Lecture 19
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This document outlines the organization of the US medical care system according to Stephen Hansell from Rutgers University. It discusses the challenges of providing affordable, high-quality healthcare to many. The current system is complex with many players like hospitals, government programs, private insurers, and physicians. Care is divided into primary, secondary, and tertiary levels with varying complexity and cost. Overall, the document suggests the US system is inefficient with high costs and unsatisfied citizens despite lower health outcomes compared to other countries.
Lecture 19
- 1. Stephen Hansell, Ph.D. Department of Sociology Institute for Health Research www.rci.rutgers.edu/~shansell shansell@rci.rutgers.edu 732-445-4740
- 2. A 55-75 B 47-54 C 37-46 D 34-36 A F 29-33
- 3. Class 19 – Organization of
- 4. I. The Challenge A. To provide the best possible health care, to the most people, at the lowest cost B. US medical care fails to do this • most of the changes of obama care implement on 2012- 2014 • its not gonna change much • survey says almost everyone in the country supports universal health care 1. Universal right to care conflicts with self- responsibility for own care
- 5. Most of the World • Enabling Factors: Outcomes: Defense Wealth Education Health • only an educated population can be econimically productive (US) • and to be economically you need to be healthy (EVERY OTHER COUNTRY) • EVERY other country have a government supported health system that provides either directly or indirectly to the health system US • Enabling Factors: Outcomes: Defense Wealth Education Health America has been the recently (until recently) for our high quality of the public education system which makes us the super power but some other countries are catching up and hence catching up on the economic system health is seen as an outcome (you deserve to good health if you work hard) rather than health as an enabaler (you will work better if you are healthy)
- 6. 1990 Data Country Satisfaction % GDP % Male Lifespan Female Lifespan Canada 56 9.4 74.4 81.0 France 41 8.9 73.5 82.0 West Germany 41 8.3 72.7 79.2 Sweden 32 8.6 74.9 80.6 Japan 29 6.6 76.4 82.8 England 27 6.2 73.5 79.0 Italy 12 8.1 73.7 78.5 US 10 12.6 72.0 78.9 US spent $371.1 billion on health care in 1996 – was it spent wisely? no relation to the choosing of the countries just what he likes no one likes anything in italy MESSAGE: we lives shorter lives, we are not happy with our healthcare system and we spend the most amount of money
- 7. II. Current US medical care system – tediously complex A. Basic elements of organization • get sick in france - they take care of you • dont get sick in england - bad food B. Major players 1. Hospitals • hospitals are loosing patients cz of the bed is not filled they loose money • growing trend - shrinking their inpatient services and starting their outpatient trends 2. US government (Medicare and Medicaid) – medicare - older people – medicaid poor people – busting the state budgets fastest growing state budgets, right next to defence so they have a gradual cut back in services – the elderly are better served than the poor people – they used to be safety nets designed for just a few people but thats not just a few anymore . most people should get insurance through employers but it is so expensive that the employers dont wanna do it anymore
- 8. 3. Private insurance companies – all other countries there are non profit healthcare systems; we are profit companies 4. Physicians – work hard and have a good life and have a monopoly in life – but lately the monopoly is challenges cz of the insurance companies (they cannot fight the insurance) take longer to fill out forms than treat patients 5. Patients – when we buy healthcare - we dont have any information about what it will cover etc and we dont understand medical jargon. so we are unable to get the correct health care – it has become so expensive that the middle class people cannot pay anymore
- 9. C. Economics of medical care D. Advantages and disadvantages of managed care • managed care = insurance companies managing the care you get • sometimes you need pre approval that the insurance companies will deny - this is how they manage their costs E. Possibility of universal health insurance? 1. Clinton plan 2. he was populat in the forst year than the was not
- 10. III. Primary care – they barely listen to you but decide if you need secondary care or not – doc listens to you for 1.8 mins – least complex medical care – they provide care that sometimes they should not be providing – sometimes perform minor surgeries A. Ordinary outpatient care • outside the hospital like private clinic B. Office or clinic based practitioners C. Initial patient contact with medical care system
- 11. D. Least complex medical care E. Refer patients to more specialized care F. Confusion among primary providers about what services to provide G. Family practice specialty as a solution? • they need a specialty care exam in family practice H.
- 12. IV. Secondary care – middle level A. Specialized, more expensive services more complicated • cardiology, neurology B. Office-based specialty services that may require routine hospitalization • they do have hospital privileges so they do complex procedures there • they have those cz hospitals have • better equipment • medical team • nursing • rehabilitation services • most imp = routine monitoring of the patient C. Current trend: more secondary services done outside of hospital • it is more popular for simpler surgical procedures cz they are cheaper • they have most of the same services
- 13. V. Tertiary care A. Super specialized, most complex, most expensive B. Found in teaching hospitals, regional trauma centers, hospitals famous for specific care C. Highly trained teams of physicians, nurses, other health professionals
- 14. D. Organizing tertiary care efficiently is difficult E. Tertiary services consume enormous resources with little proven benefit to health of population
- 15. Stephen Hansell, Ph.D. Department of Sociology Institute for Health Research www.rci.rutgers.edu/~shansell shansell@rci.rutgers.edu 732-445-4740