Introduction H Edu 5100

History of Healthcare 1600s… “Almshouses” 1800s… Hospitals 1930s… Blue Cross 1950s… Federal Funding 1960s… Medicare and Medicaid

History of Healthcare 1970s… Tremendous Growth 1980s… DRGs 1990s… Managed Care

Health Care Triangle Cost Access Quality

Leading Causes of Death 1900 Today

Causes of death in the U.S RankNumberPercent of total deaths Rate All Causes Pneumonia Tuberculosis Diarrhea, enteritis, ulceration of the intestines Diseases of the heart Intracranial lesions of vascular origin Nephritis All accidents Cancer and other malignant tumors Senility Diphtheria 343,217 40,362 38,820 28,491 27,427 21,353 17,699 14,429 12,769 10,015 8,

Causes of death in the U.S RankNumberPercent of total deaths Rate All Causes Diseases of heart Malignant neoplasm Cerebrovascular diseases Chronic lower respiratory diseases Accidents Diabetes mellitus Influenza and pneumonia Alzheimer’s disease Nephritis Septicemia Intentional self-harm (suicide) Chronic liver disease Assault (homicide) Essential hypertension 2,416, , , , , ,537 71,372 62,034 53,852 39,480 32,238 30,622 27,035 20,308 19,

Causes of death in the Utah 2001 RankNumberPercent of total deaths Rate All Causes Diseases of heart Malignant neoplasm Cerebrovascular diseases Accidents Chronic lower respiratory diseases Diabetes mellitus Influenza and pneumonia Intentional self-harm (suicide) Alzheimer’s disease Nephritis Chronic liver disease Parkinson’s disease Congenital malformations Septicemia 12,662 2,896 2,

Major Stakeholders Public Employers Providers Hospitals Other facilities

Major Stakeholders Government Managed care/Insurance plans Alternative therapies

Where are we now on the Triangle? Cost Access Quality

Challenges Cost Aging population Provider shortages Ethical dilemmas

Case study… Politicians have suggested extending Medicare to the rest of the American population. They intend to pay for increasing the population eligible for these benefits by increasing payroll taxes and premiums. Discuss which groups or interests in American society are likely to favor or oppose such legislation, and for what reason.

Questions What are the characteristics of the American health care delivery system? What are the problems and issues resulting from these characteristics? What are the reasons for these problems and issues? What are some suggestions to overcome the opposition of certain interest groups to national health insurance for all Americans?