HCM: Introduction to the
U.S. Health Care System
Are US hospital beds shrinking? - ANSWER •The overall trend since 1990 has been a
reduction in the number of staffed hospital beds
-In 1990, 1.2 million beds in 6,649 hospitals*
-In 2000, 983,628 beds in 5,810 hospitals*
-In 2010, 941,955 beds in 5,754 hospitals*
-In 2022, 919,649 beds in 6,129 hospitals**
•One reason for this trend has been the increased amount of care provided as outpatients
How are drugs accessed? - ANSWER Substances considered a "drug" must have FDA
approval before they can be marketed and sold in the United States; approval may allow access
•By prescription only (from a provider such as a doctor)
•"Over-the-counter" (OTC—may be purchased by consumers as needed)
How are health care system performances evaluated? - ANSWER •Health care system
performance may be evaluated at
-the micro level (physician practices, hospitals, other health care settings)
-or at the macro level (for regions, states, and nations)
How are health care systems evaluated? - ANSWER •Health care systems can be evaluated
on the following criteria:
-the quality of the health care provided
-the equity achieved in the provision of health care
-the efficiency with which health care is provided
How are hospitals structured? - ANSWER •Hospitals have complex structures and a variety
of operating divisions
-Administration
-Medical (physicians)
-Nursing
-Other diagnostic and therapeutic support
•Most hospitals provide inpatient and outpatient care
•Outpatient care may be through an emergency department, an outpatient clinic, or diagnostic or
therapeutic service (such as ambulatory surgery unit)
How are inpatient care hospitals classified by? - ANSWER -type of medical condition treated
,HCM: Introduction to the
U.S. Health Care System
-number of beds
-control or ownership
-short term or long term (length of stay)
-average daily census (average number of beds occupied on a given day)
How are physician visits changing? - ANSWER •Previously, U.S. physicians routinely saw
their patients both in an ambulatory setting (office) and in the hospital
•The specialty of hospitalist continues to grow. Hospitalists usually work for a hospital and see only
hospitalized patients
•In most other countries, physicians either see ambulatory patients only or work full time in
hospitals.
How are providers reimbursed for medicaid? - ANSWER •Providers are generally
reimbursed on a fee-for-service/episode-of-care basis like Medicare. Managed care has been growing
in the Medicaid program.
How can the physical environment affect health? - ANSWER •Can provide exposure to
toxins and unsafe conditions, including due to employment
-Farm workers: injuries
-Office workers: indoor air pollution
•previously asbestos
•now formaldehyde exposure and radon exposure
How can the social environment affect health? - ANSWER •Can cause health risks
•Those with a lower socioeconomic status have more health risks, particularly for
-Cardiovascular disease
-Diabetes
-Asthma
-Cancer
-HIV/AIDS
How does the DHHS provide some health services directly? - ANSWER •The DHHS provides
some health services directly and also provides financial support for others through grants and
contracts, directs biomedical research, and provides financial federal support for biomedical research
in non-government agencies (through the National Institutes of Health (NIH)).
, HCM: Introduction to the
U.S. Health Care System
How does U.S. Compares to Other Developed Countries? - ANSWER Among these 13
countries - Australia, Belgium, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands,
Spain, Sweden, the United Kingdom, and the United States
•The U.S. ranked 13th for life expectancy at birth in 2023.
--The U.S. was 47th among all nations in 2023.
•The U.S. infant mortality rate was the highest among those countries in 2021.
--In 2022 in the U.S., the infant mortality rate for African American mothers was more than twice
that for White non-Hispanic mothers (10.86 per 1,000 live births versus 4.52)
How is clinical effectiveness measured? - ANSWER •Clinical outcomes are also measures of
the quality of health care
•Common ones are:
-hospital readmission rates
-functional capacity after medical intervention
-long-term pain and discomfort after medical treatment
-infection acquired during a hospital stay
-five-year mortality rate for patients treated for cancer, heart disease, and other diseases
How is coordination of care accomplished in with PCP? - ANSWER •Coordination of care is
accomplished if the primary provider assesses the situation and refers the patients when necessary
and integrates the outcome of the referral into the patient's ongoing care.
How is quality of care measured? - ANSWER •Quality is measured in terms of structure,
process, and outcomes
-Structure encompasses the conditions under which the care is provided (facilities, equipment,
human resources, non-profit status, academic affiliation, governing structure)
-Process encompasses the activities that constitute health care (includes diagnosis, treatment,
rehabilitation, prevention, and patient education)
-Outcomes are changes, desirable and not desirable, in individuals and populations that can be
attributed to health care
How is the government involved in health care? - ANSWER •The U.S. government is less
involved with the provision of health care than any other industrialized country in the world
•The government provides health care to populations not profitable to care for or are otherwise
difficult: sick poor, mentally ill, Native Americans living on reservations, short and long term care for
the elderly, and infectious disease control
U.S. Health Care System
Are US hospital beds shrinking? - ANSWER •The overall trend since 1990 has been a
reduction in the number of staffed hospital beds
-In 1990, 1.2 million beds in 6,649 hospitals*
-In 2000, 983,628 beds in 5,810 hospitals*
-In 2010, 941,955 beds in 5,754 hospitals*
-In 2022, 919,649 beds in 6,129 hospitals**
•One reason for this trend has been the increased amount of care provided as outpatients
How are drugs accessed? - ANSWER Substances considered a "drug" must have FDA
approval before they can be marketed and sold in the United States; approval may allow access
•By prescription only (from a provider such as a doctor)
•"Over-the-counter" (OTC—may be purchased by consumers as needed)
How are health care system performances evaluated? - ANSWER •Health care system
performance may be evaluated at
-the micro level (physician practices, hospitals, other health care settings)
-or at the macro level (for regions, states, and nations)
How are health care systems evaluated? - ANSWER •Health care systems can be evaluated
on the following criteria:
-the quality of the health care provided
-the equity achieved in the provision of health care
-the efficiency with which health care is provided
How are hospitals structured? - ANSWER •Hospitals have complex structures and a variety
of operating divisions
-Administration
-Medical (physicians)
-Nursing
-Other diagnostic and therapeutic support
•Most hospitals provide inpatient and outpatient care
•Outpatient care may be through an emergency department, an outpatient clinic, or diagnostic or
therapeutic service (such as ambulatory surgery unit)
How are inpatient care hospitals classified by? - ANSWER -type of medical condition treated
,HCM: Introduction to the
U.S. Health Care System
-number of beds
-control or ownership
-short term or long term (length of stay)
-average daily census (average number of beds occupied on a given day)
How are physician visits changing? - ANSWER •Previously, U.S. physicians routinely saw
their patients both in an ambulatory setting (office) and in the hospital
•The specialty of hospitalist continues to grow. Hospitalists usually work for a hospital and see only
hospitalized patients
•In most other countries, physicians either see ambulatory patients only or work full time in
hospitals.
How are providers reimbursed for medicaid? - ANSWER •Providers are generally
reimbursed on a fee-for-service/episode-of-care basis like Medicare. Managed care has been growing
in the Medicaid program.
How can the physical environment affect health? - ANSWER •Can provide exposure to
toxins and unsafe conditions, including due to employment
-Farm workers: injuries
-Office workers: indoor air pollution
•previously asbestos
•now formaldehyde exposure and radon exposure
How can the social environment affect health? - ANSWER •Can cause health risks
•Those with a lower socioeconomic status have more health risks, particularly for
-Cardiovascular disease
-Diabetes
-Asthma
-Cancer
-HIV/AIDS
How does the DHHS provide some health services directly? - ANSWER •The DHHS provides
some health services directly and also provides financial support for others through grants and
contracts, directs biomedical research, and provides financial federal support for biomedical research
in non-government agencies (through the National Institutes of Health (NIH)).
, HCM: Introduction to the
U.S. Health Care System
How does U.S. Compares to Other Developed Countries? - ANSWER Among these 13
countries - Australia, Belgium, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands,
Spain, Sweden, the United Kingdom, and the United States
•The U.S. ranked 13th for life expectancy at birth in 2023.
--The U.S. was 47th among all nations in 2023.
•The U.S. infant mortality rate was the highest among those countries in 2021.
--In 2022 in the U.S., the infant mortality rate for African American mothers was more than twice
that for White non-Hispanic mothers (10.86 per 1,000 live births versus 4.52)
How is clinical effectiveness measured? - ANSWER •Clinical outcomes are also measures of
the quality of health care
•Common ones are:
-hospital readmission rates
-functional capacity after medical intervention
-long-term pain and discomfort after medical treatment
-infection acquired during a hospital stay
-five-year mortality rate for patients treated for cancer, heart disease, and other diseases
How is coordination of care accomplished in with PCP? - ANSWER •Coordination of care is
accomplished if the primary provider assesses the situation and refers the patients when necessary
and integrates the outcome of the referral into the patient's ongoing care.
How is quality of care measured? - ANSWER •Quality is measured in terms of structure,
process, and outcomes
-Structure encompasses the conditions under which the care is provided (facilities, equipment,
human resources, non-profit status, academic affiliation, governing structure)
-Process encompasses the activities that constitute health care (includes diagnosis, treatment,
rehabilitation, prevention, and patient education)
-Outcomes are changes, desirable and not desirable, in individuals and populations that can be
attributed to health care
How is the government involved in health care? - ANSWER •The U.S. government is less
involved with the provision of health care than any other industrialized country in the world
•The government provides health care to populations not profitable to care for or are otherwise
difficult: sick poor, mentally ill, Native Americans living on reservations, short and long term care for
the elderly, and infectious disease control
