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Health Care System in the United States

Module 1 – Case

Health Care Delivery System in the United States

Assignment Overview

Watch the following short video:

The Healthcare System of the United States https://www.youtube.com/watch?v=yN-MkRcOJjY

Having completed the assigned readings, you should now have a basic understanding of the characteristics and components of the U.S. healthcare delivery system. For the Module 1 Case Assignment, conduct additional research as needed and prepare a 4- to 6- page paper to address the following questions:

Discuss the interaction of the major components of the U.S. healthcare system on (1) Access to Healthcare (physically and financially), (2) Healthcare Expenditure, and (3) Quality of Care. Answer the questions from the perspective of two of the internal factors and one of the external factors identified in the module Home page. (*****Home page is page 2 of this attachment.  The internal and external factor sections are highlighted in red!)

Assignment Expectations

• Cite all sources and provide a reference list at the end of the paper (include at least three references).
• The paper should be 4-6 pages typed and double-spaced.
• Prepare your work using the appropriate format. This link from your course Syllabus page will help reinforce formatting expectations: http://support.trident.edu/files/Well-Written-Paper.pdf

Introduction

The course begins with an overview of the U.S. Healthcare Delivery system (Module 1).

We will then explore the various organizations responsible for delivering healthcare: the physician practices, hospitals, and integrated delivery systems. We will also examine the structure of the system, including the types of institutions that comprise it and how they interact with each other, the flow of money and services among them, and the paths that patients follow through the system.

Finally, we will delve into government-supported healthcare coverage: Medicare and Medicaid.

The U.S. Healthcare system is influenced by the following forces:

Internal factors:

Financing:

• Public health insurance programs such as Medicare, Medicaid, State Children’s Health Insurance Program, and TriCare.
• Employer provided health insurance.
• Commercial health insurance.
• Out-of-pocket payments.

Payment:

• Payment mechanisms used by public and private health insurance programs, including but not limited to fee-for-service, capitation, per diem, global budget, pay for performance, shared savings, gain sharing, bundled payments.

Delivery:

• Healthcare delivery institutions such as hospitals, ambulatory care clinics (e.g., community health clinics, and physician offices), pharmacies, and rehabilitation centers.

Resources:

• Healthcare human resources, including all types of healthcare professionals (physicians, nurses, therapists, pharmacists, technicians, and so on) as well as management and administrative personnel.
• Health IT infrastructure.
• Medical equipment.

Regulation:

• Federal and state legislation that regulates all agents in the healthcare system (e.g., Patient Protection and Accountable Care Act [PPACA], Health Insurance Portability and Accountability Act [HIPAA], Consolidated Omnibus Budget Reconciliation Act [COBRA], and Employee Retirement Income Security Act [ERISA]).

External factors:

• Economic development.
• Political climate.
• Population characteristics such as demographic composition and health outcomes.
• Social and cultural values.
• Technological development.

The combined interaction of these forces influences the structure and the development of the U.S. healthcare system.

Major Characteristics of U.S. Healthcare Delivery

• No central governing agency to integrate and coordinate healthcare.
• High in cost, unequal in access, and average on outcome.
• Access to healthcare services is selectively based on insurance coverage.
• Technology-driven delivery system focusing on acute care.
• Legal risks influence practice behavior.
• Multiple players and balance of power.
• Quest for integration and accountability.