1. Introduction  The United States has a unique system of health care delivery.  The US health care delivery system is complex and massive.

2.  No Central Governing Agency; Little Integration and Coordination  Technology-Driven and Focuses on Acute Care  High on cost, Unequal in Access, and Average in Outcomes  Imperfect Market Conditions  Government as Subsidiary to the Private Sector  Market Justice vs. Social Justice  Multiple Players and Balance of Power  Quest for Integration and Accountability Characteristics Of The U.S. Health Care System

3. Multiple Players and Balance of Power  The key system players have been:  physicians  administrators of health care institutions  insurance companies  large employers  government Characteristics Of The U.S. Health Care System

4. Introduction  187.4 million Americans have private health insurance coverage,  35.2 million Medicare beneficiaries, and  31.5 million Medicaid recipients.  Health insurance can be bought from: 1,000 health insurance companies 70 BlueCross/BlueShield plans  The managed care sector includes approximately: 540 licensed health maintenance organizations (HMOs) 925 preferred provider organizations (PPOs)

5. Introduction  In contrast to the United States, most developed countries have national health insurance programs  referred to as “universal access” provide routine and basic health care run by the government and financed through general taxes. All Americans are not “entitled” to routine and basic health care services.

6. Health Care Systems Of Other Developed Countries  Most western Europe has universal access Models for national health systems: 1. National Health Insurance 2. National Health System 3. Socialized Health Insurance System  Look at Table 1.1, page 16

7. Socialized Health Insurance Systems  Germany uses this style Health care is financed through government-mandated contributions by employers and employees Health care delivered by private providers Sickness funds collect and pay for services Insurance and payment is closely integrated Delivery characterized by independent, private arrangements Government exercises overall control Health Care Systems Of Other Developed Countries

8.  National Health Systems  Great Britain uses this system finance a tax-supported national health insurance program:  government manages the infrastructure for the delivery of medical care  most medical institutions are operated by government  most providers are government employees Health Care Systems Of Other Developed Countries

9.  National Health Insurance  Canada uses this system Core of care delivered by private providers Tighter consolidation of the financing, coordinated by government Health Care Systems Of Other Developed Countries

10.  National Health Systems  Great Britain uses this system finance a tax-supported national health insurance program:  government manages the infrastructure for the delivery of medical care  most medical institutions are operated by government  most providers are government employees Health Care Systems Of Other Developed Countries