Introduction to the US Health Care SystemDr. Nicole Hatcher

Objectives By the end of the class, you should:

Understand the basics of the US health care system

Be able to name and describe the four key components of the US health care delivery system

Be able to differentiate the U.S. health care system and the free market

Have an overview of health care in other industrialized countries

Primary Objectives of a Health Care System To enable all citizens to receive health

care services To deliver services that are most

effective and meet established standards of quality

Major Players Physicians Administrators Insurance companies Large employers Government

Characteristics of the US Health Care System No central agency Access is selective Imperfect market activity Third party insurers as intermediaries Multiple payers Balance of power Legal risk New technology Continuum of services Quality

Characteristic- #1 No central agency

Citizens are not entitled to receive a specific set of services

Lack of a global budget

Characteristic- #2 Access is selective

Insurance Affordability

Characteristic #3 Imperfect market

Quasi-free market In national health care, economic markets

do not exist

Characteristic #4 Third-party insurers and payers

Patient Provider Intermediary

Characteristic #5 Multiple payers

Billing and collection Cumbersome system

Characteristic #6 Balance of Power

Multiple payers Fragmented self-interests

Characteristic #7 Legal risk

Litigious society Defensive medicine

Characteristic #8 High technology

R&D

Characteristic #9 Continuum of services

Curative Restorative Preventative

Characteristic #10 Quality

Continuous quality improvement Higher expectations

The Role of Government Major financier Determine reimbursement rates Regulator of health professionals and

health care establishments Health policy

Basic Components of a Health Care System: Quad-function Financing Insurance Delivery Payment

Access to Care What is access? Key predictors of access

Financing and insurance Delivery and payment

A Complex Problem The uninsured

41.6 million in 2004 16-17% of the total population(Nat’l Center for Health Statistics)

Health Care Systems of Other Countries Three predominant models

National health insurance (NHI) National health system (NHS) Socialized health insurance (SHI)

References Shi, L., & Singh, D. (2011). Delivering

health care in America: A Systems Approach. 5th ed. Jones & Bartlett: Boston, MA.