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Factors Shaping the US Healthcare System: Demographics, Insurance, Managed Care

This chapter explores the various factors that shape the healthcare system in the United States, including changing demographics, health insurance (or lack thereof), managed care, shortages in healthcare personnel, medical technological advances, information technology, legal concerns, and different healthcare settings and services.

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Factors Shaping the US Healthcare System: Demographics, Insurance, Managed Care

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  1. Unit 2 Environment of the Profession

  2. Chapter 8 Health Services in the United States

  3. What Shapes the Health CareSystem in the United States? • Changing demographics • Health insurance or lack of it • Managed care

  4. What Shapes the Health CareSystem in the United States? • Shortages in health care personnel • Nurses and medical assistants • Medical technological advances • Information technology • Legal concerns

  5. Health Care Settings • Inpatient • Hospitals • Ownership? • Long-term care • Hospice care • Specialty hospitals

  6. Health Care Settings • Outpatient • Emergency care • Community-based patient care • Ambulatory centers

  7. Types of Services • Primary • Secondary • Tertiary

  8. Team Members • RNs • Advanced practice nurses • MDs • Also DOs, Chiropractors • Physician Assistants • Pharmacists, social workers, technicians

  9. Health Care Financing

  10. Health Care Financing: Medicare • 1965 • Title XVIII of the Social Security Act • Federally funded health insurance program

  11. Health Care Financing: Medicare • Persons over age 65 • 1973 • Extended to younger persons with chronic illnesses and entitled to Social Security • Those with end stage renal disease

  12. Medicare • Part A • Part B • Part D

  13. Health Care Financing: Medicaid • Federally and state funded program specifically for aged poor • Blind and disabled who have limited income

  14. Health Care Financing: Medicaid • Families with dependent children who have only one parent who is unemployed or unable to work • Low income pregnant women

  15. Managed Care • HMO • PPO • Other care systems • Uninsured

  16. Issues that Affect Health Care Delivery in the United States • Demographics • Technology • Genetics • Natural Disasters • Terrorism • Lifestyles

  17. Issues that Affect Health CareDelivery in the United States

  18. Issues that Affect Health Care Delivery in the United States

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