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US HEALTH CARE SYSTEM. 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. USA
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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
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 Other Countries Seen as a Basic Human Right Universal Coverage to all citizens Government Pays Western World Health Care
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
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
HEALTH INSURANCE STATUS • GRAPH
Who are the greatest # Uninsured ( 1993) Poor racial Minority Rural Dwellers Young adults
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 • 5%males and 1% females in 1991 made > than $75,000
PRIMARY CARE PHYSICIANLess 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
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 • 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 • Overcrowding
Medical -Industrial Complex • Money Makers • Capitalization on the market by: • >#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)
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)