This document provides an overview of the US healthcare system and key statistics. It discusses the history and development of healthcare delivery, including milestones in medicine, hospitals, public health and health insurance. It also outlines stakeholders in the current system like employers, insurers, and government. Statistics like life expectancy, infant mortality, GDP spent on healthcare are presented, showing the US lags peers on some health indicators. Tobacco rates are lower in the US while obesity rates are higher versus other OECD nations.

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Chapter 1: History of the
U.S. Healthcare System
HEED 3330
Dr. Green

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Learning Objectives
 Analyze five milestones of the hospital system and medicine
and their contribution to health care.
 Identify five milestones of public health and their importance to
health care.
 Identify five milestones of health insurance and their
importance to healthcare.
 Understand the difference between primary, secondary, and
tertiary prevention.
 Understand the concept of the iron triangle as it applies to
health care.

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What is Health?
 There are varying definitions of health based on the
organization:
 The state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity (World Health
Organization).
 A state of well-being and the capability to function in the face of
changing circumstances (Institute of Medicine).
 A state of physical and mental well-being that facilitates the
achievement of individual and societal goals (Society for Academic
Emergency Medicine).
 Social determinates of health or a person’s living conditions
such as their individual lifestyle factors, age, sex, and
socioeconomic status can play a huge role in influencing their
individual health.
 These determinates of health tie into the activities of the U.S.
healthcare delivery system and are often categorized as
primary, secondary, or tertiary prevention.

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The History of the U.S. Healthcare
System
 In order to understand the current U.S. Healthcare system, it is
important to understand the historical milestones of the
healthcare delivery system. There are four major sectors that
have influenced the current system of operations. They include:
 The history of practicing medicine and the development of medical
education
 The development of the hospital system
 The history of public health
 And the history of health insurance.
 Please review these milestones on pages 4-7 in your book.
Which milestones stand out to you? How have those
milestones impacted what you currently know about the U.S.
healthcare system?

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Current System Operations
 The federal, state, and local
government play an important
role in healthcare delivery. The
federal government is
instrumental in providing a
range of regulatory and funding
mechanisms that are aimed at
providing access to care for
vulnerable populations such as
the elderly, those of lower
socioeconomic status, children,
and individuals with disabilities.
 The private sector focuses on
the financial and delivery
aspects of the system such as
health plan coverage.

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Iron Triangle
 The Iron Triangle of Healthcare is a concept that focuses on the
balance of three factors: quality, cost, and accessibility to
health care.
 It is important that the three points of the triangle are balanced
or there may be a problem.
 If an increase in cost is emphasized, there may be a decrease
in access to affordable health care.
 If a decrease in cost is emphasized, the quality of health care
may suffer.

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Concluding Points
 There is no universal healthcare coverage in the U.S., and
there are health disparities across the nation
 The U.S. has the most expensive healthcare system in the
world
 Nearly 36 million are uninsured, which is a decrease from the
50 million in 2010
 There is participation from the government and the private
sector in healthcare
 Most individuals receive health insurance from their employers
 ACA focus increased access to healthcare and the quality of
healthcare while decreasing the number of uninsured.

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Chapter 2: Current Operations of
the U.S. Healthcare System

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Learning Objectives
 Identify the stakeholders of the U.S. healthcare system and
their relationships with each other.
 Discuss the importance of healthcare statistics and review the
healthcare statistics of the U.S. in comparison to other
countries.
 Discuss complementary and alternative medicine and its role in
healthcare.

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Stakeholder Perspective
 In the United States, in order to
provide healthcare services,
there are several stakeholders or
interested entities that participate
in the industry.
 From an organizational
perspective, the consumer is the
most important stakeholder for
an organization.
 The main groups of consumers
comprises patients who need
healthcare services from a
physician, hospital, or outpatient
facility.

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Learning Objectives
 Summarize the major provisions of the ACA.
 Evaluate the impact of the ACA on the accessibility of
healthcare plans to individuals and small businesses.
 Discuss the impact of the ACA on the health insurance industry.
 Describe the impact of the ACA on public health programs.
 Define and discuss the Health Insurance Marketplace.
 List and describe essential health benefits required by the ACA
for health insurance plans.

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Who are the Stakeholders?
 Employers consist of both
private and public employers. The
healthcare industry is the largest
U.S. employer.
 Hospitals, Nursing, and
Residential Care Facilities
 Physicians and Other
Healthcare Practitioners
 Home Healthcare Services
 Outpatient Care Centers and
Ambulatory Healthcare
Services

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Who are the Stakeholders?
 Laboratories
 Government
 Insurance Companies
 Educational and Training Organizations
 Research Organizations
 Professional Associations
 Pharmaceutical Companies

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Importance of Statistics
 Statistics are calculated to assess healthcare services in the
U.S.
 The National Center for Health Statistics (CDC) produces an
annual report on the health of the nation.
 Life expectancy rates are calculated to assess the health of a
nation.
 Infant mortality rates are also calculated to assess the health of
a nation.

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Importance of Statistics
 Healthcare access has a direct correlation between having
healthcare insurance and visiting a provider.
 Uninsured and underinsured statistics are calculated to assess
access to health care.
 Review the life expectancy rates by gender and ethnicity. What
sticks out to you?

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Health Indicators in Statistics
 Health indicators such as infant mortality rates, average life
expectancy, and health risk behaviors are used to evaluate the
health status of a population.

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Gross Domestic Product
 It is the percentage of products
or services produced within the
U.S. borders.
 In 2014, the United States spent
17.5% of its GDP on health care,
which is the highest of the 30
OECD members.

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OECD Statistical Highlights Life
Expectancy Rates
 Average life expectancy in OECD countries is 80.5 years.
 Spain and Switzerland-highest with more than 80 years old.
 Lowest is Mexico with less than 75 years.
 The U.S. average is 78.8.

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OECD Statistical Highlights
Life Expectancy Rates at age 65
 Increased over the past 20 years.
 Females are 81.1 years.
 Males are 77.8 years.
 U.S. less than the average OECD rate with a widening gap.
 U.S. men’s rate was 4.3 years less than Switzerland who was
the leader.
 U.S. women’s rate was 5.4 years shorter than the leader- Japan.

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OECD Statistical Highlights
Infant Mortality Rates
 Infant mortality rates are calculated as a comparison measure
of country health status.
 According to the OECD, the infant mortality rate is the number
of deaths per 1,000 lives births occurring among the population
of a designated area during the same calendar year.

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OECD Statistical Highlights
Infant Mortality Rates
 The average OECD rate is 3.8.
 The U.S. rate is 5.0 which is higher than the OECD average.

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OECD Statistical Highlights
Tobacco and Obesity Rates
 The U.S. has one of the lowest tobacco smoking rates in the
OECD countries.
 The U.S. has one of the highest obesity rate in the OECD
countries.
 Why the difference in the U.S.?