provided to the

patients

• Perceived quality of care and patient

satisfaction

Table 1.2

The Basic Service Components Health Promotion

Emergency Medical Services

Ambulatory Care for Simple/Limited Conditions

Ambulatory Care for Complex/Continuing Conditions

Inpatient Care for Single/Limited Inpatient Conditions

Inpatient Care for Complex/Multiple Inpatient Conditions

Long-term care (either in-home or institutional services)

Services for Social/Psychological Conditions (both inpatient and outpatient)

Rehabilitation services (both inpatient and ambulatory)

Dental Services

Pharmaceutical Services

Table 1.3

Factors Affecting Utilization Rates Consumer Provider System

Signs and symptoms Access mechanisms Contractual

arrangements

Beliefs Provider incentives Payment mechanisms

Insurance coverage Operational systems Legal considerations

Income and wealth Technology and

medical information

Networks and

providers

Information access and

knowledge

Referral arrangements