Copyright © Springer Publishing Company, LLC. All Rights Reserved.
Chapter 1: Introduction
1
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
Introduction to Health Care Systems
• Definition: Healt...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
Health and Health Care
• What is health?
– Complete phy...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
Health and Health Care (cont’d)
• Health behavior
– Beh...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
Health and Health Care (cont’d)
• Health care as a dete...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System
• Complex and unique among nati...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• Components
– Workfor...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• Financing mechanisms...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• Organization of heal...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• Types of health serv...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• Health care system a...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• The population serve...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• Health care system p...
Copyright © Springer Publishing Company, LLC. All Rights Reserved.
U.S. Health Care System (cont’d)
• History of change
– ...
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Chapt 1 introduction

  1. 1. Copyright © Springer Publishing Company, LLC. All Rights Reserved. Chapter 1: Introduction 1
  2. 2. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 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 2
  3. 3. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 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 3
  4. 4. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 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 4
  5. 5. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 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 5
  6. 6. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 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 6
  7. 7. Copyright © Springer Publishing Company, LLC. All Rights Reserved. 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) 7
  8. 8. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 8
  9. 9. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 9
  10. 10. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 10
  11. 11. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 11
  12. 12. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 12
  13. 13. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 13
  14. 14. Copyright © Springer Publishing Company, LLC. All Rights Reserved. U.S. Health Care System (cont’d) • 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 14
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