Chapter 1 - US Health Systems Flashcards
what do most modern countries have?
universal health care
Affordable Care Act (ACA)
increased coverage for a lot of Americans, is not Universal Health Care
How many Americans are on PRIVATE health insurance?
201.1 million
How many Americans are covered by Medicare and Medicaid
103.1
What is managed care?
most dominate of the health care systems;
a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.
ex) HMO and PPO
Military Coverage
TriCare - mostly free of charge to those who are currently active duty,
provides both preventative and treatment oriented services
Veterans Administration (VA) available for retired vets (9.6 mill. people)
Special Populations
vulnerable populations - those who have inadequate resources to address their needs
What accommodations do special populations use to receive care?
- Medicare
- Medicaid
- Community Health Centers
- Migrant Health Centers
- Free Clinics
- Hospital Emergency Departments
Medicare
- one of the largest sources of health insurance
- majority of insured are elderly or disabled
- 22 mill. people
Medicaid
- third larges source of health insurance
- provides coverage for low-income adults, children and elderly, and disabled
- covers 17.3% of population
- increased significantly due to ACA
Children’s Health Insurance Program (CHIP)
- provides coverage to children in uninsured families that do not qualify for Medicaid
- 8.1 million children
- Started by Hillary Clinton
Integrated Delivery Systems (IDS)
insurance companies pay a lump sum of money to hospitals to take care of you at the hospital and outside the hospital in order to decrease re-hospitalization rates
Accountable Care Organizations:
Focused on providing:
- Emphasis on primary care
- Coordination of all care (including behavioral, social and public health)
- Accountability for health outcomes
Long-Term Care
provided in various settings to consumers who have chronic health issues and disabilities that prevent them from doing their ‘regular daily tasks’
Examples of long-term care facilities:
- Consumers homes
- Assisted Living Facilities (ALF)
- Skilled Nursing Homes (SNF)
Public Health System
- mission to improve and protect community health
- amount of Federal funding for PH initiatives vary on location
- ACA established ‘Prevention and Public Health Fund’ to improve health outcomes and increase health care quality
Main Characteristics that set the US apart from other counties in HC:
1) no central governing agency and little integration and coordination
2) technology driven and focusing on acute care
3) high in cost, unequal in access, and average in outcome
4) imperfect market conditions
5) Government as Subsidiary to the private sector
6) fusion of market justice (distribution on the basis of people’s willingness and ability to pay for their care) and social justice (well being of community over well-being of self)
7) multiple players and balance of power (looks at multiple players and how they affect the individual and the individuals care)
8) quest for integration and accountability (must advocate for self as a patient)
9) access to HC services selectively based on insurance coverage (HC to those who can afford it)
10) legal risks influence practice behaviors (doctors order more tests to cover their backs incase of being sued)
System Framework:
- System Inputs (Resources)
- System Structure
- System Processes
- System Outputs (Outcomes)
- System Outlook (Future Directions)
System Inputs:
both human and non-human resources
personnel, technology, financing and reimbursement
System Processes
carried out through hospitals, clinics and LTC providers, OP clinics, community based settings
System Outputs
refers to critical issues and concerns
primary objective: provide cost-effective health services that meet quality standards of nation
System Outlook
must look forward - project the future
