US Healthcare system

1. WENDI EVANS
HCA 205: INTRODUCTION TO HEALTH
INSTRUCTOR: BRETT GARCIA
JANURARY 7, 2015

2. My name is Wendi Evans, I am pursing a degree in Health Care
Administration. I am a single mother of
three. I love to sing, shop, cook, and spend time
with my family and friends.
This presentation will explain the history of the US Health Care
System. I will be defining the Healthcare system, describing the cost,
comparing the US Healthcare system to Canada’s healthcare system,
and discussing reforms and improvements.

3.  Definition of US Healthcare system – It is and
organization of people, institutions, and resources that
delivers health care services to meet the health needs of
individuals of a targeted population.
 1900’s - The beginning of organized medicine.
 The American Medical Associations gains powerful
influence as the National Organization of State and
Local Associations. Social Insurance including Health
Insurance gains public attention. Baylor Hospital in
Dallas, Texas starts a pre-paid hospital insurance
program with a local teacher’s union, ( first example of
modern health insurance).

4.  1965 to 1980 ‘s – President Johnson signs into law the most significant
Health Care Reform of the century Medicare. Medical cost rapidly
escalate , President Nixon sign Health Maintenance Organization Act.
 2006 to present- Massachusetts implements laws to provide health care
coverage. President Obama signs Landmark
Health Care Legislation called the Patient Protection
and Affordable Care Act.

5.  The marine hospital service was
establish with the July 16, 1798 signing
by President John Adams for
relief of sick and disabled seamen. In 1875 a title of
Surgeon General came into being.
 March 3 a bill passed that authorized admission of navy
seamen an seamen of other government services to
Marine Hospitals on a reimbursable basis.
 January 4, 1889 the Public Health Services Commission
Corp. was authorized. Julius Richmond was the first
Surgeon General of Public Health Service.

6.  Financial – PPAC has
grand ambitions to provide
insurance coverage to more
than 30 million people.
 2.7 trillion spent on health
care is income to some
person or organization.
 The law also authorizes an
additional 11 billion for
federally qualified
community Health Centers.
 Legal- HIPPA protects
patients.
 Federal Anti-trust laws
 False claims whistle blower
suits
 Ethical- Balancing
quality care and efficiency.
 The end of life issues
financing that pays for this
service forced to pull the
plug due to insurance.

7.  Regulatory – 1879-
The Department of
Public Health
established by US
Congress.
 The government
regulates laws for
Health care system.
 Social - Civil War was
instrumental in
establishing the US
Health Care System.
 At the turn of the 20th
century break through in
Medicine and
Technology.
 1929 to 1941- The great
Depression

8. STAKEHOLDERS
 Patient- Expects an employer to offer a wide variety of options for health
coverage.
 Employers – Want to maintain or lower cost contributions.
 Providers – Want to provide the best service using the most accurate and
newest test and treatments.
 Payers- Want providers to follow a clear, evidence based diagnostic plan.
 Political Figures – The government regulate laws to be enforced for the
Health Care Systems.
 Schools – Most Colleges and University Campuses offers some type of
general medical care.

9.  Reimbursement methods
Fee of service: the oldest form of medical reimbursement
doctors charge for every test and service provided.
Capitation: Method of which employers pay a set price for
services no matter how many times patient visits the doctor
puts cap on spending.
Valued based: Rewards the organization for the value of
health care services delivered.
Managed Care Organizations: They enter into contracts with
hospitals and healthcare professionals to provide health care to
individuals enrolled in the plan.
MCO gives the provider economic incentives to offer less
costly care.
Provider records are reviewed regularly.

10. Medical research : Research on different diseases such as cancer, and
heart disease has increased.
Developing new treatment for previously untreated terminal
conditions. Cost for workers time spent on
experimenting.
Equipment improvements: New medical and surgical procedures,
drugs and medical
devices such as CT scanners, and defibrillators.
Delivery of quality care:
Reduce hospital acquired conditions.
Better preventive measures.
Better doctors to patient ratio.
More concern with cures for major diseases such as diabetes and
high blood pressure increase cost.

11. How do Canadians access Healthcare?
 Apply for provincial health card.
 After obtaining coverage one can register with
primary care physician.
 Card is used whenever visiting a physician or
health care provider.

12. How do Canadians pay for Healthcare?
 Health care is funded by both Federal and
Provincial levels.
 By taxation both from personal and corporate
income taxes.
 Sales taxes and lottery taxes.
 There are no deductibles.

13. Quality of Healthcare Providers.
 Canada has seen a significant decline in morality
rates from major killers such as cancer and heart
disease.
 Immunization rates are low.
 More than 80% have access to regular doctors.

14. Unique services provided
 No National plan Canada’s Healthcare is based on
its 13 provinces and territories.
 Hospital services provided to inpatient and out-
patients.
 Services medically necessary for purpose of
maintaining health.

15. PRO’S AND CON’S SIMILARITIES
AND DIFFERENCES
Pro’s Con’s
* The elimination * Patients in
Of unnecessary Canada wait
risk of harm to longer for
patients. primary care
* Doctors always appointments.
involve patients * Greater use
in decision about of ER for
Treatment. primary care
factor longer
wait time in
ER.
• The government of both
Nations are closely involved in
the Healthcare system process.
• Us spends more money on
healthcare than Canada.
• They have different mix of
funding mechanism’s.
• In Canada all residents must be
covered by the public insurance
plan run by their province on
uniform term and conditions.
• In the US all residents must
have some type of insurance not
necessarily government funded.

16.  Medicare reform: Raised the income limit on
eligibility.
 Lower spending
 Readmission rates lower
 Seniors are able to choose from a broader range
of higher quality Medicare plans.
 Programs encouraging providers to invest in
redesigning care.
 Making information available for consumers.
 Higher quality and more efficient services.

17.  State modifications:
 Has no affect on how much insurance cost.
 State regulations which mandate the group
health insurance plans must include certain
benefits.
 The cost of policies being too expensive
 The availability of insurance in each state.

18. American Journal of Public Health. (AMJ Public Health),
October, 2011; 101(10)1841.4.
Batnitzky, A., Hayes, D., & Vinall, P.E. (2014). The U.S. healthcare system: An
introduction. San Diego, CA: Bridgepoint Education, Inc.
This text is a ConstellationTM course digital materials (CDM) title.
Weather, C. ( 1900& 1908). “New York Health Board Supervising Babies”.
Clark, E. & Bidgood, E (2011-2013). “Civitas”; Canada Health website.:
FAQ Canada Healthcare Act;
http://hc-sc.gc.ca/hcs-sss/medi-sssur/faq-eng.php
Canadian Foundation of Health Care Improvement (2014).
Accelerating Health Care Improvement: CFHI’s Assessment tool of Healthcare
Delivery Organization and Systems.

19. http://www.amnhealthcare.com
http://www.Annenburgclassroom.org/files/documents
http://www.profiles.nlm.nih.gov/ps/access/QQBBCZ
www.parlgc.ca/information/library/prbpubs/944-e.htm
Canadianhealthcare.org
Centers for Medicare and Medicaid Services, Office of the Actuary, National Health
Statistics Group, http://www.cms.hhs.gov/NationalHealthExpendData/ (see
Historical, NHE summary including share of GDP, CY 1960-2005, file nhegdp05.zip;
and Historical, Projected, NHE Historical and projections, 1965-2015, file nhe65-15.zip).
Mark. V. Pauly, “Competition And New Technology,” Health Affairs 24(6)
(November/December 2005): 1523-1535.