OPT 323 Healthcare Delivery in the US

What is a health care provider?

individual (MD, OD, NP, OT, etc) or institution who provides preventative, curative, or rehabilitative health care services for individuals, families, communities

What are the 2 different classes of hospitals?

private = for-profit or non-profit (note that non-profits still make a profit)

government = federal (VA, IHS, military), state, county, city

What are the 3 modes of practice?

private = solo, group

direct employment = for-profit, non-profit

government = military, VA, IHS, state/local

What are the 3 categories of preventative health care?

primary = stop initiation of disease

secondary = early diagnosis of disease

tertiary = control the impact of disease

What are the 3 categories of curative health care?

primary = initial approach to a PCP for treatment

secondary = specialist treatment

tertiary = specialized consultative care

What is the single-payer national health service form of health care systems?

"Beveridge model" = government is a single payer and provider; gov owns mostly all hospitals and clinics = universal participation

What is an example of a single-payer national health service form of health care systems?

UK's NHS

What is the single-payer national health insurance form of health care systems?

all individuals receive government-funded health insurance which is then billed to by private providers

What is an example of a single-payer national health insurance form of health care systems?

Canada = Medicare

Taiwan

South Korea

What is the social insurance model of health care systems?

"Bismark model" = government plays central role in setting costs by private providers = insurance companies cover basic services as non-profit = universal participation

What are some examples of the social insurance model of health care systems?

Germany

Japan

France

Belgium

Netherlands

Switzerland

What is the out-of-pocket model of health care systems?

no widespread public or private system of health insurance = access to care is determined by ability to pay private providers = most expensive form of healthcare

What are some examples of the out-of-pocket model of health care systems?

developing countries:

Afghanistan

Bangladesh

Guatemala

Nigeria

The US's health care system is most similar to which country?

Germany = social insurance model

BUT has a combo of all 4 really:

single-payer national health service = VA, military, IHS, federal prisons

single-payer national health insurance = Medicare, Medicaid

social insurance = BCBS, UHC, VSP

out-of-pocket = uninsured, underinsured

What are the top 2 ways that OD's get paid?

direct pt payment

vision insurance

private medical insurers

gov

other

What are some pros of the US health care system?

tech advanced

responsive

access = lots of providers

What are some cons of the US health care system?

cost

coverage

outcomes = very low ranking in the world for infant mortality, adult mortality, life expentancy

The US has the highest _______________ health care costs in the world.

per capita

The US has the highest % of ___________ spent on health care in the Western world.

GDP

What are some reasons that health care is so expensive?

chronic disease = obesity, HTN, CVD, DM, AMD

technology = over testing

prescription drugs = brand vs generic, pharma

utilization = ED visits vs PCP, etc

administrative costs = managers, insurance, etc.

provider salaries

What are some possible cost control measures that could be utilized?

utilization controls

EHR = prevent repeat testing/redudancies

EBM recommendations

reward preventation that costs less than future tx

control fees/provider incomes

decrease price of drugs/products

increases taxes for health care

increase public health funding