PCM1: Overview of the U.S. Health Care System

=Overview of the U.S. Health Care System=

Describe social and economic forces at play in the US health care system.

 * Social forces:
 * Aging baby boomers need more health care
 * Aging baby boomer health professionals retire, straining workforce
 * Not everyone is guaranteed health care
 * Continued specialization
 * Fragmented, poorly coordinated care
 * Patients with more complicated chronic diseases
 * Most health insurance through employers
 * Economic forces:
 * Higher pay to physicians in specialties vs. primary care
 * Private insurers pay doctors better than Medicare or Medicaid for the same service, creating a financial disincentive to see Medicare/Medicaid patients
 * High cost of prescription drugs
 * Higher out-of-pocket costs for the insured
 * Social security system going broke
 * Highest health care spending per capita in the developed world
 * Financially unrealistic for many small businesses to provide health insurance for workers
 * Employers shifting more health insurance costs to employees
 * Rising costs to provide complicated, specialized care
 * Malpractice insurance premiums increase
 * Complicated system of multiple for-profit third party payers

Describe the role of the government in health care financing.

 * Medicare, Medicaid, SCHIPs, etc.
 * Federal government pays for health care for seniors, disabled Americans, unemployed adults, many poor children and many poor adults.
 * Indian Health Service, Veteran’s Affairs and Military health care
 * Tax incentives to employers to provide health insurance for workers
 * Limited tax benefits to individual taxpayers to help pay health care costs with pre-tax dollars, lowering federal income tax owed (FSAs, HSAs, etc.)

Compare the US health care system to other countries.

 * U.S. = most expensive health care system in the world (per capita and % of GDP) as of 1998
 * U.S. = only developed country, besides South Africa, that does not provide universal health care access (as of 1996)
 * U.S. ranks low among developed or industrialized countries for infant mortality rates, disability-adjusted life expectancy (DALE), fairness in health care financing and satisfaction of citizens with the health care system
 * Like many other developed nations, U.S. health care system struggles with transitional care, care coordination, medical errors, medication errors, safety, efficiency, chronic care management, patient-centered care and timely access to physicians