Intro to US Health System Chapter 2: Overview of the US Health Care System and Users Tracey Lynn Koehlmoos HSCI 678

Intro to US Health System Outline of the Overview Components of the System Defining Health Establishing US Health Seeking Behavior Demographics Detailed look at health status of population

Intro to US Health System Snap Shot of Health System Components Organizational: –Public: DHHS (since 1953); collection, research –Private: Health ins.; medical-industrial complex –Voluntary: Gap fillers, disease specific (AHA) Management: –Planning, legislation, regulation –SSA of 1964, HMO Act of 1973, TEFRA

Intro to US Health System Snap Shot of Health System Components Economic Support: (2000) –33% Private Ins., 45% Fed & State –15% Out of Pocket, 6% Foundation/Charity Resource: growing to meet needs –Workforce –Facility growth Delivery System: FFS to Manage Care –Balance equity and efficiency –Access

Intro to US Health System Defining Health WHO: –Health is not merely the absence of disease, but the state of physical, mental and social well-being. Fundamental conditions for health: Peace, shelter, education, food, income, stable ecosystem, sustainable resources, social justice, equity

Intro to US Health System Determinants of Health Physical and Mental Well-Being Access to Health Services Social Environment Physical Environment

Intro to US Health System Health Status of the USA in 2000 Birth Rate: 14.7 per 1000 women Life Expectancy: 76.9 years Birth Weight: W, 6.5%/ B, 12.9% Morbidity: 11.7% all ages, any disability Mortality: –Infant: 6.9% per 1000 –Adults: per 100,000 (1999) –Causes: Heart Disease, Cancer, Stroke

Intro to US Health System Care Seeking Behavior Injury/Illness Chronic disease monitoring Prenatal Care Prevention Palliative Care Self assessment Access THE WORRIED WELL!

Intro to US Health System Demographics and Use Women Very Young and the Old –Baby Boomers will stretch system to its limits Race and Ethnicity: Disease and Disparity Socio-Economic Status –Black and Hispanic below FPL 3x White

Intro to US Health System Utilization Models Aday Model Health Belief Model Utilization is strongly influenced by what is available (policy, delivery systems, finance) and personal beliefs and risk perception (characteristics, satisfaction).

Intro to US Health System Utilization Facts Lowest Income=Highest Physician Contacts Most Physician Contact in Office setting Hospital Utilization: More Blacks, More Women, More Low Income Home Health: More Women Nursing Home: 5% of population >65

Intro to US Health System Effects on Health of Health Services Does Health Care make us healthier? More prenatal care/Less low weight births Cancer survivors, Polio survivors Nosocomial infection, drug interactions Influence and effects of lifestyle and environment and behavior