The US Healthcare System

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The US Healthcare System

• Impact on Equity, Efficiency and Effectiveness

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BASIC SERVICE COMPONENTS OF A HEALTH CARE SYSTEM

• Public Health (Including Health Promotion and
  Disease Prevention)
• Emergency medical services (including
  transportation)
• Ambulatory care for simple/limited conditions
• Acute and community hospitals and medical centers
  
• Long-term care (either in-home or institutional
  care)
• Mental Health Services (both inpatient and
  ambulatory)
• Rehabilitation services (both inpatient and
  ambulatory)
• Dental services
• Pharmaceuticals/supplies/medical devices and
  equipment

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Need vs. Demand and Utilization

• Need an interpretation of an individuals
  evaluated requirements for obtaining professional
  care through the health service system
• Demand seeking out, but not necessarily
  receiving health services.
• Utilization actual use of services. A result of
  need and demand

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Health Care Spending in the U.S.

• In 2003, 1.7 trillion was spent on health care
  in U.S.
• In 2003, the United States spent 15.3 percent of
  its Gross Domestic Product (GDP) on health care.
  Compared to other countries
• Switzerland 10.9
• Germany 10.7
• Canada 9.7
• France 9.5
• 45 million Americans were uninsured in 2003
• Total out-of-pocket spending on health care rose
  13.7 billion, to 230 billion in 2003.

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Spending by Service in Health Care 2002
Service Amount Spent 2002 (in billions) Major cost factors
Hospitals 486.5 (9.5 increase) Inflation increase in patient volume
Physicians 339.5 (7.7 increase) Medicare costs decelerated causing a reduction in the rate of growth in physicians spending
Drugs 162.4 billion (15.4 increase) Rate decelerated from 2001. Out of pocket expenses increased.
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Percent of health care expenditures 2002
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Four Systems of Health Care

• Private, insured, middle-income Americans
• Poor, unemployed or under-employed Americans
• Active duty military personnel
• Veterans of military service

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Private, insured, middle-income Americans

• Care is coordinated by physicians in private
  practice
• Care is funded by insurance (personal,
  non-governmental sources paid for by employer,
  individual or both)
• Characterized as an informal system of care
• Even though it is an informal system, patient has
  considerable control over their care
• It is also often poorly coordinated
• Medicare for the middle-income

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Employer and Employee Health Insurance Costs

• The premiums for employer-based health insurance
  rose by 11.2 percent in 2004, the fourth
  consecutive year of double-digit increases.
• The annual premium that a health insurer charges
  an employer for a health plan covering a family
  of four averaged 9,950, or 829 a month in 2004.
  
• Health insurance premium rates have risen five
  times faster on average than workers' earnings
  since 2000
• Employee spending for health insurance coverage
  has increased 126 percent between 2000 and 2004
• Since 2001, the employees' share of health
  insurance costs has soared 63 percent for single
  coverage and 58 percent for family coverage.

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Poor, Unemployed/Underemployed Families Without
Insurance

• There is no formal system
• Majority of services are provided by local
  government agencies
• Patients have no continuity of service
• In sum, the poor must take whatever they can get
• Use of Medicaid and other government funded
  services

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Military Medical System

• A well-organized system of high quality care at
  no direct cost to the recipient
• All inclusive and omnipresent
• System in effect whether personnel want it or not
• Emphasis is on keeping personnel well, prevention
  and early treatment of injury or illness
• It is a closely organized, highly integrated,
  rational and regionalized approach

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Veterans Administration Health Care System

• Provides care to retired, disabled or other
  deserving veterans of military service
• History of VA is rooted in controversy
• Not as complete as other services
• Large number of male patients
• VA health system is just one of a system of
  social services and benefits for veterans
• Interest group representation
• 1990s represented a waning period for veterans
  and veteran services (Snowbirds)
• Future for the veteran

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Primary Cause of Death 1900
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Primary Cause of Death 1997Source Healthy
People 2010