CASE 1 - MHA507
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MHA507.docxMHA507_Module 1 - Case
Health Care Delivery System in the United States
Assignment Overview
The United States has a unique system of health care delivery which has evolved over time. Although the U.S. health care delivery system has evolved in response to cost, access, and quality, there are often assertions made about health care delivery in the United States. For example, according to Mary Mahon (2015), VP of Public Information at the Commonwealth Fund, the U.S. spends more on health care than other high-income nations, but has a lower life expectancy and worse health.
Mahon, M. (2015). U.S. spends more on health care than other high-income nations but has lower life expectancy, worse health. Retrieved from http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations
Case Assignment
After completing the assigned readings, you should have a basic understanding of the characteristics and components of the U.S. health care delivery system. For the Module 1 Case Assignment, review the following assumptions regarding health care in the U.S (Greenwald, 2010). Although these assumptions are widely publicized, they might be disputed with critical thinking. Evaluate additional literature and consider each of the following assumptions. Explain why you believe the statement is true or false.
· The U.S. spends too much on health care services.
· The poor lack health care.
· The systems in other countries are better.
· The U.S. health care system is in crisis today.
· Health care is a right.
Greenwald, H. (2010). Health care in the United States: Organization, management and Policy. John Wiley & Sons: San Francisco, CA
Assignment Expectations
1. Provide a one-paragraph (5-7 sentences) response for each statement.
2. Support each of your responses with a scholarly reference (i.e., peer-reviewed journal), using a minimum of five sources.
3. Include an introduction and conclusion in your paper.
4. Use the following link for additional information on how to recognize peer-reviewed journals: http://www.angelo.edu/services/library/handouts/peerrev.php.
5. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.
Module 1 - Background
Health Care Delivery System in the United States
Required Reading
Centers for Medicare & Medicaid Services. (2013). Lower costs, better care: Reforming our health care delivery system. Retrieved from https://www.cms.gov/newsroom/fact-sheets/lower-costs-better-care-reforming-our-health-care-delivery-system-0
Department for Professional Employees. (2016). The U.S. health care system: An international perspective. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/
Professional Eye Care Associates of America. (2014). Different types of health insurance models. Retrieved from: http://www.pecaa.com/wp-content/uploads/2014/11/Different-Types-of-Health-Insurance-Models.pdf
Institute of Medicine (US). (2002). Chapter 5: The health care delivery system. In The future of the public's health in the 21st century. Washington D.C.: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221227/
Lee, T. H., & Berenson, R. H. (n.d.). The organization of health care delivery. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/issues/2008/10/pdf/health_delivery_ch2.pdf
Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia Socio-Medica, 24(2), 112–n/a.
Schroeder, S. A. (2014). Physicians, politics, and health insurance expansion. Journal of General Internal Medicine, 29(2), 267-8.
Squires, D., & Anderson, C. (2015). U.S. health care from a global perspective. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
Videos
Coronado, L., Crosby, A., Rascano, T., Saechin, T., Salazar, L., & Taylor-Weber, J. (2014, July 29). The Healthcare System in the United States [Video file]. Retrieved from https://www.youtube.com/watch?v=nRFKCXvy3-g.
JS Downey Insurance Service. (2015, April 8). Understanding HMO, PPO, and EPO plans [Video file]. Retrieved from https://www.youtube.com/watch?v=_AqIaoxouks
Optional Reading
Nyman, J. A., & Trenz, H. M. (2016). Affordability of the health expenditures of insured Americans before the Affordable Care Act. American Journal of Public Health, 106(2), 264–266
Module 1 - Home
Health Care Delivery System in the United States
Modular Learning Outcomes
Upon successful completion of this module, the student will be able to satisfy the following outcomes:
· Case
· Evaluate the U.S. health care system and employ critical thinking to fractionize trending assumptions.
· SLP
· Evaluate health care delivery system from an individual perspective and evaluate the impact of political culture.
· Discussion
· Assess a prominent statement concerning the U.S. healthcare system and formulate a position in support or against the statement.
Module Overview
Introduction
The course begins with an overview of the U.S. Health Care Delivery system (Module 1).
We will then explore the various organizations responsible for delivering health care: the physician practices, hospitals, and integrated delivery systems. We will also examine the structure of the system, including the types of institutions that comprise it and how they interact with each other, the flow of money and services among them, and the paths that patients follow through the system.
Finally, we will delve into government-supported health care coverage: Medicare and Medicaid.
The U.S. Health care system is influenced by the following forces:
Internal Factors:
Financing:
· Public health insurance programs such as Medicare, Medicaid, State Children’s Health Insurance Program, and TriCare.
· Employer-provided health insurance.
· Commercial health insurance.
· Out-of-pocket payments.
Payment:
· Payment mechanisms used by public and private health insurance programs, including but not limited to fee-for-service, capitation, per diem, global budget, pay for performance, shared savings, gain sharing, bundled payments.
Delivery:
· Health care delivery institutions such as hospitals, ambulatory care clinics (e.g., community health clinics, and physician offices), pharmacies, and rehabilitation centers.
Resources:
· Health care human resources, including all types of health care professionals (physicians, nurses, therapists, pharmacists, technicians, and so on) as well as management and administrative personnel.
· Health IT infrastructure.
· Medical equipment.
Regulation:
· Federal and state legislation that regulates all agents in the health care system (e.g., Patient Protection and Accountable Care Act [PPACA], Health Insurance Portability and Accountability Act [HIPAA], Consolidated Omnibus Budget Reconciliation Act [COBRA], and Employee Retirement Income Security Act [ERISA]).
External factors:
· Economic development.
· Political climate.
· Population characteristics such as demographic composition and health outcomes.
· Social and cultural values.
· Technological development.
· The combined interaction of these forces influences the structure and the development of the U.S. health care system.
Major Characteristics of U.S. Health care Delivery:
· No central governing agency to integrate and coordinate health care.
· High in cost, unequal in access, and average on outcome
· Access to health care services is selectively based on insurance coverage.
· Technology-driven delivery system focusing on acute care.
· Legal risks influence practice behavior.
· Multiple players and balance of power.
ADDITIOANL INFORMATION FOR ENTIRE COURSE
Course Materials/Bibliography
Module 1
Required Reading
Centers for Medicare & Medicaid Services. (2013). Lower costs, better care: Reforming our health care delivery system. Retrieved from https://www.cms.gov/newsroom/fact-sheets/lower-costs-better-care-reforming-our-health-care-delivery-system-0
Department for Professional Employees. (2016). The U.S. health care system: An international perspective. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/
Professional Eye Care Associates of America. (2014). Different types of health insurance models. Retrieved from: http://www.pecaa.com/wp-content/uploads/2014/11/Different-Types-of-Health-Insurance-Models.pdf
Institute of Medicine (US). (2002). Chapter 5: The health care delivery system. In The future of the public's health in the 21st century. Washington D.C.: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221227/
Lee, T. H., & Berenson, R. H. (n.d.). The organization of health care delivery. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/issues/2008/10/pdf/health_delivery_ch2.pdf
Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia Socio-Medica, 24(2), 112–n/a.
Schroeder, S. A. (2014). Physicians, politics, and health insurance expansion. Journal of General Internal Medicine, 29(2), 267-8.
Squires, D., & Anderson, C. (2015). U.S. health care from a global perspective. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
Videos
Coronado, L., Crosby, A., Rascano, T., Saechin, T., Salazar, L., & Taylor-Weber, J. (2014, July 29). The Healthcare System in the United States [Video file]. Retrieved from https://www.youtube.com/watch?v=nRFKCXvy3-g.
JS Downey Insurance Service. (2015, April 8). Understanding HMO, PPO, and EPO plans [Video file]. Retrieved from https://www.youtube.com/watch?v=_AqIaoxouks
Optional Reading
Nyman, J. A., & Trenz, H. M. (2016). Affordability of the health expenditures of insured Americans before the Affordable Care Act. American Journal of Public Health, 106(2), 264–266.
Module 2
Required Reading
Andrews, M. (2014). What’s the best health plan for you? HMO, PPO, EPO or POS? Retrieved from https://www.washingtonpost.com/national/health-science/whats-the-best-health-plan-for-you-hmo-ppo-epo-or-pos/2014/08/25/772f96a8-27c1-11e4-958c-268a320a60ce_story.html?utm_term=.51bd23ba540e
Gabel, J., & Ermann, D. (1985). Preferred provider organizations: Performance, problems, and promise. Health Affairs, 4(1), 24–40.
Plunkett, L. (2015). Accountable care organizations. New York State Dental Journal, 81(3), 4–7.
Healthcare Transformation Institute. (n.d.). Healthcare delivery models. Retrieved from http://www.healthcaretransformationinstitute.org/page/healthcare-delivery-models
Haas, S. (n.d.). Health Reform Act: New models of care and delivery systems. Retrieved from https://www.aaacn.org/health-reform-act-new-models-care-and-delivery-systems
Humana. (n.d.). HMO vs. PPO: Which one is right for you? Retrieved from https://www.humana.com/all-products/understanding-insurance/hmo-vs-ppo
Rural Health Information Hub. (2017). Healthcare access in rural communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access
Shi, L., & Singh, D. (2017). Chapter 1: Major characteristics of U.S. health care delivery. In Essentials of the U.S. health care system (4th Ed.). Burlington, MA: Jones & Bartlett Learning. Available in the Trident Online Library.
Videos
BrainForestTV. (2014, September 18). Accountable Care Organizations (ACOs) explained in 1 minute [Video file]. Retrieved from https://www.youtube.com/watch?v=flYzHZwDH_0
Humana. (2013, June 25). What are PPOs and HMOs? | Humana [Video file]. Retrieved from https://www.youtube.com/watch?v=ii2H5eCGxx8&pbjreload=10
FAIR Health. (2017, November 1). Point of service (POS) (Part 4 of 8)—FAIRHealthConsumer.org [Video file]. Retrieved from https://www.youtube.com/watch?v=gm5eKYjcZbc
TheMinaSara. (2015, December 21). History of managed care [Video file]. Retrieved from https://www.youtube.com/watch?v=SoExSvjPnh0
Optional Reading
Holman, P. (1985). Healthy competition: HMOs vs. PPOs vs. Blue Cross. Executive Report, 3(7).
Module 3
Required Reading
Al-Busaidi, Z. Q. (2008). Qualitative research and its uses in health care. Sultan Qaboos University Medical Journal, 8(1), 11–19.
Center for Innovation in Research and Teaching. (n.d.). An overview of quantitative research. Retrieved from https://cirt.gcu.edu/research/developmentresources/research_ready/quantresearch/overview_quant
Bleser, W. K., Miller-Day, M., Naughton, D., Bricker, P. L., Cronholm, P. F., & Gabbay, R. A. (2014). Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home. The Annals of Family Medicine, 12(1), 37–45.
Caldas de Almeida, J. M. (2015). Mental health services and public mental health: Challenges and opportunities. World Psychiatry, 14(1), 51–53.
Daaleman, T. P., & Fisher, E. B. (2015). Enriching patient-centered medical homes through peer support. Annals of Family Medicine, 13(Suppl 1), S73–S78
Howard, H. A., Malouin, R., & Callow-Rucker, M. (2016). Care managers and knowledge shift in primary care patient-centered medical home transformation. Human Organization, 75(1), 10–20.
Jarvis, A., Perry, R., Smith, D., Terry, R., & Peters, S. (2015). General practitioners' beliefs about the clinical utility of complementary and alternative medicine. Primary Health Care Research & Development, 16(3), 246–253.
Magill, M. K., Ehrenberger, D., Scammon, D. L., Day, J., Allen, T., Reall, A. J., … Kim, J. (2015). The cost of sustaining a patient-centered medical home: Experience from 2 states. Annals of Family Medicine, 13(5), 429–435.
Patient-Centered Primary Care Collaborative. (n.d.). History: Major milestones for primary care and the medical home. Retrieved from https://www.pcpcc.org/content/history-0
Shin, P., Sharac, J., & Rosenbaum, S. (2015). Community health centers and Medicaid at 50: An enduring relationship essential for health system transformation. Health Affairs, 34(7), 1096–1104.
Videos
Genpact. (2017). What are the biggest challenges in healthcare today? [Video file]. Retrieved from http://www.genpact.com/insight/videos/what-are-the-biggest-challenges-in-healthcare-today
HPCAtube. (2012, April 25). What is a community health center? [Video file]. Retrieved from https://www.youtube.com/watch?v=kPLpNWO5uGs
Martin, M. (2014, February 10). Quantitative management in healthcare [Video file]. Retrieved from https://www.youtube.com/watch?v=v_7k3nKFIjs
Public Health Wessex Training Group. (2014, March 14). What is public health? [Video file]. Retrieved from https://www.youtube.com/watch?v=oy1CAMObRzc
SmithGroup. (2015, March 16). Ambulatory care center design [Video file]. Retrieved from https://www.youtube.com/watch?v=Cz5MxxvHMss
Optional Reading
Lockett, K. M. (2014). Integrating hospital and physician revenue cycle operations. Healthcare Financial Management, 68(3), 38–41.
Module 4
Required Reading
AARP. (2017). Medicare, Medicaid and ACA. Retrieved from https://www.aarp.org/ppi/issues/medicare/
Beckers Healthcare. (2013, February 8). 18 recent Medicare, Medicaid issues. Retrieved from https://www.beckershospitalreview.com/finance/18-recent-medicare-medicaid-issues-feb-8-2013.html
Center on Budget and Policy Priorities. (n.d.). Policy basics: Introduction to Medicaid. Retrieved from https://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid
U.S. Department of Health and Human Services. (2016). What is the difference between Medicare and Medicaid? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html
Kaiser Health News. (2015, July 30). 5 challenges facing Medicaid at 50. Retrieved from the U.S. News & World Report website at https://www.usnews.com/news/articles/2015/07/30/5-challenges-facing-medicaid-at-50
Rajaram, R., & Bilimoria, K. (2015). Medicare. JAMA, 314(4), 420.
MedPAC. (2017). Report to the Congress: Medicare and the Health Care Delivery System. Retrieved from http://www.medpac.gov/docs/default-source/reports/jun17_reporttocongress_sec.pdf
Videos
NAAIP. (2016, April 27). Medicare explained in two minutes [Video file]. Retrieved from https://www.youtube.com/watch?v=i9wGIaKE6fA
NAAIP. (2015, December 13). What is Medicaid? Excellent explanation by a board-certified elder care attorney [Video file]. Retrieved from https://www.youtube.com/watch?v=O3uY8ycWbrQ
Optional Reading
Hofstrand, D. (2016). Vision and mission statements—A roadmap of where you want to go and how to get there. Retrieved from https://www.extension.iastate.edu/agdm/wholefarm/pdf/c5-09.pdf
Josiah Macy Jr. Foundation. (2008). Continuing education in the health professions: Improving healthcare through lifelong learning. Retrieved from http://macyfoundation.org/docs/macy_pubs/Macy_ContEd_1_7_08.pdf
OSHA. (n.d.). Education and Training. Retrieved from https://www.osha.gov/dsg/hospitals/education_training.html
