Identify each of the 10 characteristics of the US health system.
1. No central governing agency and little integration and coordination
2. Technology
... [Show More] driven & focused on Acute care
3. High cost, unequal access, average outcomes
4. Imperfect market conditions
5. Private sector: Dominant Role
6. Fusion of Market Justice and Social Justice
7. Multiple Players and Balance of Power
8. Quest for integration and accountability
9. Access to healthcare services
10.Legal risks
Explain each of the 10 characteristics of the US health system - 1. No central governing agency and little integration and coordination (Dispersed in 3 Ways)
Each state sets their own regulations because it is in the constitution and that is why the US varies so much and is dispersed
- Federal Government (medicare, minimum services/maximum out-of-pocket, veteran's health, Indian health service, federal public health agencies like CDC, NIH, etc.)
- State (medicaid, CHIP, state public health agencies)
- Private (employer insurance, market insurance)
Explain each of the 10 characteristics of the US health system - 2. Technology Driven & Focused on Acute Care
- People think that is technology is newer that it is safer
- Because we are so focused on the technology that will help us if we do get sick, we don't focus as much on preventative measures
- Scanning machines(X-rays)
- Research (NIH)
- How grants are written (innovation)
- Electronics (patient charts are no longer handwritten)
- Minimally invasive surgeries (new techniques)
- New pharmaceuticals
Explain each of the 10 characteristics of the US health system - 3. High Cost, Unequal Access, Average Outcomes
GDP: goods and services produced by a country in a given year
- US spends a lot more than other countries
Uninsured Population in the U.S.
- Has decreased recently
- Constantly moving slow
> People lose jobs, people go on and off of medicaid
Healthcare System Performance
- Imperfect market conditions
Explain each of the 10 characteristics of the US health system - 4. Imperfect Market Conditions
Free market: would be considered a "perfect condition"
- US is not a free market
- If we had a free market, patients (buyers) and providers (sellers) would act independently
Explain each of the 10 characteristics of the US health system - 5. Private sector: Dominant Role
Healthcare delivery
Technology
Supply vendors
Insurance companies
- In most developed countries, the government plays a central role in health care delivery, but in the US the private sector has the dominant role
Explain each of the 10 characteristics of the US health system - 6. Fusion of Market Justice and Social Justice
Market Justice: responsibility is placed on you to figure out how you are going to pay for healthcare
- If you don't have money, you don't get treatment
Social Justice: emphasizes "social good." the well-being of the community is over that of the individual.
- Inability to obtain medical services due to a lack of financial resources is considered unjust
Explain each of the 10 characteristics of the US health system - 7. Multiple Players and Balance of Power
Players: Each player has an economic interest to protect, but problems arise when players' interests area at odds; providers seek to maximize government reimbursement (want to get as much money as they can) while the government strives to contain cost increases (they want to give out as little money as they can)
- Health care providers
- Medical suppliers
- Insurers
- Claims payers
- Education & research
Explain each of the 10 characteristics of the US health system - 8. Quest for Integration and Accountability
ACA puts different policies in places that creates an emphasis on primary care
Trying to get things integrated so people are seeing the same provider for multiple things
Value based care
- Instead of paying by the number, you pay for the value of that care
- Concept is that you are paying based on system
The model emphasizes Patient-provider relationship in improving the health of each individual person, therefore improving the health of the population
- Provider accountability: providing quality care efficiently
- Patient accountability: taking responsibility for one's health and using resources sensibly
Explain each of the 10 characteristics of the US health system - 9. Access to Healthcare Services
Based on ability to pay
Explain each of the 10 characteristics of the US health system - 10. Legal Risks
Where patients are so quick to sue over something, doctors then use defensive medicine where they over-check and do unnecessary care to be on the safe side.
- Doctors prescribe additional testing (more expensive, may not be needed, more time)- some tests have side effects or show false positives leading to more unnecessary care
- Doctors schedule checkup appointments
- Doctors maintain abundant case documentation
Compared to other countries, what is the relationship of GDP to health spending in the United States?
Of all developed countries, the US spends the most on health care services (17% of the gross GDP)
- Spend the highest percent of GDP on health
How do most people in the United States obtain health insurance?
Through their employer
Explain the differences between a national health insurance, a national health system and socialized health insurance?
NHI
- Can be public or private and reimbursement for physicians are negotiated fee-for-service - Government finances health care through tax dollars.
NHS
- Public and reimbursement for physicians are reimbursed by salaries and capitation payments - Gov. finances and manages healthcare delivery
SHI
- Insurance and payment functions are integrated, and financing is better coordinated with insurance and payment functions - Employers and employees finance healthcare
How is the U.S. system unique, when compared to other health systems?
The United States is somewhat of a melting pot of all the models
- If you can't get government insurance and you can't get private/employers' insurance, then you're SOL
National Health Insurance
- Medicaid and Medicare
National Health System
- Health Departments - Government funded
- Native Americans, Veterans health
What is a market justice? What is social justice? What is rationing like in each system?
Market Justice : places responsibility for fair distribution of health care on market forces in a free economy
- Demand-side rationing (price rationing): barriers to obtaining health care faced by individuals who do not have sufficient income to pay for services or purchase health insurance.
- Prices and ability to pay combine to ration the quality and type of healthcare services people consume.
Social Justice : emphasizes the well-being of the community over that of an individual
- Supply-side rationing (planned rationing): rationing that is generally carried out by a government to limit the availability of health care services, particularly expensive technology
- When the government makes deliberate attempts to limit the supply of healthcare services, particularly those beyond the basic level of care
What types of health care systems employ market justice? Which ones employ social justice?
Market
- Individual responsibility for health care- private insurance. If you can't pay for it, you can't get it
Social
- Distribution is societal responsibility- everyone has same access to health care; health care is a social good the government needs to provide
What type of justice does the U.S. system employ?
Mostly social justice, but kind of a mix of both social and market justice
What are the determinants of health? Which determinant plays the largest role in health outcomes? What role does medical care provide?
Determinants
- Environment (social and ecological), behavior and lifestyle, hereditary (genes), and medical care
Largest: Social and ecological characteristics
Smallest: Genes and biology
Medical care provides access to adequate services for preventative and curative health
Identify 3 key events in the history of the United States and describe how they shaped the development of the health care system.
Scientific Advances (Late 1800s, early 1900s)
1. Silmowise
- If you washed your hands between patients, you prevent the transfer of disease
- Chlorine solution to wash hands with (Would get rid of the bad smell)
2. You can't have the modern healthcare system that we have today without scientific backing
3. Medical school reform
- Forming of medical discipline
- ~1910-1915
4. 1929 penicillin developed
The Great Depression
- Start to have hospitals being built and are nicer
> Charging more for services
- The Great Depression hits
> A lot of people unemployed, couldn't afford food or medical care
World War II
- Planned Economy
> In order to push resources into the war effort there were government restrictions (food rationing)
>Froze wages in the US
> Shortages of workers
> Women enter workforce for the first time
- Employers start offering benefits to attract works
> Providing health insurance
- 1943
> Non-taxable health insurance
> Employer based healthcare system
What are the different ways that health can be defined? How do these definitions influence the delivery of health care?
Biomedical Model
- The absence of illness or disease
- Emphasizes clinical diagnosis and medical intervention to treat disease or its symptoms
Medical Sociologist
- Focuses on how the individual functions in society
Biopsychosocial Model
- WHO Definition
> State of complete physical, mental, and social wellbeing, not merely the absence of disease
- Health isn't just the absence, it's also the wellbeing
- Trying to think about health from several different angles
Holistic Medicine
- Wellbeing is every aspect of what makes a person complete and whole, including a spiritual dimension
- Quality of life
> Is this the life I want to live?
- End of life decisions
- Alternative therapies
Traditionally, what has been the relationship of the public health system and the medical system?
Medical System
- Focuses on the individual
Public Health System
- Focuses on a population was a whole
Lots of tension because PH requires the medical system to send information, disease reporting, etc. Medical System saw PH as a competitor.
What are the three major time periods of public health in the United States? What type of focus characterizes each time period?
1850-1949: State and Local Infrastructure
- Focused on Infectious Diseases
- Starting to use scientific method
- Sanitation to prevent disease
> Water systems
> Basic measures to prevent disease rates
1950-1999: Gaps in medical care delivery
- Medical care to vulnerable group
2000-now: Community health
- Starting to infuse what surrounds the person
- World health definition of health
> Everyone has total physical, social, mental, spiritual wellbeing
What is the federal role in public health? What is the state role in public health?
Federal
- Health is not mentioned in the constitution therefore federal powers that are not explicit are given to the states
- Provides "general welfare"
- Regulates interstate commerce
State:
- Control health and welfare
- Police powers
> Ability to control and abate hazards
-Common law
>Expectations rather than laws
>Informal law
>Expectation that the states would take care of the poor
> Elizabethan tradition in our system
Identify and describe the three core functions and the 10 essential services of public health.
Core Functions: (the 10 essential services fall under these 3 functions)
- Assessment
- Policy development
- Assurance
10 Essential Services:
Monitor health status to identify community health problems
- Surveys
- Collecting data
Diagnose and investigate health problems and health hazards in the community
- Lexington-Fayette reports of Nora Virus and doctors were getting multiple reports of sickness
- PH dept investigates and found that everyone was eating Food Court at Fayette Mall. People coming into work sick, unsanitary conditions, etc.
Inform, educate, and empower people about health issues
- TV ads
- Pamphlets in doctor's offices
- School programs
- Community groups
- Classes offered by PH depts
Mobilize community partnerships to identify and solve health problems
- PH dept working with other groups in the community to offer services to address a problem
- Working with different groups, agencies, employers to aid in a centralized issue
Develop policies and plans that support individual and community health efforts
- Implementing regulations/laws for the betterment of a particular health issue or behavior
- Example: smoking bans
Enforce laws and regulations that protect health and ensure safety
- Restaurant expectations
- Powers to enforce certain things for the betterment of health
- Smoking bans and enforcing the ban by expecting
Link people to necessary personal health services and assure the provisions of health care when it is otherwise unavailable
- Needle exchange
- Rehab
- AA meetings
Assure a competent public health and personal health care workers
- Deals w/ PH itself
> Ensures the workforce in PH is competent
- Lot of different pathways to PH jobs
>Don't always have proper training
> Training needed for them due to diverse education backgrounds
Evaluate effectiveness, accessibility, and quality of personal and population-based health services
- Looking at results
- Making sure policies are working
- How well are we addressing it?
- Are we coming out okay?
Research new insights and innovative solutions to health problems
- Goes at every level
> Applies at all levels
- Often done at universities
- Develop program and see if they work [Show Less]