US Healthcare Systems Test 1
UNDERSTAND THE BASIC NATURE OF THE U.S. HEALTH CARE SYSTEM - -The US health
care system is: "Extra Large Comfort"
Expensive
18%GDP 2009; >20%GDP2015
Financially driven
50/50 blend of public/private sources
Large-5 million employees
Complex-multiple providers, payers, insurance, etc.
-4 KEY COMPONENTS OF THE HEALTH CARE DELIVERY SYSTEM - -"QUAD FUNCTION
MODEL"
"FIDP"
Financing-buying insurance or paying for health services
Insurance-Protects against catastrophic risk, determines eligible services for patient
Delivery-(Providers)-entity that delivers healthcare and receives payment
Payers- (reimbursement)-to providers for services delivered
-DISCUSS THE (10) PRIMARY CHARACTERISTICS OF THE U.S. HEALTH CARE SYSTEM -
-"CAPA, I'M 3rd MP-legal risks. New Technology Continues Quest for Quality."
1. No Central Agency governs the system-53% Private, 47% Public
2. Partial Access- Selectively based on insurance and what it covers
3. Healthcare offered under Imperfect Market activity-quasi market-prices determined by
payers, not supply and demand
4. 3rd party Insurers and Payers-intermediaries between finance and deliver. Do not
advocate for patients
5. Multiple Payers-cumbersome, make it difficult to bill, know different health plans, denied
claims; high admin costs
6. Power Balance-physicians, administrators, institutions, insurance, govt.-counterforces
within system. No domination
7. Legal Risks-affects practice behavior. Risk of malpractice leads to defensive medicine;
typically costly and ineffective
8. New Technology-Creates demand for its use. New services, people associate high tech
with high quality care
9. Continuum of Services-Curative (drugs, treatments), Restorative (Therapy), Preventive
(immuniz.)-multiple settings, not just hospital
10. Quest for Quality/Quality is achievable-pressure to comply with standards, high
expectations of outcomes
-HAVE AN OVERVIEW OF HEALTH CARE SYSTEMS IN OTHER COUNTRIES - -• NHI
(National Health Insurance)-Canada-Financed by taxes, care delivered by private providers
• NHS (National Health System)-Great Britain-Financed by taxes, care delivered by govt
providers
, • SHI (Socialized Health Insurance)-Germany-Govt. mandates contributions, care delivered
by private providers
-UNDERSTAND THE SYSTEMS MODEL AS APPLIED TO HEALTH CARE DELIVERY - -
Foundation→Resource/Processes/Outcome→Outlook
I. System FOUNDATIONS-environment-cultural, beliefs, values-evolution of health services
System Features
II. System RESOURCES-Human and Non-human resources, influence change
III. System PROCESSES-infrastructure-types of care offered
IV. System OUTCOMES-Outputs (access, cost, quality); what system has been able to
accomplish; leads to reform through policy
V. System OUTLOOK-forward looking, Future trends
-UNDERSTAND THE CONCEPT OF HEALTH AND DISEASE - -Health: HQ
Holistic health: 4 Dimensions: Physical, mental, social, spiritual
Quality of life: Overall satisfaction with health care delivery and with life
Disease: Just think of ABE
Epidemiology triangle: host, agent, environment at the corners & disease in the middle.
Behavioral risk factors: for many otherwise preventable disease and death
Acuity level: acute, subacute, chronic
-KNOW THE DETERMINANTS OF HEALTH - -"MISH"
1. Medical Care-least critical-access to curative and preventive services-more access=better
health
2. Individual Lifestyle Factors-behavioral risk factors-diet, food, exercise, physical activity
3. Social/Environmental Factors-socioeconomic (money), sociopolitical, sociocultural
dimensions
4. Heredity- Genetic Factors predispose people to certain diseases
-KNOW THE AMERICAN BELIEFS AND VALUES IN THE DELIVERY OF HEALTH CARE - -U-
FECES
• Concern for the Underprivileged
• Principles of Free Enterprise-distrust of big govt.; separation between public and private
medicine
• Champion of Capitalism-healthcare viewed as an economic good/service, not as a public
resource
• Entrepreneurial Spirit and Self-determination-better services for those who can afford
better insurance; individual health versus population health-led to Medicaid, Medicare, and
CHIP
• Advancement of Science and technological innovation-increase demands for latest
treatment
-UNDERSTAND THE PROMOTION OF HEALTH AND THE PREVENTION OF DISEASE - -Do
these things and you won't "R.I.P."
1. Understand Risk factors (host/agent/environment) via the health risk appraisal
UNDERSTAND THE BASIC NATURE OF THE U.S. HEALTH CARE SYSTEM - -The US health
care system is: "Extra Large Comfort"
Expensive
18%GDP 2009; >20%GDP2015
Financially driven
50/50 blend of public/private sources
Large-5 million employees
Complex-multiple providers, payers, insurance, etc.
-4 KEY COMPONENTS OF THE HEALTH CARE DELIVERY SYSTEM - -"QUAD FUNCTION
MODEL"
"FIDP"
Financing-buying insurance or paying for health services
Insurance-Protects against catastrophic risk, determines eligible services for patient
Delivery-(Providers)-entity that delivers healthcare and receives payment
Payers- (reimbursement)-to providers for services delivered
-DISCUSS THE (10) PRIMARY CHARACTERISTICS OF THE U.S. HEALTH CARE SYSTEM -
-"CAPA, I'M 3rd MP-legal risks. New Technology Continues Quest for Quality."
1. No Central Agency governs the system-53% Private, 47% Public
2. Partial Access- Selectively based on insurance and what it covers
3. Healthcare offered under Imperfect Market activity-quasi market-prices determined by
payers, not supply and demand
4. 3rd party Insurers and Payers-intermediaries between finance and deliver. Do not
advocate for patients
5. Multiple Payers-cumbersome, make it difficult to bill, know different health plans, denied
claims; high admin costs
6. Power Balance-physicians, administrators, institutions, insurance, govt.-counterforces
within system. No domination
7. Legal Risks-affects practice behavior. Risk of malpractice leads to defensive medicine;
typically costly and ineffective
8. New Technology-Creates demand for its use. New services, people associate high tech
with high quality care
9. Continuum of Services-Curative (drugs, treatments), Restorative (Therapy), Preventive
(immuniz.)-multiple settings, not just hospital
10. Quest for Quality/Quality is achievable-pressure to comply with standards, high
expectations of outcomes
-HAVE AN OVERVIEW OF HEALTH CARE SYSTEMS IN OTHER COUNTRIES - -• NHI
(National Health Insurance)-Canada-Financed by taxes, care delivered by private providers
• NHS (National Health System)-Great Britain-Financed by taxes, care delivered by govt
providers
, • SHI (Socialized Health Insurance)-Germany-Govt. mandates contributions, care delivered
by private providers
-UNDERSTAND THE SYSTEMS MODEL AS APPLIED TO HEALTH CARE DELIVERY - -
Foundation→Resource/Processes/Outcome→Outlook
I. System FOUNDATIONS-environment-cultural, beliefs, values-evolution of health services
System Features
II. System RESOURCES-Human and Non-human resources, influence change
III. System PROCESSES-infrastructure-types of care offered
IV. System OUTCOMES-Outputs (access, cost, quality); what system has been able to
accomplish; leads to reform through policy
V. System OUTLOOK-forward looking, Future trends
-UNDERSTAND THE CONCEPT OF HEALTH AND DISEASE - -Health: HQ
Holistic health: 4 Dimensions: Physical, mental, social, spiritual
Quality of life: Overall satisfaction with health care delivery and with life
Disease: Just think of ABE
Epidemiology triangle: host, agent, environment at the corners & disease in the middle.
Behavioral risk factors: for many otherwise preventable disease and death
Acuity level: acute, subacute, chronic
-KNOW THE DETERMINANTS OF HEALTH - -"MISH"
1. Medical Care-least critical-access to curative and preventive services-more access=better
health
2. Individual Lifestyle Factors-behavioral risk factors-diet, food, exercise, physical activity
3. Social/Environmental Factors-socioeconomic (money), sociopolitical, sociocultural
dimensions
4. Heredity- Genetic Factors predispose people to certain diseases
-KNOW THE AMERICAN BELIEFS AND VALUES IN THE DELIVERY OF HEALTH CARE - -U-
FECES
• Concern for the Underprivileged
• Principles of Free Enterprise-distrust of big govt.; separation between public and private
medicine
• Champion of Capitalism-healthcare viewed as an economic good/service, not as a public
resource
• Entrepreneurial Spirit and Self-determination-better services for those who can afford
better insurance; individual health versus population health-led to Medicaid, Medicare, and
CHIP
• Advancement of Science and technological innovation-increase demands for latest
treatment
-UNDERSTAND THE PROMOTION OF HEALTH AND THE PREVENTION OF DISEASE - -Do
these things and you won't "R.I.P."
1. Understand Risk factors (host/agent/environment) via the health risk appraisal
