hlt 244 lecture
Post on 26-May-2015
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Introduction to the US Health Care SystemDr. Nicole Hatcher
Objectives By the end of the class, you should:
Understand the basics of the US health care system
Be able to name and describe the four key components of the US health care delivery system
Be able to differentiate the U.S. health care system and the free market
Have an overview of health care in other industrialized countries
Primary Objectives of a Health Care System To enable all citizens to receive health
care services To deliver services that are most
effective and meet established standards of quality
Major Players Physicians Administrators Insurance companies Large employers Government
Characteristics of the US Health Care System No central agency Access is selective Imperfect market activity Third party insurers as intermediaries Multiple payers Balance of power Legal risk New technology Continuum of services Quality
Characteristic- #1 No central agency
Citizens are not entitled to receive a specific set of services
Lack of a global budget
Characteristic- #2 Access is selective
Insurance Affordability
Characteristic #3 Imperfect market
Quasi-free market In national health care, economic markets
do not exist
Characteristic #4 Third-party insurers and payers
Patient Provider Intermediary
Characteristic #5 Multiple payers
Billing and collection Cumbersome system
Characteristic #6 Balance of Power
Multiple payers Fragmented self-interests
Characteristic #7 Legal risk
Litigious society Defensive medicine
Characteristic #8 High technology
R&D
Characteristic #9 Continuum of services
Curative Restorative Preventative
Characteristic #10 Quality
Continuous quality improvement Higher expectations
The Role of Government Major financier Determine reimbursement rates Regulator of health professionals and
health care establishments Health policy
Basic Components of a Health Care System: Quad-function Financing Insurance Delivery Payment
Access to Care What is access? Key predictors of access
Financing and insurance Delivery and payment
A Complex Problem The uninsured
41.6 million in 2004 16-17% of the total population(Nat’l Center for Health Statistics)
Health Care Systems of Other Countries Three predominant models
National health insurance (NHI) National health system (NHS) Socialized health insurance (SHI)
References Shi, L., & Singh, D. (2011). Delivering
health care in America: A Systems Approach. 5th ed. Jones & Bartlett: Boston, MA.
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