ANSWERS
Characteristics of a System - ANS Structures, Processes, Connections, Inputs & Outputs
Objectives of a Healthcare System - ANS To Enable all citizens to receive health care services
and to deliver services that are cost-effective and meet established standards of quality
Structures in a Healthcare System - ANS Education/research, suppliers, insurers, health care
administrators, providers (individuals, facilities), payers, government, patients
Insurance - ANS Spreading of risk, health insurance in America provides access to care
Processes in Health care & connections - ANS Financing -> Insurance -> Payment -> Delivery
Continuum of care - ANS the trend of health care in someone's life, i.e.. preventative care -
specialty care
Harrison JAMA Paper 1974 - ANS We must choose one of two goods with the exclusion of
the other. This is an ethical dilemma in health care, trade off of expensive care for few, or
inexpensive care for many.
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, Unique Aspects of American Health Care System - ANS No central agency governs the
system, imperfect market and non-universal access, third party insurers and multiple payers,
balance of power among many stake holders, practice of defensive medicine, love of
technology
US Government role in health care - ANS determine reimbursement rates to providers who
render Medicare or Medicaid, major financer, regulates through licensing personnel and health
care establishments
Americans Coverage Type 2013 - ANS 14% uninsured, 32% public insurance, 54% private
insurance
Private Coverage Type - ANS Employer is 91%, Self 9%
Public Coverage Type - ANS 6% other, 48% Medicaid, 46% Medicare
Why are people uninsured - ANS They cannot afford to pay out of pocket, unemployed, not
required to buy insurance, employers do not offer insurance
Access to care in US is Limited to those - ANS have health insurance via employer, covered by
government, can afford own insurance, can pay at time of service. Many providers do not
accept Medicaid, issues with getting care due to transportation etc.
Developed nations - ANS ensure care for all citizens
Bismark model - ANS Otto von bismark invented it in the 19th century, financed by sickness
funds (non profit), provided by private doctors, can opt out, but funds must cover everyone,
tight government regulations
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The Out-Of-Pocket Model - ANS The norm in most poor nations
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, National Health Insurance Model - ANS Government Insurance that everyone pays into like
in Canada
Beveridge Model - ANS Named after William Beveridge, system provided and financed by
government like in Great Britain
Health care is shaped by - ANS political climate, economic development, technological
progress, social/cultural values, physical environment, population characteristics, global
influences
US Health Care System - ANS Got there by accident, multiple payers, trying to fix it for
decades, established interests are really comfortable
Technology - ANS Driving force that brought medicine into public domain, influenced by
education, growth of institutions, urban development, creating a professional entity, making
medicine a growth enterprise
Pre-Industrial Era - ANS Medical practice in disarray, primitive medical procedures, missing
institutional core, hospitals were not good to go to, substandard medical education, unstable
demand
Post Industrial Era 1900s - ANS American physicians resisted national health care
Medicine Transformed in 1900s due to - ANS urbanization, science and technology,
industrialization, patient dependency, cohesiveness and organization, licensing, educational
reform
Urbanization - ANS more people living in cities, centralized training and practice, women
working outside of home, house calls became office visits
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