Introduction to US Health Care

3 - 1

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

3 - 2

Introduction to US Health Care

Chapter 3

Health Care Provision

3 - 3

Types of Care

1. Primary2. Secondary3. Tertiary

3 - 4

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

3 - 5

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

3 - 6

Managed Care Model

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

3 - 7

Effective Primary Care Systems

• Accessibility• Continuity• Comprehensivene

ss• Coordination• Accountability

3 - 8

Primary Care Team Approach

Nurse Practitioner

Physicians

Medical Assistant Clinicians

Receptionist

Medical Assistants

Health Educators

Primary Care Team

3 - 9

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

Chronic Care Model

Collaborative Care

3 - 10

Primary Care Specialties

• Family Physicians• General Internists• General Pediatricians

3 - 11

“Nonphysician” Clinicians

• Nurse Practitioners• Physician Assistant

3 - 12

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

3 - 13

Strategies to Improve Distribution

• National Health Service Corps and Loan Repayment Program

• Grants• Focused Recruiting of Medical Students

4 - 14

Introduction to US Health Care

Chapter 4

Financing the U.S. Health Care System

4 - 15

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

4 - 16

Change in Health Care Financing

Past: Individual Financing

Present and Future: Employer Financing

4 - 17

Differentiate…

Purchaser

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

Consumer

•Receives the service (patient)

4 - 18

Financing Health Care

• Individuals• Government• Private

Businesses

4 - 19

Financing Health Care

• Individuals

• Government• Private

Businesses

4 - 20

Financing Health Care

• Individuals• Government

• Private Businesses

4 - 21

Insurance Coverage

4 - 22

Factors Affecting Coverage

• Age• Race and Ethnicity• Poverty Level• Residence

Predict Coverage

4 - 23

• Voluntary Health Insurance

• Social Insurance• Public Welfare Insurance

Types of Health Insurance

•Indemnity Plan•Service Benefit•Managed Care

Categories…

4 - 24

Voluntary Health Insurance (VHI)

1. Commercial2. Blues3. HMOs4. Self-funded

4 - 25

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

4 - 26

• Independent Practice• Group• Network• Staff• Mixed

HMO Models