chapter 14

An Introduction to the US Health Care System

Chapters Overview

• Chapter 14: The Future of Health Services Delivery

• Chapter 10: Long-Term Care

• Chapter 11: Special Populations (overview)

• Note: Discussion boards on "Building in Antarctica" close on November 26

Key Themes and Questions Addressed

Major Forces Shaping the Future of American Health Care

• The future of health services delivery and the various forces impacting its evolution:

  • Economic

  • Political

  • Social and demographic

  • Anthro-cultural

  • Technological

  • Informational

  • Global

  • Ecological

• Prompts for reflection on what future changes may occur due to these forces.

Value in Health Care

• Definition of Value:

  • $Value = rac{Quality}{Cost}$

• Components of Value:

  • Quality

  • Access

  • Cost

Key Health Concerns of Interest Groups

• Health priorities identified by selected interest groups as addressed in Exhibit 13-1; Shi & Singh, Delivering Health Care in America, 9th edition. (p. 579)

Near Term Priorities in Health Care Delivery

Opportunities and Challenges

• Discussion on health care reform in transition

  • Maintenance of the Affordable Care Act (ACA)

  • Concepts for universal coverage and "Medicare for All"

  • Possibility of a public option to buy into Medicare

  • Trust maintenance in the health care system

  • Innovations in health care delivery infrastructure

  • Population health focus and patient responsibility engagement

  • Necessary workforce changes, particularly in primary care, nursing, and geriatrics

  • Importance of international cooperation

  • Developments in medical technology and AI

  • Evidence-based health care practices

  • Public health threats, influenced by past years' experiences including the COVID-19 pandemic

  • Addressing firearm violence as a public health crisis

  • The impact of climate change on health care delivery and outcomes

  • Safeguarding individuals' rights, including women's rights to choose

Trust in US Health Care

Current State of Trust

• Trust in US health care is declining:

  • Confidence in health care leadership dropped from 73% in 1966 to 34% in 2012

  • During COVID-19, confidence surged to 51% by mid-2020, but fell to 40% by 2024

  • Contributing factors:

  • General mistrust in institutions, especially government

  • Managed care financial incentives

  • Conflicts of interest in health care institutions

  • Communication constraints and consumerism issues

  • Trust disparities among racial groups due to access barriers and systemic racism

Strategies for Rebuilding Trust

• Addressing merger consequences in the health care sector

  • Focus on relationships with patients and communities

  • Understanding trust as an ecosystem

  • Emphasize patient engagement and workforce diversity

  • Workplace strategies that prioritize the patient experience

  • Adopt the "4 Cs of Trust" (Competence, Consistency, Character/Compassion, Communication)

Lessons from COVID-19

Reflections on Outcomes

• Highlighted values, challenges, and deficiencies in the health care response:

  • Preparedness of public health systems

  • Public compliance and behaviors regarding health directives

  • Equity issues exacerbated by the pandemic

  • Moral determinants of health impacting vulnerable populations

  • Socioeconomic consequences of pandemics impacting various sectors: employment, education, etc.

The Moral Determinants of Health

• Overview of public health rights and human rights in the US context:

  • Uninsured individuals exceeding 30 million

  • Lack of ratified UN human rights agreements by the US

  • Addressing systemic issues such as hunger, homelessness, and discrimination

Observations on Health System Change Post-COVID-19

Emerging Trends

• Health systems resiliency and adaptation

• Increase in telehealth services

• Changes in labor force dynamics related to healthcare

Predictions and Future Outlooks

Deloitte's Global Vision for 2025

• Health care evolution predictions:

  1. Transition from health care to healthy aging

  2. Public health enhancements driving productivity

  3. Empowered clinicians through new diagnostic and treatment paradigms

  4. Person-centered care models

  5. Enhanced MedTech innovations

  6. Pharmaceutical industry returning to viable R&D

  7. Integrated next-generation supply chains

  8. Environmental sustainability initiatives

  9. Fostering of patient-centric care models

  10. Trust-building through partnerships

Final Examination and Course Review Information

Important Details

• Review course materials for the final exam preparation, emphasizing understanding from chapters and lecture notes.

• Special accommodations must be discussed by December 1st, 2025.

• Final exam will cover a range of questions across topics discussed throughout the course, designed to reinforce learning goals and outcomes.

Closing Reflections

Final Thoughts

• Emphasizing health care as a human right

• The importance of understanding the complex implications of health care policies and changes

• Encouragement to inquire and engage deeply with course material