Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 4 Health Care Delivery in the United States
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Models of Health Care Delivery in the U.S. Allopathic Osteopathic Homeopathic Complementary
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Political Foundation of Health Care Individual control of health care choices Governmental influence Policies Federal, State, County Health care as a private business
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Sources of Health Care Financing in the U.S. Individual Employer Private insurance Tax revenue Public insurance Medicare Medicaid Voluntary organizations
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Uninsured and the Underinsured 80% – 85% of the population has access to insurance 17.5 % of the population is uninsured Causes of uninsurance Inability to pay premiums Pre-existing conditions Change of employment
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Health Insurance and Managed Care Indemnity insurance Fee for service Managed Care Capitation
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Characteristics of Fee for Service Increased services Episodic care Emphasis on specialty care Cost shifting Independent providers Limited peer review
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Characteristics of Managed Care Using Capitation Decreased services Continuum of services Emphasis on primary care and case management Cost management Integrated providers Extensive peer review
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Equalizing cost, quality, and access to care Existing Services Cost Management Access Content and Quality Management Care
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Ownership of Health Delivery Organizations Private Not-for-profit For-profit Public Government
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Types of Private Ownership in the Health Care Services Delivery System Not-for-Profit (Voluntary/Charitable) For-Profit (Investor Owned)
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Not-for Profit Sectarian or religiously affiliated Community-based groups Fraternal organizations Business and industry Unions
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Not-for Profit (cont.) Disease-specific groups Foundations Professional associations Some insurance companies
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 For Profit Individually owned Partnerships Limited liability companies Corporations
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Health services organizations Organizations that provide health care services Evidence-based practice
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Public Health System Mission of public health “As fulfilling society’s interest in assuring conditions in which people can be healthy” (Institute of Medicine, 1988, p. 7)
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Public Programs and Services Direct/Contracted Services Policy Development/Planning Regulation Education/Research
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 U.S. Department of Health and Human Services Administration for Children and Families Administration on Aging Health Care Financing Administration Centers for Disease Control Indian Health Services
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 U.S. Department of Health and Human Services (cont.) Food and Drug Administration Health Resources and Services Administration National Institutes of Health Substance Abuse and Mental Health Services Administration
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 U.S. Department of Health and Human Services (cont.) Agency for Toxic Substances and Disease Registry
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Characteristics of Primary Health Care Systems Provide essential care Universally accessible Emphasize disease prevention, health promotion Cost effective Community based
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Primary Health Care Systems include Hospitals Ambulatory surgery Long-term care Home health care Hospice Community-based care
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Services Delivery Socio-cultural events Politics Economics Environment Demography
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Care Regulation Law Financing Technology
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Care (cont.) Payment approaches Benefit plan design Access to market
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Care (cont.) Consumer choice of service
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Services Delivery Sociocultural, political, economic, demographic and environmental events Legal, regulation, technology, and financial influences Access to the market, payment approaches and benefit plan design Consumer choice of service
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends Shaping the Future of Public Health Changing population demographics Population growth, aging population, increased diversity Increased prevalence of chronic disease Increased prevalence of diseases resulting from poor lifestyle choices Violence and crime Environmental concerns
Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Reforming Health Care in the United States Paradigm shift Considerations Consumer sovereignty and responsibility Wellness and care Costs Quality