US HEALTH CARE SYSTEM

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US HEALTH CARE SYSTEM
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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

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Western World Health 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

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INSURANCE?

• Governmental Programs
• 65 y/o gt ( Medicare 1965)
• person may still share in the cost
• Enrolls 36 million
• Restrictions placed on Medical Services
• Must have supplemental coverage
• For the Poor. ( Medicaid1965)
• some providers do not accept
• strict financial guidelines to qualify

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INSURANCE?

• Private Insurances
• 70of 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

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HEALTH INSURANCE STATUS

• GRAPH

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Who are the greatest
Uninsured ( 1993)
Poor racial Minority Rural Dwellers Young adults
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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 SPECIALIZATIONMEANSlt FAMILY
  PHYSCIANS
• Doctors mean salary (1991) 171,000
• 5males and 1 females in 1991 made gt than
  75,000

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PRIMARY CARE PHYSICIAN Less than 12 family
doctors

• DEFINITION
• IN THE COMMUNITY VS HOSPITAL
• NO REFERALS FORM OTHER MDs
• CONTINUING VS EPISODIC CARE
• MANAGES Patient's CARE W/ REFERAL MD AND OTHER
  COMMUNITY BASED SERVICES

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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

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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

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Medical -Industrial Complex

• Money Makers
• Capitalization on the market by
• gtof 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

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PAST AND PRESENT

• HOSPITALS
• Prior to 1960S nonprofit
• serving the poor was the focus
• usually run by
• communities
• religious groups
• 1990s 1/4 of the hospitals are for profit
• Columbia /HCA
• HMOs ( Health Maintenance Organizations)

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Past and Present (ContD)

• 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)