introduction to us health care

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Introduction to US Health Care

• Text by

Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs &

James R. Knickman with Tracy Barr

• PowerPoints by Robin Pickering Eastern Washington University

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Introduction to US Health Care

Chapter 3

Health Care Provision

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Types of Care

1. Primary2. Secondary3. Tertiary

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Comparing Care Models

• Consult with primary care provider first

• Send difficult problems with secondary or tertiary

• Benefits– Quality of care– Cost containment– Public sentiment

•Primary Care Model

•Specialty Care Model

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Comparing Care Models

• More dispersed model• Does not require patient

to consult first with primary care provider

• Contributed to the rising cost of health care

•Primary Care Model

•Specialty Care Model

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Managed Care Model

Health organizations control costs by funneling all medical necessities through the PCP

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Effective Primary Care Systems

• Accessibility• Continuity• Comprehensivene

ss• Coordination• Accountability

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Primary Care Team Approach

Nurse Practitioner

Physicians

Medical Assistant Clinicians

Receptionist

Medical Assistants

Health Educators

Primary Care Team

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• Disease registries• Performance feedback• Case management• Chronic care visits

Chronic Care Model

Collaborative Care

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Primary Care Specialties

• Family Physicians• General Internists• General Pediatricians

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“Nonphysician” Clinicians

• Nurse Practitioners• Physician Assistant

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Access to Health Care

•Too few generalists•Lack of health insurance•Maldistribution of PCPs -(HPSAs)

Two-thirds of all HPSAs are

in rural regions *Rural

*Inner City

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Strategies to Improve Distribution

• National Health Service Corps and Loan Repayment Program

• Grants• Focused Recruiting of Medical Students

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Introduction to US Health Care

Chapter 4

Financing the U.S. Health Care System

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Increased Health Care Expenditures

• Inflation in economy• Inflation in medical

component of consumer price index

• Growth of population• Changes in the type

and quality of health care service

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Change in Health Care Financing

Past: Individual Financing

Present and Future: Employer Financing

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Differentiate…

Purchaser

• Pays for the service (insurance company or the government)

Consumer

•Receives the service (patient)

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Financing Health Care

• Individuals• Government• Private

Businesses

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Financing Health Care

• Individuals

• Government• Private

Businesses

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Financing Health Care

• Individuals• Government

• Private Businesses

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Insurance Coverage

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Factors Affecting Coverage

• Age• Race and Ethnicity• Poverty Level• Residence

Predict Coverage

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• Voluntary Health Insurance

• Social Insurance• Public Welfare Insurance

Types of Health Insurance

•Indemnity Plan•Service Benefit•Managed Care

Categories…

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Voluntary Health Insurance (VHI)

1. Commercial2. Blues3. HMOs4. Self-funded

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Compare Programs

Attribute Medicare MedicaidPopulation

served•65 and older•Disabled (SS)•Kidney failure

•Those in need (state determined)

Funding •Federal gov’t (payroll deductions)

•57% federal, remainder from states

Administered •Managed by federal gov’t

•Federal gov’ t sponsored, administered by states

*adapted from table 4-5 in text

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• Independent Practice• Group• Network• Staff• Mixed

HMO Models