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The US Healthcare System

The US Healthcare System. Lecture 1 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems. Course Organization. US Healthcare System, Roemer Model (Quiz #1) Canada, Europe Asia, Pacific Rim (Quiz #2) Developing Nations. Course Requirements.

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The US Healthcare System

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  1. The US Healthcare System Lecture 1 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems

  2. Course Organization • US Healthcare System, Roemer Model (Quiz #1) • Canada, Europe • Asia, Pacific Rim (Quiz #2) • Developing Nations

  3. Course Requirements • Read assigned chapters • Watch video lectures • Additional Readings and Chat Sessions • Attend three out of four • Discussion Board postings • Introduction, 4 additional postings • Country Health Services Project • Apply Roemer Model • Assess a population/country of your choice

  4. US Healthcare System • Complex, fragmented, in constant flux • 16% of Gross Domestic Product (2005) • $1.3 trillion • Per capita: $4,673 (2000) • 16-20% no access at any given time • 80:20 paradox: 80% of services used by 20% of the population • Tremendous variation in quality and access based on state and rural differences

  5. High Price/Low Payoff? • Most technologically advanced in world • > $28 Billion for Biomedical Research (2006) • US lags behind other OECD nations for outcomes: (2000 data) • Life expectancy: 73.9 Male/ 79,4 Female • Infant mortality: 7.2 per 1000

  6. Why? • Demographic factors: diverse population with varying beliefs; racial and ethnic disparities; aging population • Systemic Factor: Curative focus rather than prevention and promotion focus • Insurance is access: linked to age, poverty and employment (historical development) • 30% of Medicare and Medicaid expenditures on patients in last year of life

  7. Core Values of US Healthcare System ACCESS QUALITY COST

  8. Major Policy Initiatives • Social Security Act (1965)—Access • Medicare: Elderly, ESRD, disabilities • Medicaid: State/Fed; Low Income & disabled, HIV, pregnant, BC/CC, children, blind • HMO Act 1973—Cost Containment • Reduce costs to employer, employee • Slow start, by 2002 managed care covers 92% of employee sponsored US population • Tax Equity & Fiscal Responsibility Act (1982)—Cost Containment and Quality • Prospective Payment for Medicare (DRGs) • Peer Review Organizations

  9. Issues and Trends • The Rise and Fall of Managed Care • Aging of the Baby Boomer generation • Medicare Part D • Emergence of Allied Health professionals • Nursing Crisis • Fragmented Long Term Care • Costs continue to skyrocket

  10. More facts… • Healthcare spending is the US government’s second largest expenditure • The health services workforce is the largest segment of the population, 11% • If change does not take place in the US healthcare system; by 2065 we will spend 25% of our GDP on health services

  11. Where do we go from here? • Next lecture: more US healthcare system details using the Roemer Model • Be sure to introduce yourself via the discussion board • Read the chapters • Watch the lectures • Take the quiz • Let me know if you have any questions

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