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US Health Care System
US Health Care System
Part 1/3
Agenda
Health Care System Complexity US Health Care Problems Walk through
Payers Public Private
Hospital work flow Inpatient Outpatient
Future
Health Care a Complex Adaptive System!
Multiple Stake Holders Patients Health Care Providers Government Payers
Private and public insurance
Non linear – dynamic Internal External
Conflicting interest No single point of control Buyer is not payer(for insured patient)
Healthcare in US today - Area 1
1. Tasks and workflow of healthcare Decisions often require reasoning under high degrees
of uncertainty about patient’s medical state and effectiveness of past and future treatment of a the particular patient
Workflows are complex with little documentation of steps, expectations and outcomes
Time and resource pressured environment because of the need to contain the costs
Healthcare in US today - Area 2
2. The institutions and economics of healthcare Large number of healthcare payers and coverage plans, each
with their own rules of coverage complicates administration Incentives for payment are often distorted or perverse, leading
(for example) to more generous compensation for medical procedures than for communication with patients or for diagnosis or preventive care
Confusing landscape of tertiary care centers, community hospitals, clinics, primary and specialist doctors and other providers, payers, health plans and informtion sources
Healthcare in US today - Area 3
3. Current implementation of health care IT Monolithic IT implementation which makes even small
changes hard to introduce Mostly focusing on automation of tasks and business
processes Mostly mimic paper based systems and little support for
cognitive tasks of clinicians Sometimes poor design add to workload and increase
chance of errors Much of healthcare is transactional – or appear to be
transactional
US Health Care Problems
High Cost – current 2,4 Trillion
US Health Care Problems
US Health Care Problems
Ineffective Care
US Health Care Problems
US Health Care Problems
USA Health Care• non-profit hospitals
65% of hospitals in the country
for-profit hospitals
government hospitals The urban public hospitals are often associated with medical
schools public hospitals receive significant funding from local, state,
and/or federal governments they may charge Medicaid, Medicare, and private insurers for the
care of patients Poor uninsured patients receive their care for free.
Statistics
85% of Americans have insurance 60% through an employer 9% purchase directly 28% government agencies There is some overlap in these figures
In 2007, there were nearly 46 million people in the US (over 15% of the population) who were without health insurance for at least part of that year.
Ref: http://en.wikipedia.org/wiki/Health_insurance_in_the_United_States
Payers
Government (elderly, poor, veteran ….) Medicare – Federal funding, Federal administration, people over
65, certain disabilities, end stage renal disease
Medicaid – Federal/State match, state administration, needs
based, eligible low income parents, children, seniors, disabilities
Veteran’s administration
Military HealthCare
Private Employers- employees and their families
Individuals – self insured, co pay, deductible
An example : Hospital
Hospital
A hospital is a Complex business of businesses
Hospital Complex eco-system
Hospi
tal w
ork
flow
Inpatient Work Flow
Hospital Emergency Room
Demo – Patient journey through hospital emergency room
http://www.statcom.com/Landing/PPC/NationalSurvey.aspx?Page=26&sc_cid=PPC:1-google2-brand3-brand4-Landing/PPC/NationalSurvey.aspx|Page-26&s_kwcid=statcom|2338011651
Future
21 Century HIT(IMO Report)
Patient centered Interoperable
Standards Ubiquitous care Data in context Knowledge
intensive Cognitive support
Health Care Domain
By:
- Roomana Channa
-The City School,
-Senior Branach. Sukkur
