Topic 1 - Overview of The U.S. Healthcare
System Questions
1. Define Health?
health is defined as the absence of illness or disease. Optimal health exists when a person is free
of symptoms and does not require treatment. health is the state of optimal capacity of an
individual to perform expected social roles and tasks, such as work, school, and household
chores.
2. How have historical, cultural, and socioeconomic factors influenced the current
healthcare delivery system?
Socioeconomic
Is related to health and well-being, and people with higher incomes often live in areas with less
exposure to environmental risks and enjoy better access to care. Income inequality is associated
with a variety of health indicators, such as life expectancy, age-adjusted mortality rates, and
leading causes of death. The greater the economic gap between the rich and the poor in a given
geographic area, the worse the overall health of the population in that area.
cultural
The U.S. society’s cultural mix, which also reflects the rate and nature of immigration, will
continue to slowly transform health care delivery in the United States. Social and cultural
factors affect exposure and vulnerability to disease, risk-taking behaviors, health promotion and
disease prevention, and health care–seeking behaviors. For example, rates of health risk
behaviors among students in grades 9–12 are generally higher among blacks and Hispanics
compared to whites, and emergency department use is disproportionately higher among blacks
compared to whites. Even though illegal immigrants are technically uninsured, they do get
health care through a variety of sources, including emergency rooms, community health
centers, and charity from hospitals. Increasing dependency on government assistance and a
haphazard immigration policy that does not promote cultural assimilation have the potential to
alter the traditional American health care system in important ways in the future
Historical
Preindustrial era
Postindustrial era
Corporate era
3. why should American healthcare professionals develop literacy in more holistic modes
of healthcare delivery?
Holistic medicine seeks to treat the whole person. Holistic health incorporates the spiritual
dimension in addition to the physical, mental, and social aspects of optimal health, and thus
provides the most complete understanding of health. A growing volume of medical literature
illustrates the healing effects of religion and spirituality on morbidity and mortality. Studies have
identified an inverse association between religious involvement and all-cause mortality. Religious
and spiritual beliefs and practices positively influence physical, mental, and social well-being and
This study source was downloaded by 100000839311665 from CourseHero.com on 01-20-2023 23:46:54 GMT -06:00
https://www.coursehero.com/file/102995606/Topic-1-c425docx/
, may affect the incidences, experiences, and outcomes of many medical problems.
4. Identify types of
insurance. Medicare
Medicaid
Private insurance
5. Explain each type of insurance: Medicare, Medicaid/CHIP,
Private Medicare
▪ Covers all elderly persons, nonelderly disabled persons on Social security, and
nonelderly person with end-stage renal disease
▪ No income/means test
▪ No class distinction
▪ Part A: for hospitalization and short-term nursing home stay
• Financed through Social Security taxes
▪ Part B: for physician and other outpatient services
• Subsidized through general taxes, but the participants pay part of
the premium cost
▪ Nationally uniform program
▪ Title 18 of the Social Security
Act Medicaid/chip
▪ Covers only the very poor
▪ Income criteria established by states (means test)
▪ Public welfare
▪ All services are covered under one program
▪ Program varies from state to state
▪ Title 19 of the Social Security Act
▪ Finances by the states, with matching funds from the federal
government according to each state’s per capital income
Private
▪ Also referred to as voluntary health insurance because it is not mandatory
▪ Mostly employer based
• Bcbs/etna/etc.
6. Explain theory of risk pooling.
Under this system, insurance companies come together to form a pool, which can provide
protection to insurance companies against catastrophic risks such as floods or earthquakes
7. Explain reimbursement methods.
Insurance companies, MCOs, BCBS, and the government (MEDICARE and MEDICAID) are referred
to as third-party payers, with the other two parties in the arrangement being the patient and the
provider. Payment made by the third-party payers to the providers of services is called
reimbursement.
8. How does demand-side rationing create obstacles to obtaining healthcare, and will current
and proposed changes remove some of these obstacles?
9. Explain Medicare and Medicaid legislation.
This study source was downloaded by 100000839311665 from CourseHero.com on 01-20-2023 23:46:54 GMT -06:00
https://www.coursehero.com/file/102995606/Topic-1-c425docx/
System Questions
1. Define Health?
health is defined as the absence of illness or disease. Optimal health exists when a person is free
of symptoms and does not require treatment. health is the state of optimal capacity of an
individual to perform expected social roles and tasks, such as work, school, and household
chores.
2. How have historical, cultural, and socioeconomic factors influenced the current
healthcare delivery system?
Socioeconomic
Is related to health and well-being, and people with higher incomes often live in areas with less
exposure to environmental risks and enjoy better access to care. Income inequality is associated
with a variety of health indicators, such as life expectancy, age-adjusted mortality rates, and
leading causes of death. The greater the economic gap between the rich and the poor in a given
geographic area, the worse the overall health of the population in that area.
cultural
The U.S. society’s cultural mix, which also reflects the rate and nature of immigration, will
continue to slowly transform health care delivery in the United States. Social and cultural
factors affect exposure and vulnerability to disease, risk-taking behaviors, health promotion and
disease prevention, and health care–seeking behaviors. For example, rates of health risk
behaviors among students in grades 9–12 are generally higher among blacks and Hispanics
compared to whites, and emergency department use is disproportionately higher among blacks
compared to whites. Even though illegal immigrants are technically uninsured, they do get
health care through a variety of sources, including emergency rooms, community health
centers, and charity from hospitals. Increasing dependency on government assistance and a
haphazard immigration policy that does not promote cultural assimilation have the potential to
alter the traditional American health care system in important ways in the future
Historical
Preindustrial era
Postindustrial era
Corporate era
3. why should American healthcare professionals develop literacy in more holistic modes
of healthcare delivery?
Holistic medicine seeks to treat the whole person. Holistic health incorporates the spiritual
dimension in addition to the physical, mental, and social aspects of optimal health, and thus
provides the most complete understanding of health. A growing volume of medical literature
illustrates the healing effects of religion and spirituality on morbidity and mortality. Studies have
identified an inverse association between religious involvement and all-cause mortality. Religious
and spiritual beliefs and practices positively influence physical, mental, and social well-being and
This study source was downloaded by 100000839311665 from CourseHero.com on 01-20-2023 23:46:54 GMT -06:00
https://www.coursehero.com/file/102995606/Topic-1-c425docx/
, may affect the incidences, experiences, and outcomes of many medical problems.
4. Identify types of
insurance. Medicare
Medicaid
Private insurance
5. Explain each type of insurance: Medicare, Medicaid/CHIP,
Private Medicare
▪ Covers all elderly persons, nonelderly disabled persons on Social security, and
nonelderly person with end-stage renal disease
▪ No income/means test
▪ No class distinction
▪ Part A: for hospitalization and short-term nursing home stay
• Financed through Social Security taxes
▪ Part B: for physician and other outpatient services
• Subsidized through general taxes, but the participants pay part of
the premium cost
▪ Nationally uniform program
▪ Title 18 of the Social Security
Act Medicaid/chip
▪ Covers only the very poor
▪ Income criteria established by states (means test)
▪ Public welfare
▪ All services are covered under one program
▪ Program varies from state to state
▪ Title 19 of the Social Security Act
▪ Finances by the states, with matching funds from the federal
government according to each state’s per capital income
Private
▪ Also referred to as voluntary health insurance because it is not mandatory
▪ Mostly employer based
• Bcbs/etna/etc.
6. Explain theory of risk pooling.
Under this system, insurance companies come together to form a pool, which can provide
protection to insurance companies against catastrophic risks such as floods or earthquakes
7. Explain reimbursement methods.
Insurance companies, MCOs, BCBS, and the government (MEDICARE and MEDICAID) are referred
to as third-party payers, with the other two parties in the arrangement being the patient and the
provider. Payment made by the third-party payers to the providers of services is called
reimbursement.
8. How does demand-side rationing create obstacles to obtaining healthcare, and will current
and proposed changes remove some of these obstacles?
9. Explain Medicare and Medicaid legislation.
This study source was downloaded by 100000839311665 from CourseHero.com on 01-20-2023 23:46:54 GMT -06:00
https://www.coursehero.com/file/102995606/Topic-1-c425docx/
