The Health Care System of the U. S.

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After reading Chapter 14 and reviewing information at, respond to the following questions:

How does Medicare work?
What are the basic programs offered through Medicare?
How does Medicaid work?
What are the basic services offered through Medicaid?

Make sure you spell check, proofread, and include in-text citations and a reference listing if you use words that are not your own.

Chapter 14: The Health Care System of the United States

Chapter Summary

The focus of this chapter is to trace the health care system in United States. The health care system in the United States has been less than effective. America spends more than other countries, yet has more than 47 million people without health insurance.

The cost of health care has been provided by a variety of sources such as employers, individuals and families, and the government. The greatest brunt of payments has come from third-party payers over time. Medicaid and Medicare have made the federal government the largest payer of health care services.

Health care costs are escalating. There are several factors that have created this rise, such as new medical technologies, people living longer and needing more care for chronic and acute illnesses, medical wastes, and medical entrepreneurialism. Because of concern over rising costs, and in an effort to contain said costs, the country shifted to managed care.

Managed care programs attempt to cut costs while providing cost-effective care by securing lower provider reimbursements, regulating patient care, and rewarding physicians for keeping their patients healthy. There are several types of managed care organizations such as HMOs, PPOs, and a combination of health insurance and health care delivery in a single package.

The United States passed significant health care legislation in 2010. This legislation should bring health insurance to an additional 32 million people over the next several years.

Chapter Outline

I. Introduction
II. Rating the U.S. Health Care System
A. Based on Systematic Analysis
B. Based on Consumer Attitudes
III. The U.S. Health Care System
A. The Foundation of the Health Care System
B. The Development of Private Health Insurance
C. The Development of a Nonprofit Health Insurance Alternative
D. The Entry of Public (Government-Sponsored) Health Insurance
1. Medicare
2. Medicaid
3. Children’s Health Insurance Program (CHIP)
E. Incentives to Overuse Services
1. Provision of Unnecessary Services
F. Cost Containment
G. The Development of Managed Care
1. Managed Care
2. Types of Managed Care Organizations
a) Health maintenance organizations (HMOs)
b) Preferred provider organizations (PPOs)
c) Point-of-service (POS)
IV. The Financing of Health Care in the United States
A. How Much Money Does the United States Spend on Health Care?
a) National health expenditures (NHE)
b) Personal health expenditures (PHE)
B. Who Receives the Dollars Spent on Personal Health?
1. Hospital care
2. Physician services
3. Drugs and other medical nondurables
4. Nursing home care and home health care
5. Dental care
C. Who Spends the Dollars for Personal Health Care?
D. Private Sources
1. Employers
2. Individuals and Families
E. Public Sources (Government)
V. Explanations for the High Cost of American Medicine
A. The Aging of the Population
B. The High Cost of New Medical Technologies
1. Defensive Medicine
2. Physician Self-Referral
C. Medical Entrepreneurialism
1. The Medical-Industrial Complex
2. Corporate Profit
3. High Administrative Costs
4. Exorbitant CEO Salaries and Compensation Packages
5. Medical Fraud
VI. America’s Uninsured Population
A. Who are the Uninsured?
B. The Role of the Employment-Based Health Insurance System
1. Individuals who are unemployed
2. Individuals after retirement but before Medicare
3. Individuals during any transition period from one job to another
4. Individuals working part-time
5. Individuals who work for small businesses
6. Individuals who cannot afford the employee share of employer-provided health insurance
7. Individuals who are in this country illegally
C. The Consequences of Being Uninsured

VII. Historical Efforts to Reform the Health Care System
A. The 1990s and the Clinton Health Initiative
B. Health Care Reform at the State Level
VIII. Health Care Reform of 2010
C. Positions on Health Care Reform
1. Advocates for a Private Market Approach
2. Advocates for an Incremental Social Justice Approach
3. Advocates for a Social Justice Approach
D. The Political Process of Reform
1. Summer, 2009: Opponents of Large-Scale Reform Go on the Attack
2. September and October, 2009: Supporters of Large-Scale Reform Strike Back
3. November, 2009: House Passes Reform Bill, But It Stalls in the Senate
4. December, 2009: Senate Passes Reform Bill
5. January, 2010: The Importance of a Single Vote
6. February, 2010: A Democrat-Republican Summit But No Change
7. March 2010: Congressional Passage of Large-Scale Reform—But Not an End to Partisan Politics
E. Benefits of Health Care Reform
F. Who Will Pay for Health Care Reform?
G. Who Benefits the Most from Reform?
H. What are the Key Criticisms of the Plan?
I. What Was the Successful Strategy in Getting Health Care Reform Legislation Passed?
1. Physicians
2. Hospitals
3. Health insurers
4. Pharmaceutical companies
5. Business groups
J. How Much Did Public Opinion Influence the Process?

IX. Summary

Chapter Objectives

After reading this chapter students should be able to:

1. Trace the milestones of the health care system in the United States.
2. Identify the types of health insurance.
3. Identify managed health care organizations and their roles.
4. Discuss how much money is spent on health care in the United States.
5. Identify the dollars spent and who receives those dollars spent on personal health.
6. Identify the factors that contribute to the high cost of American medicine.
7. Discuss the failures of the public/private, employment-based system in the United States.
8. Discuss the consequences of being uninsured.
9. Compare presidential health initiatives.
10. Trace the political process of the reform of 2010.
11. Identify the basic benefits of the health care reform.
12. Identify who will pay for the health care reform.
13. Identify who benefits from the health care reform.
14. Identify the key criticisms of the health care reform.
15. Identify the stakeholders in the health care reform.

Possible Test Questions

1. Discuss the key criticisms of the health care reform. What are your criticisms?
2. Do you think everyone has “the right to” free health care? Why or why not?
3. Propose a health care policy.
4. What is your biggest concern with health care?
5. Discuss the entry of public (government-sponsored) health insurance.
6. Trace the historical development of health care in the United States.
7. Discuss the factors that contribute to the high cost of American medicine,
8. Discuss the key criticisms of the health care reform of 2010.
9. What role is there for private (commercial) health insurance companies?
10. Why did the government opt to sponsor health insurance?
11. What is Medicare?
12. What is Medicaid?
13. What is the Children’s Health Insurance Program?
14. What is managed care?
15. Name the types of managed care organizations.
16. What contributes to the high cost of medical care?
17. Who suffers from the public/private, employment-based system in the United States?
18. Trace the historical efforts of heath care reform in the United States.
19. What are the benefits of health care reform?
20. Who benefits most from health care reform?
21. What are the criticisms of the plan?
22. What groups helped to get the health care reform legislation passed?


Health Reform Summary:

Health Care Explained:

Key Words and Terms

Children’s Health Insurance Program (CHIP)
Consumer-driven health plans (CDHPs)
Cost containment
Health maintenance organizations (HMOs)
Managed care
Managed care organizations (MCOs)
Managed competition
Medical entrepreneurialism
Medical fraud
Medical-industrial complex
National health expenditures (NHE)
Personal health expenditures (PHE)
Physician self-referral
Point of service (POS)
Preferred provider organizations (PPOs)
Private (commercial) health insurance companies
Private market approach
Social justice approach

Suggested Readings

Foreman, L (2009). Health care reform. Edina, MN: ABDO Publishing Company.

Jacobs, L. (2009). Health care reform and American politics: What everyone needs to
know. Oxford University Press.

Mechanic, D. (2010). Truth about health care: Why reform is not working in
America. Critical issues in health and medicine. New Jersey: Rutgers University.

Saputo, L. (2009). A return to healing: Radical health care reform and the future of
medicine. Origin Press.


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