Dynamics of healthcare

Government Health Funding

Government health insurance is paid for by taxes, federal funding, state funding, and premiums paid by patients in the programs.

Fee-for-Service (Before ACA)

Doctors were paid for every visit, test, or procedure, encouraging more services instead of better care.

Value-Based Care (After ACA)

Doctors are paid based on quality of care, patient outcomes, and prevention rather than number of services.

Capitation

A payment system where doctors get a fixed amount of money per patient per month, no matter how many times the patient visits.

Managed Care Organizations (MCOs)

Insurance organizations that contract with doctors to control costs, improve care coordination, and avoid unnecessary treatments.

Medicare

Federal insurance for people 65+, disabled people, and kidney failure patients; includes Parts A (hospital), B (medical), C (Advantage), and D (drugs).

Medicaid

Insurance for low-income individuals and families, funded by federal and state governments; eligibility depends on state income limits. 138%

CHIP

Insurance for children in families who make too much for Medicaid but cannot afford private insurance.

First Insured Group

Teachers in Dallas, Texas in 1929. - blue cross

First Insurance Company

Blue Cross, created by Baylor Hospital to help teachers pay hospital bills.

HMO

Low-cost plan with strict rules; must stay in-network and need referrals for specialists.

health matience

PPO

Higher-cost plan with more freedom; allows in-network and out-of-network care and requires no referrals.

preffered provider org

EPO

Middle option between HMO and PPO; no referrals needed but no out-of-network coverage except emergencies. exclsuive provider org

Significant Healthcare Changes

More telehealth, more technology, shift to quality-based payment, rising costs, and increased focus on prevention.

Future Provider Expectations

More teamwork, more technology use, more prevention-focused care, and more emphasis on quality measurements.

Growing Healthcare Jobs

More hiring in home health care, outpatient care, primary care, elderly care, and telehealth roles.

Decreasing Healthcare Jobs

Fewer inpatient hospital jobs and fewer administrative jobs due to automation and electronic systems.

Co-pay

A set dollar amount paid at each medical visit.

Coinsurance

A percentage of the cost paid after the deductible is met.

Deductible

The amount the patient must pay out-of-pocket before insurance starts covering costs.