Health Management

Financing

Pays for health insurance coverage (employers, government individuals)

Insurance

protects against catastrophic financial risk

Delivery

Provision of health services by providers (physicians, hospitals, clinics)

Payment

Reimbursement to providers for rendered services

Quad-Function Model

Financing, Insurance, Delivery, Payment

National Health System (NHS)

Government manages infrastructure, finances, and delivers care through government-employed providers

• Great Britain

Social Health Insurance (SHI)

Mandated sickness funds(non-profit funds) financed by joint employer-employee contributions; private delivery

• Germany

Single-Payer System (NHI)

Government acts as the single insurer financed through taxes; remains mostly private- Canada

Educ/Research

Universities and Colleges

Supplies

Pharmaceutical companies, Biotech companies (produce meds/devices).

Insurers

BCBS (Blue Cross Blue Shield), Medicaid, Medicare

Payers

Commercial insurance, Government, Veterans Affairs, TRICARE.

Providers

Deliver actual healthcare services to patients.

Government

Sets policy, provides funding, and operates public insurance programs.

Medicare

Federal program for adults aged $65+$ or individuals with certain disabilities.

Medicaid

Joint federal-state program for low-income individuals, children, and younger populations (varies by state)

Primary Prevention

Interventions before disease occurs to prevent onset (e.g., immunizations, lifestyle modifications, health education).

Secondary Prevention

Early detection and prompt treatment to stop disease progression (e.g., mammograms, BP screening, routine blood tests).

Tertiary Prevention

Treatment and rehabilitation to restore function and prevent further complications (e.g., stroke rehab, physical therapy, chronic disease management).

Blum’s Model of Health Determinants

• Environment

• Lifestyle/Behavior

• Heredity/Genetics

• Medical Care Services

Market Justice

Views care as an economic good; market forces distribute health services based on willingness and ability to pay.

Social Justice

Views care as a social good; equitable distribution managed by central government intervention regardless of ability to pay.

Preindustrial Era of US Healthcare

Unregulated, informal domestic care; primitive medical education; almshouses/pest houses as social welfare rather than medical care.

Postindustrial Era of US Healthcare

Professionalization of medicine (AMA formation), growth of hospitals, introduction of private health insurance (Baylor Plan / Blue Cross).

Corporate Era of US Healthcare

• Managed care dominance, consolidation of health systems, integration of information technology.