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Chapter 1: Introduction
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Introduction to Health Care Systems
• Definition: Health care system
– All institutions, processes supporting diagnosis,
and treatment
– For legitimized patients by appropriate providers
• Variation among nations’ health care systems
– Definitions of health problems (e.g., obesity)
– Diagnosis and treatment models
– Social position, training, and authority of healers
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Health and Health Care
• What is health?
– Complete physical, mental, and social well-being
– Not just absence of disease or infirmity (WHO)
• Determinants of health
– Genetic inheritance
– Health behavior
– Physical environment
– Social environment
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Health and Health Care (cont’d)
• Health behavior
– Behavior that affects health, usually negatively
• Smoking, alcohol/drug abuse, diet, exercise
– Implicated in leading causes of death in
United States
• Heart disease, cancer, stroke, respiratory diseases, etc.
– Most common target for health improvement
efforts
– Healthy People 2020
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Health and Health Care (cont’d)
• Health care as a determinant of health
– Main goals
• Restore health
• Prevent worsening of problems
– Late in causal chain leading to illness
– Levels of prevention
• Primary: eliminate risk factors to prevent onset (least
focused on now)
• Secondary: early detection and treatment and restoration of
pre-onset health status
• Tertiary: prevent further exacerbation of health problem
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U.S. Health Care System
• Complex and unique among nations
• Highly decentralized and fragmented
• Mix of private and public financing and
provision of care
• Historically has produced high physician
incomes and profits for suppliers of
therapeutics
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U.S. Health Care System (cont’d)
• Components
– Workforce: 15.5 million people
– Facilities: 5010 acute-care hospitals
– Therapeutics: $299.6 billion in drugs and products
– Training and research: contributes to character of
health care system
– Financing: $2.486 trillion in 2009 (17.6% GDP)
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U.S. Health Care System (cont’d)
• Financing mechanisms
– Health “insurance”
• HMOs: care within network, primary care physician
• PPOs: care within or outside of network
• POS plans: choice between HMO and PPO
– Managed care
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U.S. Health Care System (cont’d)
• Organization of health care services
– Government sector: federal, state, and local
• Department of Health and Human Services
– Private, nonprofit sector
• Many hospitals and voluntary agencies: American Heart
Association, Red Cross
– Private, for-profit sector
• Pharmaceuticals, insurance, nursing homes, hospitals,
MCOs
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U.S. Health Care System (cont’d)
• Types of health services
– Primary care
• Exercise promotion, immunization, prenatal care,
health exam
– Secondary care
• Surgical procedures and common diagnostic and
treatment interventions
– Tertiary care
• Organ transplantation, open-heart surgery,
chemotherapy
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U.S. Health Care System (cont’d)
• Health care system administration
– Administration
• Hospital staffs function independently, not as a team
– Planning
• Weak because not backed by law
– Government regulation: mainly reactive, not
proactive
– Evaluation: applied program evaluation seldom
done
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U.S. Health Care System (cont’d)
• The population served
– U.S. population in 2010: 309 million
– Racially and ethnically diverse
(72.4% white, 12.6% black, 4.8% Asian, 10.2% other race)
– Historically different in access to health care
– Large income differentials
– Aging of Baby Boomers
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U.S. Health Care System (cont’d)
• Health care system performance
– Quality
• Health outcomes vs. technical accomplishments
– Equity
• Distribution and access uneven
• Geography and health coverage are major
determinants
– Efficiency: allocative vs. productive, micro vs.
macro
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U.S. Health Care System (cont’d)
• History of change
– Changes called for as early as 1932 (CCMC)
– Medicare and Medicaid enactment
• Present situation
– Same problems: financing, distribution, and
delivery
• Future directions
– New financing and organizational models
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