chapt 1 introduction

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Chapter 1: Introduction

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Introduction to Health Care Systems

• Definition: Health care system– All institutions, processes supporting diagnosis,

and treatment– For legitimized patients by appropriate providers

• Variation among nations’ health care systems– Definitions of health problems (e.g., obesity)– Diagnosis and treatment models– Social position, training, and authority of healers


Health and Health Care

• What is health?– Complete physical, mental, and social well-being– Not just absence of disease or infirmity (WHO)

• Determinants of health– Genetic inheritance– Health behavior– Physical environment– Social environment


Health and Health Care (cont’d)

• Health behavior– Behavior that affects health, usually negatively• Smoking, alcohol/drug abuse, diet, exercise

– Implicated in leading causes of death in United States• Heart disease, cancer, stroke, respiratory diseases, etc.

– Most common target for health improvement efforts

– Healthy People 2020


Health and Health Care (cont’d)

• Health care as a determinant of health– Main goals

• Restore health• Prevent worsening of problems

– Late in causal chain leading to illness– Levels of prevention

• Primary: eliminate risk factors to prevent onset (least focused on now)

• Secondary: early detection and treatment and restoration of pre-onset health status

• Tertiary: prevent further exacerbation of health problem


U.S. Health Care System

• Complex and unique among nations• Highly decentralized and fragmented• Mix of private and public financing and

provision of care• Historically has produced high physician

incomes and profits for suppliers of therapeutics


U.S. Health Care System (cont’d)

• Components– Workforce: 15.5 million people– Facilities: 5010 acute-care hospitals– Therapeutics: $299.6 billion in drugs and products– Training and research: contributes to character of

health care system– Financing: $2.486 trillion in 2009 (17.6% GDP)



• Financing mechanisms– Health “insurance” • HMOs: care within network, primary care physician• PPOs: care within or outside of network• POS plans: choice between HMO and PPO

– Managed care



• Organization of health care services– Government sector: federal, state, and local• Department of Health and Human Services

– Private, nonprofit sector• Many hospitals and voluntary agencies: American Heart

Association, Red Cross

– Private, for-profit sector• Pharmaceuticals, insurance, nursing homes, hospitals,

MCOs



• Types of health services– Primary care• Exercise promotion, immunization, prenatal care,

health exam

– Secondary care• Surgical procedures and common diagnostic and

treatment interventions

– Tertiary care• Organ transplantation, open-heart surgery,

chemotherapy



• Health care system administration– Administration• Hospital staffs function independently, not as a team

– Planning• Weak because not backed by law

– Government regulation: mainly reactive, not proactive

– Evaluation: applied program evaluation seldom done



• The population served– U.S. population in 2010: 309 million– Racially and ethnically diverse

(72.4% white, 12.6% black, 4.8% Asian, 10.2% other race)

– Historically different in access to health care– Large income differentials– Aging of Baby Boomers



• Health care system performance– Quality• Health outcomes vs. technical accomplishments

– Equity• Distribution and access uneven• Geography and health coverage are major

determinants

– Efficiency: allocative vs. productive, micro vs. macro



• History of change– Changes called for as early as 1932 (CCMC)– Medicare and Medicaid enactment

• Present situation– Same problems: financing, distribution, and

delivery• Future directions– New financing and organizational models

chapt 1 introduction

Health & Medicine