health care policies week 2
gregueira82
chapter4.pdf
Chapter 4:
Overview of the Health Care
System
Chapter Overview
• Chapter 4 is intended to provide a general
understanding of how the health care system
works in the United States as
• Chapter 4 focuses on:
– Health care finance
– Access to health care services
– Quality of care
– Comparative Health Systems
Health Care Finance
• 2009, US spent $2.5 trillion on health care
services, representing 17.6% of GDP
– Health care spending estimated to reach 19.6%
GDP by 2019
– Spending projected to grow by 9.2% in 2014 when
many provisions of the Affordable Care Act
(ACA) will be effective
Health Care Finance — Insurance
• An estimated 93% will be insured once the
ACA is implemented
– 22 million insured in state health exchanges
– 16 million newly insured in Medicaid or CHIP
• Most people in US obtain insurance through
their employer
• Health insurance acts as an intermediary
between patients and providers
Health Care Finance — Direct Service
• Federal, state, and local governments fund
programs that directly provide care to
individuals
– FQHCs
– HIV/AIDS programs
– Family Planning programs
Health Care 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
• 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
Health Care Access – Insurance coverage
limitations
• High cost-sharing
– Co-payments, deductibles, premiums
• Reimbursement and visit caps
• Service exclusions
Health Care Access – Workforce Issues
• Provider shortages
– Especially primary care and public health
– Problem will be 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
Health Care Quality
• US spends more per person on health care but
often ranks poorly on preventive and primary
care health care measures
• IOM focuses on six areas to improve quality
– Safety, efficacy, patient-centeredness, timeliness,
efficiency, and equity
Comparative Health Systems
• Three common types of health care systems
– Publically financed, privately delivered national
health care system (Canada)
– Publically financed and delivered national health
systems (Britain)
– Socialized insurance system with mandatory
contributions and private delivery (Germany)
Comparative Health Systems
• 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
