WENDI EVANS

HCA 205: INTRODUCTION TO HEALTH

INSTRUCTOR: BRETT GARCIA

JANURARY 7, 2015

My name is Wendi Evans, I am pursing a degree in Health Care Administration. I am a single mother of

three. I love to sing, shop, cook, and spend time

with my family and friends.

This presentation will explain the history of the US Health Care System. I will be defining the Healthcare system, describing the cost, comparing the US Healthcare system to Canada’s healthcare system, and discussing reforms and improvements.

Definition of US Healthcare system – It is and organization of people, institutions, and resources that delivers health care services to meet the health needs of individuals of a targeted population.

1900’s - The beginning of organized medicine.

The American Medical Associations gains powerful influence as the National Organization of State and Local Associations. Social Insurance including Health Insurance gains public attention. Baylor Hospital in Dallas, Texas starts a pre-paid hospital insurance program with a local teacher’s union, ( first example of modern health insurance).

1965 to 1980 ‘s – President Johnson signs into law the most significant

Health Care Reform of the century Medicare. Medical cost rapidly

escalate , President Nixon sign Health Maintenance Organization Act.

2006 to present- Massachusetts implements laws to provide health care

coverage. President Obama signs Landmark

Health Care Legislation called the Patient Protection

and Affordable Care Act.

The marine hospital service was establish with the July 16, 1798 signing by President John Adams for relief of sick and disabled seamen. In 1875 a title of Surgeon General came into being.

March 3 a bill passed that authorized admission of navy seamen an seamen of other government services to Marine Hospitals on a reimbursable basis.

January 4, 1889 the Public Health Services Commission Corp. was authorized. Julius Richmond was the first Surgeon General of Public Health Service.

Financial – PPAC has

grand ambitions to provide insurance coverage to more than 30 million people.

2.7 trillion spent on health care is income to some person or organization.

The law also authorizes an additional 11 billion for federally qualified community Health Centers.

Legal- HIPPA protects

patients.

Federal Anti-trust laws

False claims whistle blower suits

Ethical- Balancing

quality care and efficiency.

The end of life issues financing that pays for this service forced to pull the plug due to insurance.

Regulatory – 1879-The Department of

Public Health

established by US

Congress.

The government

regulates laws for

Health care system.

Social - Civil War was

instrumental in

establishing the US

Health Care System.

At the turn of the 20th

century break through in

Medicine and

Technology.

1929 to 1941- The great

Depression

STAKEHOLDERS Patient- Expects an employer to offer a wide variety of options for health

coverage.

Employers – Want to maintain or lower cost contributions.

Providers – Want to provide the best service using the most accurate and

newest test and treatments.

Payers- Want providers to follow a clear, evidence based diagnostic plan.

Political Figures – The government regulate laws to be enforced for the

Health Care Systems.

Schools – Most Colleges and University Campuses offers some type of

general medical care.

Reimbursement methodsFee of service: the oldest form of medical reimbursement

doctors charge for every test and service provided.Capitation: Method of which employers pay a set price for

services no matter how many times patient visits the doctor puts cap on spending.

Valued based: Rewards the organization for the value of health care services delivered.

Managed Care Organizations: They enter into contracts with hospitals and healthcare professionals to provide health care to individuals enrolled in the plan.

MCO gives the provider economic incentives to offer less costly care.

Provider records are reviewed regularly.

Medical research : Research on different diseases such as cancer, and heart disease has increased.

Developing new treatment for previously untreated terminal conditions. Cost for workers time spent on

experimenting.

Equipment improvements: New medical and surgical procedures, drugs and medical

devices such as CT scanners, and defibrillators.

Delivery of quality care: Reduce hospital acquired conditions. Better preventive measures. Better doctors to patient ratio.More concern with cures for major diseases such as diabetes and

high blood pressure increase cost.

How do Canadians access Healthcare?

Apply for provincial health card.

After obtaining coverage one can register with primary care physician.

Card is used whenever visiting a physician or health care provider.

How do Canadians pay for Healthcare?

Health care is funded by both Federal and

Provincial levels.

By taxation both from personal and corporate

income taxes.

Sales taxes and lottery taxes.

There are no deductibles.

Quality of Healthcare Providers.

Canada has seen a significant decline in morality

rates from major killers such as cancer and heart

disease.

Immunization rates are low.

More than 80% have access to regular doctors.

Unique services provided

No National plan Canada’s Healthcare is based on

its 13 provinces and territories.

Hospital services provided to inpatient and out-

patients.

Services medically necessary for purpose of

maintaining health.

PRO’S AND CON’S SIMILARITIES

AND DIFFERENCES

Pro’s Con’s

* The elimination * Patients in

Of unnecessary Canada wait

risk of harm to longer for

patients. primary care

* Doctors always appointments.

involve patients * Greater use

in decision about of ER for

Treatment. primary care

factor longer

wait time in

ER.

• The government of both Nations are closely involved in the Healthcare system process.

• Us spends more money on healthcare than Canada.

• They have different mix of funding mechanism’s.

• In Canada all residents must be covered by the public insurance plan run by their province on uniform term and conditions.

• In the US all residents must have some type of insurance not necessarily government funded.

Medicare reform: Raised the income limit on eligibility.

Lower spending

Readmission rates lower

Seniors are able to choose from a broader range of higher quality Medicare plans.

Programs encouraging providers to invest in redesigning care.

Making information available for consumers.

Higher quality and more efficient services.

State modifications:

Has no affect on how much insurance cost.

State regulations which mandate the group health insurance plans must include certain benefits.

The cost of policies being too expensive

The availability of insurance in each state.

American Journal of Public Health. (AMJ Public Health),

October, 2011; 101(10)1841.4.

Batnitzky, A., Hayes, D., & Vinall, P.E. (2014). The U.S. healthcare system: An

introduction. San Diego, CA: Bridgepoint Education, Inc.

This text is a ConstellationTM course digital materials (CDM) title.

Weather, C. ( 1900& 1908). “New York Health Board Supervising Babies”.

Clark, E. & Bidgood, E (2011-2013). “Civitas”; Canada Health website.:

FAQ Canada Healthcare Act;

http://hc-sc.gc.ca/hcs-sss/medi-sssur/faq-eng.php

Canadian Foundation of Health Care Improvement (2014).

Accelerating Health Care Improvement: CFHI’s Assessment tool of Healthcare

Delivery Organization and Systems.

http://www.amnhealthcare.com

http://www.Annenburgclassroom.org/files/documents

http://www.profiles.nlm.nih.gov/ps/access/QQBBCZ

www.parlgc.ca/information/library/prbpubs/944-e.htm

Canadianhealthcare.org

Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, http://www.cms.hhs.gov/NationalHealthExpendData/ (see Historical, NHE summary including share of GDP, CY 1960-2005, file nhegdp05.zip; and Historical, Projected, NHE Historical and projections, 1965-2015, file nhe65-15.zip).

Mark. V. Pauly, “Competition And New Technology,” Health Affairs 24(6) (November/December 2005): 1523-1535.