1. 3 - 1 Introduction to US Health Care Text by Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs & James R. Knickman with Tracy Barr PowerPoints by Robin Pickering Eastern Washington University

2. 3 - 2 Introduction to US Health Care Chapter 3 Health Care Provision

3. 3 - 3 Types of Care 1.Primary 2.Secondary 3.Tertiary

4. 3 - 4 Comparing Care Models Consult with primary care provider first Send difficult problems with secondary or tertiary Benefits –Quality of care –Cost containment –Public sentiment Primary Care Model Specialty Care Model

5. 3 - 5 Comparing Care Models More dispersed model Does not require patient to consult first with primary care provider Contributed to the rising cost of health care Primary Care Model Specialty Care Model

6. 3 - 6 Managed Care Model Health organizations control costs by funneling all medical necessities through the PCP

7. 3 - 7 Effective Primary Care Systems Accessibility Continuity Comprehensiveness Coordination Accountability

8. 3 - 8 Primary Care Team Approach Primary Care Team Health Educators Medical Assistants ReceptionistClinicians Medical Assistant Physicians Nurse Practitioner

9. 3 - 9 Disease registries Performance feedback Case management Chronic care visits Chronic Care Model Collaborative Care

10. 3 - 10 Primary Care Specialties Family Physicians General Internists General Pediatricians

11. 3 - 11 “Nonphysician” Clinicians Nurse Practitioners Physician Assistant

12. 3 - 12 Access to Health Care Too few generalists Lack of health insurance Maldistribution of PCPs - (HPSAs) Two-thirds of all HPSAs are in rural regions *Rural *Inner City

13. 3 - 13 Strategies to Improve Distribution National Health Service Corps and Loan Repayment Program Grants Focused Recruiting of Medical Students

14. 3 - 14 Copyright Notice © 2006 John Wiley & Sons, Inc. All rights reserved. Reproduction or translation of this work beyond that permitted in section 117 of the 1976 United States Copyright Act without express permission of the copyright owner is unlawful. Request for further information should be addressed to the Permissions Department, John Wiley & Sons, Inc. The purchaser may make back-up copies for his/her use only and not for distribution or resale. The Publisher assumes no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information herein. All clipart and photos courtesy of Microsoft.com, unless otherwise noted.

15. 4 - 15 Introduction to US Health Care Text by Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs & James R. Knickman with Tracy Barr PowerPoints by Robin Pickering Eastern Washington University

16. 4 - 16 Introduction to US Health Care Chapter 4 Financing the U.S. Health Care System

17. 4 - 17 Increased Health Care Expenditures Inflation in economy Inflation in medical component of consumer price index Growth of population Changes in the type and quality of health care service

18. 4 - 18 Change in Health Care Financing Past: Individual Financing Present and Future: Employer Financing

19. 4 - 19 Differentiate… Purchaser Pays for the service (insurance company or the government) Consumer Receives the service (patient)

20. 4 - 20 Financing Health Care Individuals Government Private Businesses

21. 4 - 21 Financing Health Care Individuals Government Private Businesses

22. 4 - 22 Financing Health Care Individuals Government Private Businesses

23. 4 - 23 Insurance Coverage

24. 4 - 24 Factors Affecting Coverage Age Race and Ethnicity Poverty Level Residence Predict Coverage

25. 4 - 25 Voluntary Health Insurance Social Insurance Public Welfare Insurance Types of Health Insurance Indemnity Plan Service Benefit Managed Care Categories…

26. 4 - 26 Voluntary Health Insurance (VHI) 1.Commercial 2.Blues 3.HMOs 4.Self-funded

27. 4 - 27 Compare Programs AttributeMedicareMedicaid Population served 65 and older Disabled (SS) Kidney failure Those in need (state determined) FundingFederal gov’t (payroll deductions) 57% federal, remainder from states AdministeredManaged by federal gov’t Federal gov’ t sponsored, administered by states *adapted from table 4-5 in text

28. 4 - 28 Independent Practice Group Network Staff Mixed HMO Models

29. 4 - 29 Copyright Notice © 2006 John Wiley & Sons, Inc. All rights reserved. Reproduction or translation of this work beyond that permitted in section 117 of the 1976 United States Copyright Act without express permission of the copyright owner is unlawful. Request for further information should be addressed to the Permissions Department, John Wiley & Sons, Inc. The purchaser may make back-up copies for his/her use only and not for distribution or resale. The Publisher assumes no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information herein. All clipart and photos courtesy of Microsoft.com, unless otherwise noted.

30. Check Your Understanding 1. In a primary care system, a patient, as the primary decision maker, is free to seek medical care from any physician without consulting a primary care physician. True or False? 3 - 30

31. Check Your Understanding 2. The United States uses a highly structures primary care model. True or False? 3 - 31

32. Check Your Understanding 3. A hospitalist is: A. a physician who provides inpatient care in hospitals B. a primary care physician whose practice is based in a hospital. C. a physician assistant who provides primary care to hospitalized patients. D. a researcher who studies the impact of primary care on hospitalization rates. 3 - 32

33. Check Your Understanding 4. Define HPSA A. health profession shortage area: an area that lacks adequate health care providers or access to health care providers B. health profession study area: a geographic region feature in studies on health care trends in the U.S. C. health profession service area: a geographic are identified by the type and number of both primary and secondary health care providers. D. none of the above 3 - 33

34. Check Your Understanding 5. Identify the area that is most likely to be classified as an HPSA: A. suburban areas B. business districts C. inner-city areas D. rural areas 3 - 34

35. Check Your Understanding 6. Health care is the largest industry in the United States, accounting for more than 15 percent of the gross domestic product. True or False? 3 - 35

36. Check Your Understanding 7. The primary purchasers of health care today are: A. patients B. insurance companies C. government agencies and private employers D. B and C 3 - 36

37. Check Your Understanding 8. Which of the following is not a cause of the increases in health care expenditures? A. inflation B. population growth C. changes in health services D. changes in the tax base 3 - 37

38. Check Your Understanding 9. What economic circumstances have resulted in the increasing numbers of uninsured? A. more families at or below the poverty level B. fewer employers offering health insurance C. higher out of pocket expenses D. a and b E. all of the above 3 - 38

39. Check Your Understanding 10. Identify which type of insurance – voluntary, social, or welfare – each of the following is: A. Aetna = B. Medicare = C. Medicaid = 3 - 39

40. Check Your Understanding 11. Of the different types of HMOs, which is the most popular? A. IPA B. Group C. Combined 3 - 40

41. Check Your Understanding 12. Complete this sentence: Medicaid is: A. a federal health insurance program B. managed by state governments C. funded by employee contributions D. a and c 3 - 41

42. Check Your Understanding 13. Complete this sentence: Medicare is: A. funded through federal and state monies B. managed by the federal government C. available in all states D. a federal welfare program 3 - 42

43. Check Your Understanding 14. Complete this sentence: a key characteristic of a Health Maintenance Organization is: A. its growing popularity among health care providers B. its combining health plans and service providers into one entity C. its growing popularity among patients D. All of he above 3 - 43

44. Check Your Understanding 15. Medicare Part A and Part B each provide funding for specific services. Identify these services: A. Part A: Hospital care and physician services; Part B: prescription drugs B. Part A: Prescription drugs; Part B: Hospital care and physician services C. Part A: Physician services; Part B: Hospital care D. Part A: Hospital care; Part B: Physician services 3 - 44