1- 1 Introduction to US Health Care UUnit 1: The US Health Care System HS230 Health Care Administration Kaplan University Live Seminar Presentation Kathy L. Lantz, MHS, MBA

1- 2 Introduction to US Health Care Today, health care is one of the US economy’s largest industries, employing more than 12 million people.

1- 3 Health Care Expenditures US Health Care Industry Professional Services Nursing Home and Home Health Care Retail Sales of Medical Products Government Expenses Investment

National Health Care Expenditures (projected) *values represent billions of dollars

Multiple Choice The US healthcare industry employs: 4 million people 6 million people 8 million people 12 million people 1- 5

1- 6 Introduction to US Health Care Today, health care is one of the US economy’s largest industries, employing more than 12 million people.

1- 7 Types of HCOs Private Services consumed by individuals Enhance and protect health of the individual Public Services targeted towards health and wellbeing of populations or communities

1- 8 Horizontal Systems Vertical Systems Combined System Types of Healthcare Systems Ownership Affiliation Contracts Joint venture Lease

Horizontal Systems Combine functionally similar organizations, such as short-term general hospitals, physician practices or nursing homes Horizontal systems can be composed of similar organizations in a particular market (such as a city) or spread across a number of markets (hospital located in various regions of the country 1- 9

Vertical Systems Combine functionally different organizations, where patient outputs of one organization in the system (physician group practice) are inputs to another (hospital) Vertical systems always combine organizations within a given market 1- 10

True or False? Horizontal healthcare systems combine functionally different organizations

FALSE Horizontal systems combine functionally SIMILAR organizations. Horizontal systems can be composed of similar organizations in a particular market (such as a city) or spread across a number of markets (hospital located in various regions of the country 1- 12

Forming Health Systems Ownership: built or acquired through purchase or merger Affiliation: agreement to cooperate with each other Contracts: arrangement made for one to manage another Joint venture: two organizations undertake a single, specific goal 1- 13

Multiple Choice Health systems are formed through which of the following mechanisms? Ownership Not-for-profits For-profits Mergers 1- 14

Forming Health Systems Ownership: built or acquired through purchase or merger 1- 15

1- 16 Health Care Industry Sectors Financing Institutional Provider Individual Provider Public Health Agencies Enablers Regulators

Multiple Choice Healthcare regulators include all but one on the following? State licensing boards Federal agencies Local citizen groups Nonprofit organizations 1- 17

Healthcare Regulators YES State licensing boards YESFederal agencies NO Local citizens groups YESNonprofit organizations 1- 18

1- 19 Genetic flaws Progressive biological breakdown External agents Trauma Personal habits Other factors Causes of Disease

1- 20 Indicators of Public Health 1.Infant Mortality Rate 2.Cause of Death 3.Population with Chronic Health Conditions

1- 21 Factors Affecting Utilization Age Insurance Coverage Race/Ethnicity Number of Providers Education Level Referral Patterns Income Level Attitudes and Beliefs

1- 22 Roles: Assessing needs Evaluating medical service delivery Factors affecting health care access and delivery Health Services Administration Research

Critical Thinking Application How do public healthcare organizations protect populations? 1- 23

How do public healthcare organizations protect populations? Federal, state, and local government agencies create public policy affecting health related issues. The primary goal of policies and programs is to foster and support the well-being of an entire community. Examples of this include: Federal and state funding of health programs Policies relating to infectious disease Antismoking legislation Federal nutrition and exercise guidelines State licensing procedures for medical professionals Community sanitation laws Pollution standards Medical research funding Interventions in control of infectious disease 1- 24

Who reimburses healthcare providers? Critical Thinking Application

Who reimburses healthcare providers? Health care providers are paid by a variety of mechanisms. Most often the consumer of health care may not be the payer. Payers may be independent third parties such as insurers. These insurers may be for-profit, not-for–profit, or government agencies. These organizations may include CMS, federal agencies, state programs, health insurance companies, HMOs, small and large employers, and individuals

Fill in the Blank The World Health Report of 2000 ranked the US ____out of 191 countries

ANSWER: 37 Reference in textbook

Fill in the Blank The leading cause of death in the US is ______________

ANSWER: Health Disease Reference: in textbook

Fill in the Blank What ethnic group has the highest number of death per live births? 1- 31

ANSWER: Black Reference: in textbook

Fill in the Blank What federal agency produces a report projecting health expenditures for the coming decade? 1- 33

ANSWER: Centers for Medicare and Medicaid Services Reference: 1.1 in textbook

Fill in the Blank ___________ systems combine functionally similar organization

ANSWER: Horizontal Systems Reference: in textbook

Short Answer Name the United Nations Agency that focuses on global health issues

1- 38

Unit 1 QUIZ (5) T/F Questions (5) Multiple Choice Questions (1) Short Answer (1) Essay Question 1- 39

1- 40 Thank your for your participation! UUnit 1: The US Health Care System HS230 Health Care Administration Kaplan University Live Seminar Presentation Kathy L. Lantz, MHS, MBA