1. Delmar Learning Copyright © 2003 Delmar Learning, a Thomson Learning company Chapter 4 Health Care Delivery in the United States

2. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Models of Health Care Delivery in the U.S. Allopathic Osteopathic Homeopathic Complementary

3. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Political Foundation of Health Care Individual control of health care choices Governmental influence  Policies  Federal, State, County Health care as a private business

4. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Sources of Health Care Financing in the U.S. Individual Employer  Private insurance Tax revenue  Public insurance  Medicare  Medicaid Voluntary organizations

5. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Uninsured and the Underinsured 80% – 85% of the population has access to insurance 17.5 % of the population is uninsured Causes of uninsurance  Inability to pay premiums  Pre-existing conditions  Change of employment

6. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Health Insurance and Managed Care Indemnity insurance  Fee for service Managed Care  Capitation

7. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Characteristics of Fee for Service Increased services Episodic care Emphasis on specialty care Cost shifting Independent providers Limited peer review

8. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Characteristics of Managed Care Using Capitation Decreased services Continuum of services Emphasis on primary care and case management Cost management Integrated providers Extensive peer review

9. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Equalizing cost, quality, and access to care Existing Services Cost Management Access Content and Quality Management Care

10. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Ownership of Health Delivery Organizations Private  Not-for-profit  For-profit Public  Government

11. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Types of Private Ownership in the Health Care Services Delivery System Not-for-Profit (Voluntary/Charitable) For-Profit (Investor Owned)

12. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Not-for Profit Sectarian or religiously affiliated Community-based groups Fraternal organizations Business and industry Unions

13. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Not-for Profit (cont.) Disease-specific groups Foundations Professional associations Some insurance companies

14. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 For Profit Individually owned Partnerships Limited liability companies Corporations

15. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Health services organizations Organizations that provide health care services Evidence-based practice

16. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Public Health System Mission of public health “As fulfilling society’s interest in assuring conditions in which people can be healthy” (Institute of Medicine, 1988, p. 7)

17. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Public Programs and Services Direct/Contracted Services Policy Development/Planning Regulation Education/Research

18. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 U.S. Department of Health and Human Services Administration for Children and Families Administration on Aging Health Care Financing Administration Centers for Disease Control Indian Health Services

19. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 U.S. Department of Health and Human Services (cont.) Food and Drug Administration Health Resources and Services Administration National Institutes of Health Substance Abuse and Mental Health Services Administration

20. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 U.S. Department of Health and Human Services (cont.) Agency for Toxic Substances and Disease Registry www.hhs.gov

21. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Characteristics of Primary Health Care Systems Provide essential care Universally accessible Emphasize disease prevention, health promotion Cost effective Community based

22. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Primary Health Care Systems include Hospitals Ambulatory surgery Long-term care Home health care Hospice Community-based care

23. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Services Delivery Socio-cultural events Politics Economics Environment Demography

24. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Care Regulation Law Financing Technology

25. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Care (cont.) Payment approaches Benefit plan design Access to market

26. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Care (cont.) Consumer choice of service

27. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends and Influences on Health Services Delivery Sociocultural, political, economic, demographic and environmental events Legal, regulation, technology, and financial influences Access to the market, payment approaches and benefit plan design Consumer choice of service

28. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Trends Shaping the Future of Public Health Changing population demographics  Population growth, aging population, increased diversity Increased prevalence of chronic disease Increased prevalence of diseases resulting from poor lifestyle choices Violence and crime Environmental concerns

29. Copyright © 2003 Delmar Learning, a Thomson Learning companyChapter 4 Reforming Health Care in the United States Paradigm shift Considerations  Consumer sovereignty and responsibility  Wellness and care  Costs  Quality