2. Introduction
The United States has a unique system of
health care delivery.
The US health care delivery system is
complex and massive.
“Health care delivery” and “health services
delivery”
187.4 million Americans have private health insurance
coverage,
•35.2 million Medicare
beneficiaries, and 31.5
million Medicaid recipients.
Health insurance can be bought from:
1,000 health insurance companies
70 BlueCross/BlueShield plans
3. Subsystems of US Health Care Delivery
• Managed care
• Military
• Vulnerable populations
• Integrated delivery
4. Managed care
•A system of health care delivery that:
1) seeks to achieve efficiency by integrating the basic functions of healthcare delivery
2) employs mechanisms to control (manage) utilization of medical services
3) determines the price at which the services are purchased and how much the providers get paid.
5. Military
The military medical care system is available free of charge to:
active duty military personnel of the U.S. Army,
•Navy, Air Force, and Coast Guard,
certain uniformed nonmilitary services such as
• the Public Health Services and
• the National Oceanographic and Atmospheric Association (NOAA)
6. Vulnerable populations
• Particularly the poor, uninsured, minorities and immigrants
• live in disadvantaged communities and receive care from “safety net” providers.
7. Integrated Delivery
The hallmark of the US health care industry:
•to form integrated delivery systems (IDS)
IDS
are various forms of ownership and links among
hospitals, physicians and insurers
IDS’ objective:
• To have one health care organization deliver a
range of services
8. Characteristics Of The U.S. Health Care System
No Central Governing Agency;
Little Integration and Coordination
Technology-Driven and Focuses on Acute Care
High on cost, Unequal in Access, and Average in
•Outcomes
Imperfect Market Conditions
No Central Governing Agency;
Little Integration and Coordination
The US system is different from other developed
countries
It is not centrally-controlled
• Central systems are less complex, less
costly
Has different payment, insurance, and delivery
mechanisms
Health care is financed both publicly and
privately
