/
© 2012 Jones and Bartlett Publishers © 2012 Jones and Bartlett Publishers

© 2012 Jones and Bartlett Publishers - PowerPoint Presentation

marina-yarberry
marina-yarberry . @marina-yarberry
Follow
379 views
Uploaded On 2019-01-25

© 2012 Jones and Bartlett Publishers - PPT Presentation

Chapter 1 Major Characteristics of US Health Care Delivery 2012 Jones and Bartlett Publishers Introduction The United States has a unique system of health care delivery The US health care ID: 748251

care health jones system health care system jones bartlett publishers delivery 2012 services subsystems characteristics systems government military market

Share:

Link:

Embed:

Download Presentation from below link

Download Presentation The PPT/PDF document "© 2012 Jones and Bartlett Publishers" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

Slide1

© 2012 Jones and Bartlett Publishers

Chapter 1

Major Characteristics

of U.S. Health Care DeliverySlide2

© 2012 Jones and Bartlett Publishers

Introduction

The United States has a unique system of health care delivery.

The US

health care

delivery system is complex and massive.Slide3

© 2010 Jones and Bartlett Publishers

Introduction

“Health care delivery” and “health services delivery”

Can

have slightly different meanings

, but

in a broad sense, both terms refer to the:

-Major

components of the

system.

-Processes

that enable people to receive health care.

-Provision

of health care services to patients.

Slide4

IntroductionIn contrast to the United States, -Most developed countries have national health insurance programs. Referred to as “universal access”-Provide routine and basic health care

-Run

by the government and

financed-through

general taxes.

-All

Americans are

not

“entitled” to routine and basic health care services. Slide5

© 2012 Jones and Bartlett Publishers

Subsystems

of US Health Care Delivery

Managed Care

Military

Vulnerable Populations

Integrated Delivery

Long-term Care

Public HealthSlide6

© 2012 Jones and Bartlett Publishers

Managed Care

A

system of health care delivery that:

1) seeks to achieve efficiency by integrating the basic functions of healthcare

delivery.

2) employs mechanisms to control (manage) utilization of medical

services.

3) determines the price at which the services are purchased and how much the providers get paid.

Subsystems

of US Health Care DeliverySlide7

© 2012 Jones and Bartlett Publishers

Managed Care

-Is

the most dominant health care delivery system in the United States and available to most Americans.

-Employers

and government are the primary financiers of managed

care.

-An

MCO functions

like:

A

n

insurance

company.

It

promises to provide health care services contracted under the health plan to the enrollees of the plan.

Subsystems of US Health Care DeliverySlide8

© 2012 Jones and Bartlett Publishers

Managed Care

-Enrollee

refers to:

a member

an individual covered under the plan

-Health

plan:

a contractual arrangement between the MCO and the enrollee

-includes

a list of covered health services to which enrollees are entitled

uses selected providers

-usually

primary care, general

practioners

-the

“gatekeepers

Subsystems of US Health Care DeliverySlide9

© 2010 Jones and Bartlett PublishersSlide10

© 2012 Jones and Bartlett Publishers

Military

-The

military medical care system is available free of charge to:

Active

duty military personnel of the U.S. Army, Navy, Air Force, and Coast

Guard.

C

ertain

uniformed nonmilitary services such as

-The

Public Health Services and

-The

National Oceanographic and Atmospheric Association (NOAA

).

Subsystems of US Health Care DeliverySlide11

© 2012 Jones and Bartlett Publishers

Military

-The

military medical care system is

well-organized.

highly

integrated.

Comprehensive.

-Covers

preventative care

Subsystems of US Health Care DeliverySlide12

© 2012 Jones and Bartlett Publishers

Military

-TRICARE

Financed by the military, and covers families, dependents or retired

military.

Subsystems of US Health Care DeliverySlide13

© 2012 Jones and Bartlett Publishers

Military

The VA health care system

-Is available

to retired

veterans.

-Focuses

on

H

ospital

, mental health and long-term

care.

-Is

one of the largest and oldest (1946) organized health systems in the

world.

Subsystems of US Health Care DeliverySlide14

Subsystems of US Health Care DeliveryMilitaryThe mission of the VA health care system:-Is to provide medial care, education and training, research, contingency support and emergency management for the Department of Defense medical care system.Slide15

© 2010 Jones and Bartlett Publishers

Subsystems of

US

Health Care Delivery

Military

The VA:

-Budgets

over $40 billion

-Employs

over 280,000Slide16

© 2012 Jones and Bartlett Publishers

Military

The VA is:

-Organized

into 23 geographically-distributed Veterans Integrated Service Networks (VISN

).

-Each

VISN

Coordinates

its own

services.

R

eceives

federal

funds.

Subsystems of US Health Care DeliverySlide17

© 2012 Jones and Bartlett Publishers

Vulnerable Populations

-Particularly

the poor, uninsured, minorities and

immigrants:

L

ive

in disadvantaged communities and receive care from “safety net” providers.

Subsystems of US Health Care DeliverySlide18

© 2012 Jones and Bartlett Publishers

Vulnerable Populations

-Safety

nets are not

secure.

Provider

type and availability

vary.

Some individuals forego care and seek hospital emergency services if

nearby.

Providers pressured to see the rising number of

uninsureds

.

Medicaid, the primary financial source for the safety net, does not allow much cost

shifting.

Subsystems of US Health Care DeliverySlide19

Integrated DeliveryThe hallmark of the US health care industry:To form integrated delivery systems (IDS)IDS-Are various forms of ownership and links among hospitals, physicians and insurers.

-IDS

’ objective:

To have one health care organization deliver a range of

services.

Subsystems of US Health Care DeliverySlide20

© 2012 Jones and Bartlett Publishers

Integrated Delivery

IDS

is

-A

network of organizations that provides or arranges to provide a coordinated continuum of services to

D

efined

populations held clinically and fiscally accountable for outcomes and health

status.

Subsystems of US Health Care DeliverySlide21

© 2012 Jones and Bartlett Publishers

Long-term Care

C

onsists

of medical and nonmedical care that is provided to individuals who are chronically ill or who have a disability.

By 2020, more than 12 million Americans are projected to require

LTC.

Subsystems of US Health Care DeliverySlide22

Public Health1. Monitoring health status to identify and solve community health problems.2. Diagnosing and investigating health problems and hazards.3. Informing and educating people about health problems and

hazards.

4. Mobilizing the community to solve health

problems.

5. Developing policies to support individual and community health

efforts.

Subsystems of US Health Care DeliverySlide23

© 2012 Jones and Bartlett Publishers

Public Health

6

. Enforcing laws and regulations to support health

safety.

7. Providing people with access to necessary

care.

8. Assuring a competent and professional health

workforce.

9. Evaluating the effectiveness, accessibility, and quality of personal and population-based health

services.

10. Performing research to discover innovative solutions to health

problems.

Subsystems of US Health Care DeliverySlide24

© 2012 Jones and Bartlett Publishers

No Central Governing Agency; Little Integration and Coordination

Technology-Driven and Focuses on Acute Care

High on cost, Unequal in Access, and Average in Outcomes

Imperfect Market

Conditions

Key Characteristics of the U.S. Health Care SystemSlide25

Government as Subsidiary to the Private SectorMarket Justice vs. Social JusticeMultiple Players and Balance of PowerQuest for Integration and AccountabilityAccess to Healthcare Selectively Based on Insurance Legal Risk Influences Practice Behavior© 2010 Jones and Bartlett PublishersKey Characteristics of the U.S. Health Care SystemSlide26

Characteristics Of The U.S. Health Care SystemNo Central Governing Agency; -Little Integration and Coordination-The US system is different from other developed countries.It is not centrally-controlled.

-Central

systems are less complex, less

costly.

Has different payment, insurance, and delivery

mechanisms.

Health care is financed both publicly and

privately.Slide27

© 2010 Jones and Bartlett PublishersSlide28

© 2012 Jones and Bartlett Publishers

Technology-Driven and Focuses on Acute Care

-The

US invests in research and innovations in new medical

technology.

-Growth

in science and technology helps create demand for new services, despite shrinking resources to finance sophisticated

care.

Characteristics Of The U.S. Health Care SystemSlide29

Technology-Driven and Focuses on Acute Care-Technology has had successful interventions, but is overused.-This prohibits Employers extending benefits to part-time workers andInsurers lowering

premiums.

Characteristics Of The U.S. Health Care SystemSlide30

High in Cost, Unequal in Access, and Average in Outcome The United States spends more than any other developed country on health care.-Costs continue to rise at an alarming rate.-Many have limited access to basic

care.

Characteristics Of The U.S. Health Care SystemSlide31

© 2012 Jones and Bartlett Publishers

Characteristics Of The U.S. Health Care System

High in Cost, Unequal in Access, and Average in Outcome

-

Access

The

ability of an individual to obtain health care services when

needed.Slide32

© 2012 Jones and Bartlett Publishers

High in Cost, Unequal in Access, and Average in Outcome

-Access

Is restricted in the US to those who:

-Have

health insurance through an

employer.

2. Are covered under a government

program.

3. Can afford to buy insurance

out-of-pocket.

4. Are able to pay for services

privately.

Characteristics Of The U.S. Health Care SystemSlide33

High in Cost, Unequal in Access, and Average in Outcome -The absence of insurance inhibits a patient’s ability to receive well-directed, coordinated, and continuous care to primary and specialty services if referred.

Characteristics Of The U.S. Health Care SystemSlide34

Imperfect Market Conditions -Under national health care programs, Patients have varying degrees of choice in selecting providers.True “free market” forces are virtually nonexistent.

Characteristics Of The U.S. Health Care SystemSlide35

Imperfect Market Conditions -In a free market, Multiple patients (buyers) and providers (sellers) act independently.Patients should be able to choose their provider based on price and quality.

Characteristics Of The U.S. Health Care SystemSlide36

Imperfect Market Conditions -For the health care market to be free,Unrestrained competition must occur among providers, on the basis of price and quality.

Characteristics Of The U.S. Health Care SystemSlide37

© 2012 Jones and Bartlett Publishers

Imperfect Market Conditions

-A

free market requires that patients have

I

nformation

about the availability of various

services.

Characteristics Of The U.S. Health Care SystemSlide38

© 2012 Jones and Bartlett Publishers

Imperfect Market Conditions

-In

a free market, patients as consumers must:

D

irectly

bear the cost of services received.

M

ake

decisions about the purchase of health care

services.

Characteristics Of The U.S. Health Care SystemSlide39

Government as Subsidiary to the Private Sector-In most developed countries, -Government plays a central role in the provision of health care.-In the US, -The private sector plays the dominant role because of American tradition, and the desire to limit government.

Characteristics Of The U.S. Health Care SystemSlide40

© 2012 Jones and Bartlett Publishers

Market Justice and Social Justice:

Conflict Throughout Health Care

-Market

justice and social justice are:

T

wo

contrasting theories that govern the production and distribution of health care services in the United States.

Characteristics Of The U.S. Health Care SystemSlide41

© 2012 Jones and Bartlett Publishers

Multiple Players and Balance of Power

The

key system players have been:

P

hysicians

A

dministrators

of health care institutions

I

nsurance

companies

L

arge

employers

G

overnment

Characteristics Of The U.S. Health Care SystemSlide42

© 2012 Jones and Bartlett Publishers

Quest

for integration and accountability

In the U.S., there is:

-A

drive to use primary care as the organizing hub for continuous and coordinated health services with seamless

delivery.

Accountability

-

E

thically

providing quality health care in an efficient

manner.

-S

afeguarding

one’s own health and using resources

sensibly.

Characteristics Of The U.S. Health Care SystemSlide43

© 2012 Jones and Bartlett Publishers

Health Care Systems Of Other Developed Countries

Most western Europe has universal access

-Models

for national health systems:

1. National Health Insurance

2. National Health System

3. Socialized Health Insurance SystemSlide44

© 2010 Jones and Bartlett PublishersSlide45

National Health InsuranceCanada uses this system-Core of care delivered by private providers.-Tighter consolidation of the financing, coordinated by government.

Health Care Systems Of Other Developed CountriesSlide46

National Health SystemsGreat Britain uses this system.-Finance a tax-supported national health insurance program: Government manages the infrastructure for the delivery of medical care.

M

ost

medical institutions are operated by

government.

M

ost

providers are government

employees.

Health Care Systems Of Other Developed CountriesSlide47

© 2012 Jones and Bartlett Publishers

Socialized Health Insurance Systems

Germany uses this style

-Health

care is financed through government-mandated contributions by employers and

employees.

-Health

care

is delivered

by private

providers.

-Sickness

funds collect and pay for

services.

-Insurance

and payment is closely

integrated.

-Delivery

characterized by independent, private

arrangements.

-Government

exercises overall

control.

Health Care Systems Of Other Developed CountriesSlide48

Systems FrameworkSystems consist of: -A set of interrelated and interdependent components designed to achieve some common goals.Slide49

Systems FrameworkThe systems framework:-Explains the structure of health care services in the U.S. based on the foundations.-Provides a logical arrangement of various components.

-D

emonstrates

a progression from inputs to

outputs.Slide50

© 2012 Jones and Bartlett Publishers

The framework outlines:

-System

Foundations

-System

Resources

-System

Processes

-System

Outcomes

-System

Outlook

Look at Figure 1.2, page 25

Systems FrameworkSlide51

© 2010 Jones and Bartlett PublishersSlide52

© 2012 Jones and Bartlett Publishers

Conclusion

The U.S. has a unique system of delivery, therefore

C

ontinuous

and comprehensive care is not enjoyed by all

Americans.

I

t’s

a patchwork of

subsystems.

-No

country has a perfect

system.

The

Systems Framework is an

-Organized

approach to understanding the components of the US health care delivery

system.