Healthcare System (self-made) - Public Health

What are the main characteristics of the U.S. healthcare system?

Complexity, high costs, a mix of public/private providers, technological innovation, and unequal access.

What percentage of the U.S. GDP is spent on healthcare?

Approximately 18%.

Name the four major components of the healthcare system.

Providers, payers, regulators, and suppliers. (PPRS)

What are examples of healthcare providers?

Physicians, hospitals, nursing facilities, and home health agencies.

Who are the primary payers in the U.S. healthcare system?

Government programs (Medicare, Medicaid) and private insurers.

What federal agencies regulate the healthcare system?

CMS (Centers for Medicare & Medicaid Services), FDA (Food and Drug Administration), and others.

Who are considered healthcare suppliers?

Pharmaceutical and medical device companies.

What are common issues related to healthcare access?

High uninsured rates, cost barriers, and disparities in access.

What is the main goal of the Affordable Care Act (ACA)?

Expand insurance coverage and improve healthcare affordability and quality.

What is value-based care?

A healthcare delivery model that rewards providers for quality and outcomes rather than quantity of services.

What are some current trends in healthcare?

Telemedicine, digital health, population health management, and policy reform discussions.

What public programs provide health insurance in the U.S.?

Medicare and Medicaid.

What is Medicare?

A federal program providing health coverage to people 65+ or with certain disabilities

What is Medicaid?

A joint federal-state program providing health coverage for low-income individuals and families.

What are common healthcare system challenges?

Rising costs, inefficiencies, fragmentation, health disparities, and administrative burden.

What does the ACA stand for and what did it do?

Affordable Care Act; expanded Medicaid, prevented insurance denial for pre-existing conditions, created insurance exchanges.

What is an HMO?

Health Maintenance Organization; care is managed within one organization, often cheaper but less flexible.

What is a PPO?

Preferred Provider Organization; more flexibility in choosing providers but usually higher costs.

What are process-based quality measures in healthcare?

Measures that evaluate whether the correct procedures or treatments were followed.

What are outcome-based quality measures?

Measures that evaluate if the treatment improved health (e.g., lower mortality or better disease control).

What does the mnemonic STEEEP stand for in healthcare quality?

Safe, Timely, Effective, Efficient, Equitable, Patient-centered.

What report shifted focus from individual blame to system design in healthcare errors?

"To Err Is Human" by the Institute of Medicine (1999)

What is one major limitation of the U.S. healthcare system despite high spending?

It ranks poorly on key outcomes like life expectancy and infant mortality.