US HEALTH CARE

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US HEALTH CARE by Mind Map: US HEALTH CARE

1. FUNDING

1.1. Government

1.1.1. Owners with total control

1.1.2. Low cost per capita

1.2. Employers

1.2.1. Financed via payroll

1.3. Employees

1.3.1. Annual premium

1.3.1.1. based on family size

1.3.1.2. type of insurance

1.4. Private- sector providers

1.5. Insurance pools

1.5.1. paid annually

1.5.2. Predicted expenses

1.5.2.1. admin cost added

2. ELIGIBLITIY AND ACCESS

2.1. Those who can afford it

2.1.1. Get help or stay sick and die

2.2. Sick enough to be seen

2.3. Access not guaranteed

2.3.1. see a specific doctor and when

2.4. Limited care

2.4.1. where you live

2.4.2. Type of insurance

3. PURPOSE

3.1. Let the healthy stay healthy and poor die

3.2. Initially protect against potentially catastrophic expense, in particular, the cost of hospitalization or other care that was not routine

3.3. unexpected and potentially catastrophic healthcare needs but predictable healthcare needs

4. TYPES OF COVERAGE

4.1. Commercial (private) health

4.1.1. Employer-sponsored

4.2. Medicare program

4.2.1. Federally sponsored

4.2.2. elderly (Americans 65 and older

4.2.3. disabled

4.2.4. d those with end-stage renal disease (ESRD)

4.3. Medicaid

4.3.1. administered by the states but funded by both the state and federal government

4.3.2. economically disadvantaged

4.3.3. certain categories of women (especially pregnant women)

4.3.4. children (through Medicaid or through a similar program called the State Children’s Health Insurance Program [SCHIP], or now simply the Children’s Health Insurance Program [CHIP]

4.4. No coverage

4.4.1. pay a penalty that the Supreme Court of the United States has recently declared “a tax”)

5. Cost

5.1. Limited service given

5.1.1. shortage of physicians

5.1.2. Shortage in primary care

5.2. Lower prices

5.3. Patients wait to be seen

6. Quality

6.1. poor care for patients

6.1.1. Adverse events

6.1.2. Injuries

6.2. Lower life expentacy

6.3. Higher infant mortality

7. Public Health system

7.1. Federal

7.2. State

7.2.1. primary governmental entity responsible for protecting

7.2.2. active role

7.2.3. directed by a health commissioner or secretary of health

7.2.4. report responsibility are bioterrorism, vaccines for children, injury control epidemiology, injury control and prevention, and breast and cervical cancer screening

7.3. Local

7.3.1. directly deliver public health services

7.3.2. Providing health education, offering screening and immunizations, and collecting health statistics.

8. Stakeholders

8.1. buyers, workers, suppliers, regulators, and owners who cooperate through economic exchanges.

8.1.1. a direct interest in an organization's success

8.2. Customer Partners

8.2.1. Patients and their Family

8.2.1.1. They expect, and deserve, care that meets the goals

8.2.1.1.1. safe, effective, patient-centered, timely, efficient, and equitable

8.2.1.2. expect reasonably comfortable amenities and confidentiality

8.2.1.3. Trust that doctors have more knowledge about the patient's needs than the patient does

8.2.1.4. Trust that doctors have more knowledge about the patient's needs than the patient does

8.2.2. Health Insurers and Payment Agencies

8.2.2.1. provide most of the revenue

8.2.2.2. agents for buyers, which include governments, employers, and citizens at large

8.2.2.3. Medicare and Medicaid

8.2.2.3.1. federal Medicare program deals with HCOs through its intermediaries

8.2.2.3.2. Medicaid, a combination state and federal program that finances care for the poor, is run by the state

8.2.2.4. Representing the buyers, payment organizations use contractual requirements, regulatory support, and incentive payments to improve the quality, safety, and cost of care

8.3. Employers

8.4. Regulatory Agencies

8.4.1. Government regulatory agencies

8.4.1.1. nominally act on behalf of the patient and buyer

8.4.2. Quality improvement organizations

8.4.2.1. external agencies that review the quality of care and use of insurance benefits by individual physicians and patients for Medicare and other insurers

8.4.3. Courts

8.4.3.1. HCOs may be sued for malpractice or negligence—harmful conduct that is unintentional but avoidable with reasonable care.

8.5. Provider Partners

8.5.1. Associates who give their time and energy to the organization

8.5.1.1. employees, trustees and other volunteers, and medical staff members.

8.5.2. Associate Organizations

8.5.2.1. individuals choose it because a group can meet some needs that would otherwise go unmet. The success of the group depends on the exchanges that commit the individuals to the group.

8.5.3. Suppliers and Financing Agencies

8.5.3.1. HCOs use goods and services purchased from outside suppliers

8.5.3.2. Financing partners help HCOs acquire capital through a variety of equity, loan, and lease arrangements

8.5.4. Other Providers

8.5.4.1. organizations and agencies whose service lines may be either competing or complementary, such as primary care clinics, mental health and substance abuse services, home care agencies, hospices, and long-term-care facilities.

8.5.4.1.1. referral agreements, strategic partnerships, joint ventures, and acquisition and ownership.

8.6. Sources of Influence

8.6.1. the marketplace to participate in the exchange

8.6.2. efforts are proactive and extensive.

8.6.2.1. identify stakeholder needs and design effective responses before unmet needs become points of contention.

8.6.2.2. successful negotiation

8.6.3. Social Control

8.6.3.1. reflect good intentions—safety, quality, individual rights, equity, and efficiency.