Question

5-7 takeaways from the chapter one of delivering health care in America-an overview of U.S. healthcare delivery

Answer 1

An overview of U.S. healthcare delivery: the united states has a unique system of health care delivery and also complex and massive, subsystem of US health care delivery consists of a) managed care b) military, c) vulnerable populations, d) integrated delivery, the complexity of healthsystem in US relies on a combinations of governemental action, market forces, and voluntary charitable initiatives to deliver health services, and the delivery system is in piecemeal and overall system goes like this: 1) physicians office( self employed physician): contractual agreement is made between group of individual and physician office and payement mode can be direct or reimbursement, 2) hospitals: large number of primary care is been provided by the hospitals only and payment mode is direct or by reimbursement only. componenets of US health system :a) health care provider consists of hospitals , ambulatory care provider and mental and substance abuse care and pharmacy service providers, b) Hospitals consists of federal hospital, nonfederal hospital and community hospital, c) community hospital: consists of nonprofit , for profit and state local government. Health maintenance organizations( HMOs) these are unique features of US health system these organizations are within the private system in US only , staffmodels : physicians works for HMOs, group model, prepaid group practice and individual practice association. Health care purchasers: are 2 they are private health insurances and government health insurances, private health insurances includes employer supported and self supported, then government health insurance consists of medicare, medicaid, SCHIP,VA 1). Medicare: it is a governmental health insurances it has 3 basic categories beneficiaries they are individuals age 65 and older and individuals who are permanently and completely disabled and individuals with end stage renal disease, and medicare has 4 major components they are part A : it includes short stay hospital, skilled nursing facilities, home health services and hospice care, part A is financed by medicare trust fund and out of pocket deductiable for hospital care and fixed amount for an episode of care, partB: it covers physicians care and other outpatient services and optional benefits and beneficiaries are responsible for paying a monthly premium and beneficaries eposed to significant outof pocket costs including deductibles, copayments and costs for noncovered srevices, part C: components of the medicare program, covers an array of managed care plan an alternative to the traditional medicare program and part D: coverage for outpatient prescription drugs and as part of the medicare moderization act of 2003 and took effecting during 2006 2) Medicaid : it is a single largest health care program in the country and jointly financed and adminstered by the federal government and individual state government , beneficiary are poor , elderly, disable, children, pregnant women and parents of young children , 3) SCHIP( State childrens health insurance program) it is for loww income children not eliglible for the traditional medicaid program , it is jointly financed and adminstered by the federal government and individual state government. 4) veterans adminstrations: federally adminstered program for veterans of the military , and health care is delivered in government owned veterans adminstrations hospitals and clinics. Private health insurance: it includes employer sponsored insurance , self insured company and private nongroup , The public health system has 3 core functions they are assurance, policy development, assessment. and based on the 3 core priciples they are ten essential services. The other unique features of the US public health system are A) council on linkages between public health practice and academia B) organization under the public health systems include the national institutes of health, and centres for disease control and prevention, and health resurces and services adminstration and indian health services and food and drug adminstration and agency for toxic substanaces and disease registry and substance abuse and mental health adminstration( SAMHA).