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7/25/2019 1.28.16 Chapter 1 HAP 301 002.ppt
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Chapter 1: Major Characteristicsof U.S. Health Care Delivery
Nancy Freeborne, DrPH, MPH, P!C
"an#ary $%th, $&1'
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(hat is Health Care
Delivery) *t incl#+es ajor coponents of the health care
syste an+ the processes that allo- people toobtain access/ health care
0he act of provi+in health care services to patients
23aples)
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4oals of Health Care
Delivery Provi+e accessto services
Deliver services that are cost e5ective
Meet certain levels of 6#ality
ccess, Cost, 7#ality are interrelate+
Use+ by policya8ers to assess ho- -ell the systeis -or8in
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Health Care Delivery Syste iU.S.
Can be an iportant sector of a co#ntry9s econoy: eployent,research, e3ports
Nearly 1'. illion people eploye+ in vario#s health +eliverysettins
*nstit#tions incl#+e: ;,%1; hospitals, 1',&&& n#rsin hoes, 11,&&&hoe health aencies an+ hospices, $,
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0he Health Care Syste of
a Nation *s in>#ence+ by: Political Cliate
Stae of 2conoic Developent
0echnoloical Proress
Social an+ C#lt#ral ?al#es
Physical 2nvironent
Pop#lation characteristics
23aples)
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U.S. vers#s @ther
Develope+ Co#ntries *n ost +evelope+ co#ntries there is a national
health ins#rance prora r#n by the
overnent an+ pai+ for by eneral ta3es.
ll citiAens are entitle+ to receive services
0hese co#ntries have -hat is calle+#niversal
accessto health care or a #niversal syste of
health care
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S#bsystes of U.S. Health CareDelivery
C#rrently, there is N@0 #niversal access to health care services in theU.S.
ll ericans are N@0 entitle+ to basic health care
S#bsystes have +evelope+ in response to ar8et forces an+ to coversoe v#lnerable pop#lations
S#bsystes: See 0e3t p =!1&,/
Manae+ Care Military
?#lnerable Pop#lations
*nterate+ Delivery
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Characteristics of the U.S. HealthCare Syste
No central overnin aency
Bac8 of coor+ination
Bac8 of *nteration
0echnoloy Driven
Foc#s on c#te Care
Hih Cost
Une6#al ccess
verae @#tcoes
Beal is8s
*perfect Mar8et Con+itions
Private Sector Doinant ole
Mar8et "#stice vs. Social "#sticeCon>ict
M#ltiple Players
ccess base+ on *ns#ranceCoverae
Desire for interation,acco#ntability
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U.S. No Central 4overnin
ency No central aency is responsible for provi+in health care centralsystes are less cople3, less costly/
Health care is Enance+ both p#blically an+ privately
*ncl#+es a variety of payent, ins#rance an+ +elivery echaniss
Syste is cople3 an+ fraente+ -ith little interation an+
coor+ination
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0echnoloy
*n the U.S. a reat +eal of oney is spent on research
innovations an+ a+vances in e+ical technoloy -ith
any beneEts
Ho-ever, there are +ra-bac8s ne- technoloy can be
e3pensive, over#se+, an+ creates +ean+ for ne-
services
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Hih Costs, Une6#al ccess,verae @#tcoes
0he U.S. spen+s ore than any other +evelope+ co#ntry on health care
1' $&&%/ an+ 1G.' $&&
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Health Care efor *n $&1, soe states e3pan+e+ their Me+icai+ proras a8in
ore people eliible an+ overnent s#bsi+ies becae available
to soe of lo- incoe not covere+ by Me+icai+ to cover soe
health ins#rance costs. @thers are re6#ire+ to obtain ins#rance or
pay a Ene. 0his sho#l+ re+#ce the n#ber of people in the Unite+
States -itho#t health ins#rance coverae. Patient Protection an+
5or+able Care ct, March, $&1&/
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@ther Characteristics
$& of the pop#lation acco#nts for %& of all healthe3pen+it#res referre+ to as the $&!%& r#le/
Majority of the Services provi+e+ foc#s on treatentof illness an+ +isease not health prevention,prootion an+ palliative care/
arton, $&&G/
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*perfect Mar8et
Con+itions Not a tr#e free ar8et systeI6#asi or iperfect ar8et syste *n a totally free ar8et:
patients an+ provi+ers act in+epen+ently
patients choose provi+ers base+ on price an+ 6#ality
copetition #st occ#r base+ on price an+ 6#ality
patients bear costs of services, a8e +ecisions abo#t p#rchasin
health care an+ have coplete inforation on services available
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4overnent as S#bsi+iary
to Private Sector *n ost +evelope+ co#ntries overnent plays a
central role in provi+in health care to its citiAens
U.S. the private sector plays +oinant role
4overnent spen+in Ells in aps
23aple: Me+icare an+ Me+icai+
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Mar8et "#stice vers#s Social
"#stice
Mar8et "#stice: Me+ical care is +istrib#te+ base+ on ability an+ +esireto pay
Social j#stice: Me+ical care is +istrib#te+ base+ on nee+
U.S.Ihas historically preferre+ ar8et sol#tions -hich can res#lt in#ne6#al allocation of reso#rces
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M#ltiple Players an+
alance of Po-er Jey players in the health care syste:
Physicians
+inistrators
*ns#rance Copanies
Bare eployers
4overnent
ll have +i5erent interests
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*nteration of Health Care
Services 0here is a +esire to iprove interation an+
acco#ntability of health care services
Use of priary care as point of coor+ination for health
care services
Provi+e 6#ality healthcare in an eKcient anner
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ccess
ccess: the ability to obtain health careservices -hen nee+e+
*n $&1&, %.$ illion #nins#re+ 1%.$ of thepop#lation/ Shi an+ Sinh, $&1=/
0his n#ber sho#l+ +ecrease as a res#lt of theprovisions of the Patient Protection an+5or+able Care ct March, $&1&/
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Beal is8s in>#ence
Practice Decisions Defensive e+icine is practice+ in or+er to avoi+
litiation
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Health Care Systes of
@ther Develope+ Co#ntries Most of -estern 2#rope has #niversal access to health care
Mo+els for national health systes:
Cana+a ! ta3es pay for health care +elivere+ by the privatesector
4reat ritain ! Enance+ by ta3es, overnent anaes
+elivery, provi+ers are overnent eployees
4erany ! overnent an+ate+ contrib#tions by eployeesan+ eployers. Health care +elivere+ by private provi+ers
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Dra-bac8s to Universal
Health Care Most (estern 2#ropean co#ntries provi+e
national health care proras that provi+e
#niversal access
Boo8 in yo#r te3t, p.$&!$$
(hat are soe of the +ra-bac8s of theseproras)
Note: Lo# -ill be responsible for this inforation
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Systes Frae-or8: a loicalarraneent of the coponents of
health care +elivery
Syste Fo#n+ations! Chapters $!=:historical, c#lt#ral, social, an+econoic factors
Syste eso#rces Chapters !':h#an an+ nonh#an reso#rces Syste Processes Chapters G!11:
physical str#ct#res an+ Enancinechaniss
Syste @#tcoes Chapters 1$!1=:ccess, cost an+ 6#ality Syste @#tloo8 Chapter 1:F#t#re
+esire+ o#tcoes
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C@NCBUS*@N 0he Unite+ States has a #ni6#e syste of health care +elivery. *t is
cople3 an+ fraente+. Unli8e ost +evelope+ co#ntries, the syste
lac8s #niversal access. *t is a coprise+ of s#bsystes create+ thro#h
ar8et forces or +evelope+ to cover soe v#lnerable pop#lations.
Historically, there have been a lare n#ber of #nins#re+ in the US.
einnin in $&1, this sho#l+ chane to soe +eree as a res#lt of the
Patient Protection an+ 5or+able Care ct as Me+icai+ coverae e3pan+s
in soe states, s#bsi+ies are provi+e+ to other lo- incoe persons by
the fe+eral overnent, an+ in+ivi+#als are re6#ire+ to have health
ins#rance or pay a Ene.
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iblioraphy
arton, P.B. $&&G/. Understanding the U.S. Health Services System.Chicao, ll:Health +inistration Press, Fo#n+ation of the erican Collee of Healthcare
23ec#tives.
Shi, Beiy# an+ Sinh, Do#las . $&1=/. 2ssentials of the U.S. Health CareSyste. S#+b#ry, M: "ones an+ artlett P#blishers, BBC.
Shi, Beiy# an+ Sinh, Do#las . $&1&/. Essentials of the U.S. Health CareSystem. S#+b#ry, M: "ones an+ artlett P#blishers, BBC.
Sic8o trailer retrieve+ fro : http:---.yo#t#be.co-atch)v3lDUJSh
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0railer for OSic8o by
Michael Moore
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