Health Care Systems Flashcards
Health Care
Health care is the total societal effort, undertaken in
the private and public sectors, focused on pursuing
health
Health Services
Health services are specific activities undertaken to
maintain or improve health or quality of life or prevent
decrements of health
Health Care System
Health care system or health system is the
organization of people, institutions, and resources
to deliver health care services to meet the health
needs of target populations.
Health Care Delivery System Components
3
Institutions and Structure: how the system is organized
Functions: what the system aims to achieve
Education and Personnel: who works in the system
Economics and Funding: how the system is funded
Reimbursement: how health professionals are paid
Target Populations:
•who gets care from the system and
•what services are covered
4 Main Types of Health Care Systems **This is an Exam Question!
- The Beveridge Model
- The Bismarck Model
- The National Health Insurance Model
- The Out-of-Pocket Model
*KNOW THIS
Beveridge system is financed by who
Government! Thus the tax Payers -Cuba
(not all hospitals are owned by gov-but doc may be gov employee)
**Know this one
Bismarck Model
Provided through insurance-jointly financed by employers and employees
**Everyone is expected to be covered without making profit!
National Health Insurance Model
Has elements of both Beveridge and Bismarck
Uses mainly private-sector providers
Payment for services come from a government-run
insurance program that every citizen pay into
There is no marketing, no financial motive to deny
claims and no profit to be made
This universal system tend to be cheaper and simpler
administratively
Countries: Canada, Taiwan and South Korea
The out of pocket Model
No mass medical health care, Rich gets care and poor die
Rural Africa and China
Nigeria
part of Africa
Regionalized or Traditional Health care model
**EXAM QUESTION
Each level of care corresponds with certain unique patient needs—
Different types of personnell and facilities are assigned to distinct tiers of care
NO FREE FLOW OF PATIENTS -NO Specialized care provider at level of primary
Dispersed or Non-Traditional model
**EXAM QUESTION
•This model emphasizes the primary care base
•The flow of patients across levels is in an orderly,
regulated fashion
FREE FLOW OF PATIENTS—Places High value at tertiary level
Mr. Alex, a 60 year-old man, living in a London suburb, is registered with Dr. Smith, a general practitioner in his neighborhood.
Mr. Alex goes to Dr. Smith for most of his health problems,
including
hay fever, back spasms and hypertension. One day, he experiences numbness and weakness in his face and arm.
By the time Dr. Smith examines him later that day, the symptoms have resolved. Suspecting that Mr. Alex has had a transient
ischemic attack, Dr. Smith prescribed aspirin and refers him to the neurologist at the local hospital, where a carotid artery sonogram reveals high-grade carotid stenosis.
Dr. Smith and the neurologist agree that Mr. Alex should make an appointment at a London teaching hospital with a vascular surgeon, specialized in head and neck surgery.
He went through levels of treatment.
primary, secondary, and tertiary
Ms. Cathy, a 50 year-old woman with commercial or private health insurance who lives in the United States, sees several physicians for a variety of problems—a dermatologist for eczema, a gastroenterologist for recurrent heart burn, and an orthopedist for tendonitis in her shoulder. She may ask her gastroenterologist to treat a few general problems, such as borderline diabetes. On occasion, she has gone to the nearby hospital emergency room for treatment of urinary tract infections.
One day, Ms. Cathy feels a lump in her breast and consults a gynecologist. She is referred to a surgeon for a biopsy, which indicates cancer. After discussing treatment options with Ms. Cathy, the surgeon performs a lumpectomy and refers her to an oncologist and radiation therapy specialist for further therapy. She receives all of these treatments at a local hospital, a short distance from her home.
Non-Traditional (US is this)
US Health Care System Size and Scope
•Institutions and programs: hospitals, nursing homes,
home health agencies, federally qualified health
centers, health services for migrant workers, etc
•The United States has a unique system of health care delivery, different from all other developed countries
•The US health care industry constitutes more than 3
percent of the total labor force
