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Introduction to US Health Care. Text by Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs & James R. Knickman with Tracy Barr PowerPoints by Robin Pickering Eastern Washington University. Introduction to US Health Care. Chapter 3 Health Care Provision. Types of Care. - PowerPoint PPT Presentation
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Introduction to US Health Care
• Text by
Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs &
James R. Knickman with Tracy Barr
• PowerPoints by Robin Pickering Eastern Washington University
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Introduction to US Health Care
Chapter 3
Health Care Provision
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Types of Care
1. Primary2. Secondary3. Tertiary
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Comparing Care Models
• Consult with primary care provider first
• Send difficult problems with secondary or tertiary
• Benefits– Quality of care– Cost containment– Public sentiment
•Primary Care Model
•Specialty Care Model
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Comparing Care Models
• More dispersed model• Does not require patient
to consult first with primary care provider
• Contributed to the rising cost of health care
•Primary Care Model
•Specialty Care Model
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Managed Care Model
Health organizations control costs by funneling all medical necessities through the PCP
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Effective Primary Care Systems
• Accessibility• Continuity• Comprehensivene
ss• Coordination• Accountability
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Primary Care Team Approach
Nurse Practitioner
Physicians
Medical Assistant Clinicians
Receptionist
Medical Assistants
Health Educators
Primary Care Team
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• Disease registries• Performance feedback• Case management• Chronic care visits
Chronic Care Model
Collaborative Care
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Primary Care Specialties
• Family Physicians• General Internists• General Pediatricians
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“Nonphysician” Clinicians
• Nurse Practitioners• Physician Assistant
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Access to Health Care
•Too few generalists•Lack of health insurance•Maldistribution of PCPs -(HPSAs)
Two-thirds of all HPSAs are
in rural regions *Rural
*Inner City
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Strategies to Improve Distribution
• National Health Service Corps and Loan Repayment Program
• Grants• Focused Recruiting of Medical Students
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Introduction to US Health Care
Chapter 4
Financing the U.S. Health Care System
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Increased Health Care Expenditures
• Inflation in economy• Inflation in medical
component of consumer price index
• Growth of population• Changes in the type
and quality of health care service
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Change in Health Care Financing
Past: Individual Financing
Present and Future: Employer Financing
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Differentiate…
Purchaser
• Pays for the service (insurance company or the government)
Consumer
•Receives the service (patient)
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Financing Health Care
• Individuals• Government• Private
Businesses
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Financing Health Care
• Individuals
• Government• Private
Businesses
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Financing Health Care
• Individuals• Government
• Private Businesses
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Insurance Coverage
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Factors Affecting Coverage
• Age• Race and Ethnicity• Poverty Level• Residence
Predict Coverage
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• Voluntary Health Insurance
• Social Insurance• Public Welfare Insurance
Types of Health Insurance
•Indemnity Plan•Service Benefit•Managed Care
Categories…
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Voluntary Health Insurance (VHI)
1. Commercial2. Blues3. HMOs4. Self-funded
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Compare Programs
Attribute Medicare MedicaidPopulation
served•65 and older•Disabled (SS)•Kidney failure
•Those in need (state determined)
Funding •Federal gov’t (payroll deductions)
•57% federal, remainder from states
Administered •Managed by federal gov’t
•Federal gov’ t sponsored, administered by states
*adapted from table 4-5 in text
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• Independent Practice• Group• Network• Staff• Mixed
HMO Models
