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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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