Transcript US HEALTH CARE SYSTEM

US HEALTH CARE SYSTEM
7/17/2015
OVERVIEW
 Most Expensive Health Care System in The
World
• Consumes 14% of Gross National Product
• Is the 2nd largest industry in the USA
• Expenditures take up 1/5 of the Federal Budget
 The health Status of the people Does not
equal the Cost of the care
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Western World Health Care
– USA



Individual is responsible
to obtain coverage
Pay as You Go ( Fee for
Service)
Not all people are in a
position to buy into the
system
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– Other Countries



Seen as a Basic Human
Right
Universal Coverage to all
citizens
Government Pays
INSURANCE?
 Governmental Programs
• 65 y/o > ( Medicare : 1965)
– person may still share in the cost
– Enrolls 36 million
– Restrictions placed on Medical Services
– Must have supplemental coverage
• For the Poor. ( Medicaid:1965)
– some providers do not accept
– strict financial guidelines to qualify
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INSURANCE?
 Private Insurances
• 70%of the citizens under the age of 65 y/o
– employer may share if they offer the
insurance
– some pay full premiums
– not all family members may be covered
– some medical procedures may not be
covered
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HEALTH INSURANCE STATUS
 GRAPH
MEDICARE
70
59.2
60
48.3
50
39.7
40 33.1
31.7
30
20
10
0
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MEDICAID
NOT COVERED
GROUP HEALTH
PLANS
TOTAL #
PERSON(MILLION)
Who are the greatest #
Uninsured ( 1993)
Poor racial Minority
Rural Dwellers
Young adults
35%
30%
25%
20%
15%
10%
5%
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32%
0%
21%
14%
LATINO
AFRICAN
AMERICAN
WHITES
WHO IS THE US HEALTH CARE
SYSTEM
 PHYSICIANS
• 600,000 PRATICING TODAY
– 1 MD/ EVERY 450 PEOPLE
– “ARTIFICIAL DOCTOR SHORTAGE” - MIGRATION TO RICH
AREAS IN ORDER TO MAKE MONEY AND SPECIALIZE
– PUSH IS TOWARD SPECIALIZATIONMEANS< FAMILY
PHYSCIANS
• Doctors mean salary (1991) $171,000
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– 5%males and 1% females in 1991 made > than
$75,000
PRIMARY CARE PHYSICIAN
Less than 12% family doctors
DEFINITION
• IN THE COMMUNITY VS HOSPITAL
• NO REFERALS FORM OTHER MD’s
• CONTINUING VS EPISODIC CARE
• MANAGES Patient's CARE W/ REFERAL
MD AND OTHER COMMUNITY BASED
SERVICES
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CONSEQUENCES
 FOR THE POOR
• PUT OFF NEEDED CARE : = INCREASED INCIDENCES
OF SERIOUS DISABILITY
• USES ER AS PRIMARY SOURCE OF CARE
– LACK OF FOLLOW THROUGH
– LONG WAITS/ HURRIED STAFF
 FOR OTHERS
 STRAINED HOSPITAL BUDGETS
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
HIGHER INSURANCE RATES
BARRIERS TO HEALTH CARE
 Fraud and Abuse
• Medicaid and Medicare- increase visit#
decrease quality , in order to bill
• Private Insurance's
 If without insurance when hospitalized
• Poor care
• Refusal to provide care/ turned away
• Public / Teaching Hospitals
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• Overcrowding
Medical -Industrial Complex
 Money Makers
• Capitalization on the market by:
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– >#of investors in the for-profit hospitals
– growth in the firms owning hospitals that run
chains ( Mc Donaldization)
– expand for-profit operators for health care
– private investors and corporate expansion into
Nursing homes, Home Care companies, local
surgical centers and clinic
– investor owned hospitals moving into private
health care insurance
PAST AND PRESENT
 HOSPITALS
• Prior to 1960S nonprofit
• serving the poor was the focus
• usually run by:
– communities
– religious groups
• 1990’s 1/4 of the hospitals are for profit
– Columbia /HCA

HMO’s ( Health Maintenance Organizations)
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Past and Present (Cont’D)
• For- profit health care providers
• Large corporate operators
 Dangers
• Services not provided if does not yield a
positive bottom line
– Examples
– Closures of Emergency Rooms
– closure of entire community health systems
– Hospital stays drastically cut ( Drive through Deliveries)
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