Subsystems of U.S. Healthcare Delivery
The 3rd largest source of health insurance in the U.S., insuring approximately 19.8% of the U.S. population and providing coverage for low-income adults
What is Medicaid?
Healthcare delivery in the U.S. is largely in private hands, but healthcare is only partially governed by free-market forces
These traits have contributed greatly to the understanding that a singular focus on care delivery is unlikely to improve population health
What are determinants of health?
What is the principle of market justice?
The quality of care achieved (numerator) divided by the cost of care (denominator); i.e. ,patient health outcomes achieved per dollar spent
What is value?
This covers most Americans in private and public health insurance programs through contracts with an MCO, such as HMO or a PPO
What is managed care?
Patients (buyers) and providers (sellers) act independently and patients can choose providers based on price and quality of services
What is a free market?
These encompass the physical, socioeconomic, sociopolitical, and sociocultural dimensions of life
What are environmental factors?
Together, prices and ability to pay limit or ration the quantity and type of services consumed, and these limitations to access are called what
What is demand-side/price rationing?
The 4th installment of the DHH's series of 10-year national objectives to help individuals, organizations, and communities that are committed to improving health and well-being by addressing public health priorities
What is Healthy People 2020?
An individual covered under a managed care plan
What is an enrollee (member)?
They seek to maximize governmetn reimbursement for Medicare and Medicaid services, but the government strives to contain cost increases
Who are providers?
Individual lifestyle factors that include diet, exercise, stress, risky or unhealthy behaviors, and other choices that may contribute to significant health problems
What are behavioral factors?
This principle of justice is based on the idea that responsibility for health is shared
What is social justice?
In contrast to individual health, this plan focuses on improving population health and well-being
What is public health?
This healthcare system focuses on hospital care, mental health services, and long-term care, and is one of the largest and oldest formally organized healthcare systems in the world
What is the VA (Veterans Administration)?
This Act requires screening and evaluation of all patients, provision of necessary stabilizing treatment, and hospital admission when necessary, regardless of ability to pay
What is The Emergency Medical Treatment and Labor Act of 1986?
This is the key determinant of health because genetic factors predispose individuals to certain diseases
What is heredity?
This concept believes that the government must limit the availability of certain services by deciding, for instance, how technology is distributed and who has access to certain high-tech services, even as basic services may be available to all
What is planned/supply-side rationing?d
This policy directly guards the welfare of the nation through product safety regulations, screening food and water sources, enforcing safe work environments, and other ways
What is public policy?d
Non-profit groups that educate the general public about a number of diseases, so that people will be informed about ways to avoid risks and identify early signs of disease before they develop a severe health problem
What is a Patient Advocacy Organization (PAO)?
The ACA (Affordable Care Act) is an example of this, a non-comprehensive, reform that primarily addresses coverage
What is incremental reform?
Well-being and susceptibility to premature death, and access to this is also a key factor influencing health
What is medical care?
This helps define a society's ideals
What is a value system?
Interventions such as integrated electronic medical record systems can improve patient care and prevent safety events while simultaneously reducing waste in the healthcare system
What are healthcare interventions?