Introduction to US Health Care

1. Introduction to US Health Care • Text by Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs & James R. Knickman with Tracy Barr • PowerPoints by Robin Pickering Eastern Washington University

2. Introduction to US Health Care Chapter 3 Health Care Provision

3. Types of Care • Primary • Secondary • Tertiary

4. Comparing Care Models • Consult with primary care provider first • Send difficult problems with secondary or tertiary • Benefits • Quality of care • Cost containment • Public sentiment • Primary Care Model • Specialty Care Model

5. Comparing Care Models • More dispersed model • Does not require patient to consult first with primary care provider • Contributed to the rising cost of health care • Primary Care Model • Specialty Care Model

6. Managed Care Model Health organizations control costs by funneling all medical necessities through the PCP

7. Accessibility Continuity Comprehensiveness Coordination Accountability Effective Primary Care Systems

8. Health Educators Medical Assistants Nurse Practitioner Primary Care Team Receptionist Physicians Clinicians Medical Assistant Primary Care Team Approach

9. Chronic Care Model • Disease registries • Performance feedback • Case management • Chronic care visits Collaborative Care

10. Family Physicians General Internists General Pediatricians Primary Care Specialties

11. “Nonphysician” Clinicians • Nurse Practitioners • Physician Assistant

12. Access to Health Care • Too few generalists • Lack of health insurance • Maldistribution of PCPs -(HPSAs) *Rural *Inner City Two-thirds of all HPSAs are in rural regions

13. Strategies to Improve Distribution • National Health Service Corps and Loan Repayment Program • Grants • Focused Recruiting of Medical Students

14. Introduction to US Health Care Chapter 4 Financing the U.S. Health Care System

15. Increased Health Care Expenditures • Inflation in economy • Inflation in medical component of consumer price index • Growth of population • Changes in the type and quality of health care service

16. Change in Health Care Financing Present and Future: Employer Financing Past: Individual Financing

17. Purchaser Pays for the service (insurance company or the government) Consumer Differentiate… • Receives the service (patient)

18. Financing Health Care • Individuals • Government • Private Businesses

19. Financing Health Care • Individuals • Government • Private Businesses

20. Financing Health Care • Individuals • Government • Private Businesses

21. Insurance Coverage

22. Factors Affecting Coverage • Age • Race and Ethnicity • Poverty Level • Residence Predict Coverage

23. Types of Health Insurance • Voluntary Health Insurance • Social Insurance • Public Welfare Insurance Categories… • Indemnity Plan • Service Benefit • Managed Care

24. Voluntary Health Insurance (VHI) • Commercial • Blues • HMOs • Self-funded

25. Compare Programs *adapted from table 4-5 in text

26. HMO Models • Independent Practice • Group • Network • Staff • Mixed