1. Introduction H Edu 5100

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

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

4. Health Care Triangle Cost Access Quality

5. Leading Causes of Death 1900 Today

6. Causes of death in the U.S. 1900 RankNumberPercent of total deaths Rate 1 2 3 4 5 6 7 8 9 10 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 8,056 100.0 11.8 11.3 8.3 8.0 6.2 5.2 4.2 3.7 2.9 2.3 72.3 64.0 50.2 40.3 38.3 31.7 25.9 22.9 17.9 14.4

7. Causes of death in the U.S. 2001 RankNumberPercent of total deaths Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 14 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 2,416,425 700,142 553,768 163,538 123,013 101,537 71,372 62,034 53,852 39,480 32,238 30,622 27,035 20,308 19,250 100.0 29.0 22.9 6.8 5.1 4.2 3.0 2.6 2.2 1.6 1.3 1.1 0.8 848.5 245.8 194.4 57.4 43.2 35.7 25.1 21.8 18.9 13.9 11.3 10.8 9.5 7.1 6.8

8. Causes of death in the Utah 2001 RankNumberPercent of total deaths Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 14 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 2,313 870 643 525 509 411 321 314 178 138 134 120 112 100.0 22.9 18.3 6.9 5.1 4.1 4.0 3.2 2.5 1.4 1.1 0.9 555.7 127.1 101.5 38.2 28.2 23.0 22.3 18.0 14.1 13.8 7.8 6.1 5.9 5.3 4.9

11. Major Stakeholders Public Employers Providers Hospitals Other facilities

12. Major Stakeholders Government Managed care/Insurance plans Alternative therapies

13. Where are we now on the Triangle? Cost Access Quality

14. Challenges Cost Aging population Provider shortages Ethical dilemmas

15. 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.

16. 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?