Introduction The United States has a unique system of health care delivery. The US health care...
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Introduction The United States has a unique system of health care delivery. The US health care delivery system is complex and massive.
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Transcript of Introduction The United States has a unique system of health care delivery. The US health care...
Introduction
The United States has a unique system of health care delivery.
The US health care delivery system is complex and massive.
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
Government as Subsidiary to the Private Sector
Market Justice vs. Social Justice
Multiple Players and Balance of Power
Quest for Integration and Accountability
Characteristics Of The U.S. Health Care System
Multiple Players and Balance of Power
The key system players have been:
physicians
administrators of health care institutions
insurance companies
large employers
government
Characteristics Of The U.S. Health Care System
Introduction 187.4 million Americans have private health insurance
coverage,
35.2 million Medicare beneficiaries, and
31.5 million Medicaid recipients.
Health insurance can be bought from:
1,000 health insurance companies
70 BlueCross/BlueShield plans
The managed care sector includes approximately:
540 licensed health maintenance organizations (HMOs)
925 preferred provider organizations (PPOs)
Introduction In 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.
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 System
Look at Table 1.1, page 16
Socialized Health Insurance Systems
Germany uses this style
Health care is financed through government-mandated contributions by employers and employees
Health care 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 Countries
National Health Systems
Great Britain uses this system
finance a tax-supported national health insurance program:
government manages the infrastructure for the delivery of medical care
most medical institutions are operated by government
most providers are government employees
Health Care Systems Of Other Developed Countries
National Health Insurance Canada uses this system
Core of care delivered by private providers
Tighter consolidation of the financing, coordinated by government
Health Care Systems Of Other Developed Countries
National Health Systems
Great Britain uses this system
finance a tax-supported national health insurance program:
government manages the infrastructure for the delivery of medical care
most medical institutions are operated by government
most providers are government employees
Health Care Systems Of Other Developed Countries
