1. US HEALTH CARE SYSTEM

2. OVERVIEW • Most Expensive Health Care System in The World • Consumes 14% of Gross National Product • Is the 2nd largest industry in the USA • Expenditures take up 1/5 of the Federal Budget • The health Status of the people Does not equal the Cost of the care

3. USA Individual is responsible to obtain coverage Pay as You Go ( Fee for Service) Not all people are in a position to buy into the system Other Countries Seen as a Basic Human Right Universal Coverage to all citizens Government Pays Western World Health Care

4. INSURANCE? • Governmental Programs • 65 y/o > ( Medicare : 1965) • person may still share in the cost • Enrolls 36 million • Restrictions placed on Medical Services • Must have supplemental coverage • For the Poor. ( Medicaid:1965) • some providers do not accept • strict financial guidelines to qualify

5. INSURANCE? • Private Insurances • 70%of the citizens under the age of 65 y/o • employer may share if they offer the insurance • some pay full premiums • not all family members may be covered • some medical procedures may not be covered

6. HEALTH INSURANCE STATUS • GRAPH

7. Who are the greatest # Uninsured ( 1993) Poor racial Minority Rural Dwellers Young adults

8. WHO IS THE US HEALTH CARE SYSTEM • PHYSICIANS • 600,000 PRATICING TODAY • 1 MD/ EVERY 450 PEOPLE • “ARTIFICIAL DOCTOR SHORTAGE” - MIGRATION TO RICH AREAS IN ORDER TO MAKE MONEY AND SPECIALIZE • PUSH IS TOWARD SPECIALIZATIONMEANS< FAMILY PHYSCIANS • Doctors mean salary (1991) $171,000 • 5%males and 1% females in 1991 made > than $75,000

9. PRIMARY CARE PHYSICIANLess than 12% family doctors • DEFINITION • IN THE COMMUNITY VS HOSPITAL • NO REFERALS FORM OTHER MD’s • CONTINUING VS EPISODIC CARE • MANAGES Patient's CARE W/ REFERAL MD AND OTHER COMMUNITY BASED SERVICES

10. CONSEQUENCES • FOR THE POOR • PUT OFF NEEDED CARE : = INCREASED INCIDENCES OF SERIOUS DISABILITY • USES ER AS PRIMARY SOURCE OF CARE • LACK OF FOLLOW THROUGH • LONG WAITS/ HURRIED STAFF • FOR OTHERS • STRAINED HOSPITAL BUDGETS • HIGHER INSURANCE RATES

11. BARRIERS TO HEALTH CARE • Fraud and Abuse • Medicaid and Medicare- increase visit# decrease quality , in order to bill • Private Insurance's • If without insurance when hospitalized • Poor care • Refusal to provide care/ turned away • Public / Teaching Hospitals • Overcrowding

12. Medical -Industrial Complex • Money Makers • Capitalization on the market by: • >#of investors in the for-profit hospitals • growth in the firms owning hospitals that run chains ( Mc Donaldization) • expand for-profit operators for health care • private investors and corporate expansion into Nursing homes, Home Care companies, local surgical centers and clinic • investor owned hospitals moving into private health care insurance

13. PAST AND PRESENT • HOSPITALS • Prior to 1960S nonprofit • serving the poor was the focus • usually run by: • communities • religious groups • 1990’s 1/4 of the hospitals are for profit • Columbia /HCA • HMO’s ( Health Maintenance Organizations)

14. Past and Present (Cont’D) • For- profit health care providers • Large corporate operators • Dangers • Services not provided if does not yield a positive bottom line • Examples • Closures of Emergency Rooms • closure of entire community health systems • Hospital stays drastically cut ( Drive through Deliveries)