1. Organization of the US Health Services System
Chapter 4
T L Koehlmoos, PhD, MHA
Adjunct Professor
HSCI 678 Intro to US Health System

2. Health Services Organization
Central component of the Roemer Model
Ministry of Health, Public Health, Private Market
USA
No centralized Ministry of Health
Department of Health and Human Services
Regulation and Finance of some healthcare
Most personal care in Private Sector

3. Public Health Public Health = Population Health
Emphasizes: Prevention, Promotion, Reporting, Environmental Factors, Collection of Vital Events
Although some public health facilities deliver personal care (vaccines, STD, HIV/AIDS), most personal care is in the private sector.

4. Public Health: Nationally
Department of Health and Human Services
Cabinet-level position
Public Health Service (PHS)
CDC, FDA, HRSA, NIH, SAMSHA, AHQR
Public Health Service: “To prevent unnecessary disability and disease and to achieve a better quality of life for all Americans”

5. CDC Centers for Disease Control and Prevention Atlanta, Georgia
Birth Defects and Disabilities
Chronic Disease and Health Promotion
Health Statistics, Global Health
Infectious Disease (STD/HIV/TB Prevention)
National Immunization Program
National Inst for Occupational Safety & Health
And much more!

6. Other Important DHHS Agencies
Food and Drug Administration—
Food, cosmetics, drug, device safety
Health Resources and Services Admins.
Development of healthcare workforce
National Practitioner Database
National Institutes of Health
Biomedical Research/ Technology assessments
National Library of Medicine

7. More DHHS Agencies
Substance Abuse and Mental Health Services Administration
Indian Health Service
Agency for Healthcare Research & Quality
Cost, Quality and Access
Patient Outcome Research Teams
Several National Databases
CMS-Centers for Medicare and Medicaid Services (formerly HCFA)

8. State Level Public Health
Vary widely from state to state
Funded by State and by federal block grants
Most likely to focus on:
Vital Statistics
Public Health Education
Environmental Sanitation
Public Health Laboratories
Prevention & Control of Communicable Disease
MCH (if no other available)

9. Local Level Public Health
City, county, multi-city or –county
Wide variations
Common functions:
Assess and monitor local health problems
Provide policy and leadership
Ensure high quality services
Protection of public health at the local level
Various means of financial support

10. Other Ministry Level Health Functions
Department of Defense
Department of Veterans Affairs
Department of Justice
Drug Enforcement Agency
Department of Agriculture (WIC)
Department of Labor
Environmental Protection Agency

11. Voluntary Agencies Disease Specific Population Specific
March of Dimes, ACS, AHA
Population Specific
AARP, Children’s Defense Fund
Red Cross
Professional Associations--AMA
Philanthropic Foundations--RWJohnson
Religious Groups

12. Enterprises in US Healthcare
Enterprises: health functions sponsored by non-health businesses
Occupational Health Clinics
Fitness Centers at work
Substance Abuse programs at work

13. The Private Market In US most healthcare delivered in private sector
Medical Equipment and Devices
Pharmaceuticals and supplies (10% of US total healthcare expenditures)
Health Insurance
Training the Workforce (Public/Private)

14. Conclusion The US Healthcare System is complex and decentralized
DHHS is the equivalent of a Ministry of Health in the Roemer Model
Combination of national, state and local public health services
Private Market is responsible for the delivery and production of most care in the US