Chapter 1: Basic Components of a Health Services Delivery System

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Chapter 1: Basic Components of a Health Services Delivery System by Mind Map: Chapter 1: Basic Components of a Health Services Delivery System

1. Quad-function model

1.1. Financing

1.2. Insurance

1.2.1. Uninsured Employer based financing system Employers pay for insurance in most states, employers are not mandated to offer health insurance to their employees in some workplaces, participation in insurance is voluntary premium cost sharing

1.2.2. Children's Heath Insurance Program (CHIP)

1.3. Delivery

1.3.1. No central agency Government sets expenditures and reimbursement rates Government sets standards of participation

1.4. Payment

1.4.1. insurer determines how much is paid for a certians service

1.4.2. government insurance plans are paid by tax revenues

2. Managed Care

2.1. Seeks to integrate all function of quad-function system

2.2. employees mechanisms to manage utilization of medical services

2.3. set prices for services and how much providers get paid

3. Imperfect Market

3.1. with the majority of individuals in government sponsored insurance programs, power shifts from the patient to the administrators of the plans

3.2. healthcare plans, not the patients, are the real buyers in the healthcare services market

3.3. prices determined by the payer (insurance)

3.4. In order for the health market to be free, there must be unrestrained competition among providers based on price and quality

3.5. Restricted information

3.5.1. phantom providers

3.5.2. package pricing

3.5.3. capitation


4.1. Health insurance is purchased to be used, vice home insurance is purchased for unlikely events that probably won't happen

5. Other Countries

5.1. National Health Insurance (NHI)

5.1.1. financed by government, delivered by private providers

5.2. National Health System (NHS)

5.2.1. delivery managed by government

5.3. Socialized Health Insurance (SHI)

5.3.1. government-mandated contributions by employers and employees fiance healthcare; private providers deliver care