Answer the following questons

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Question Description

1.Compare and contrast England’s NHS, Canada’s NHI and U.S. Health System models.Who or what is responsible for providing health services (public and/or private) in each system?How is each system financed?How are providers paid for their services in each kind of system?How relatively effective is each system in prolonging the length and quality of life for people living in each country?

2.Why does the “vulnerable population” in the U.S. continue to grow?What characteristics do personsbelonging to this category of need have in common? Pick three separate groups, highlighting their particular set of problems.Name and explain three kinds of government solutions which have been established to help vulnerable populations in the U.S.. How is care for vulnerable populations paid for at federal and state levels?

3.Recent data show that Americans consume, on average, more than three times the recommended level of sodium per day in their food and beverages.High salt intake contributes to high blood pressure and its complications—stroke, heart attack, congestive heart failure, and kidney failure. In fact, thousands of lives could be saved if sodium consumption could be lowered in people with hypertension (high blood pressure). Compare and contrast (highlight similarities and differences) between how a health care provider like a Kishwaukee hospital doctor (part of Northwestern Medicine) might address this problem in their patient population using the medical model versus how a public health official would address this same problem using the population health model (three comparison-contrast examples required).

4. Although the United States spends more money per capita on health care than any other country, its performance is relatively poor by comparison. How can ideas such as the “Triple Aim Initiative” or “patient centeredness” help to improve performance in the U.S. health care system?


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Chapter 2: A Visual Overview of Health Care Delivery in the United States Catherine K. Dangremond Consumer Perceptions of the U.S. Health Care System Likes Dislikes • Choice of plans & coverage • Cost of care and insurance coverage • Access to latest medical technologies & pharmaceuticals • Perceived high quality clinical care • Access to doctors and medical professionals • Poor care coordination • Administrative hassles related to billing and insurance • Poor communication between patients and providers © 2015 Springer Publishing Company, LLC. 2 The Role of the U.S. Federal Government in Health Care • Develop national health policies • Provide health insurance for poor, disabled, & elderly • Provide care for certain groups (e.g., veterans) • Formulate tax policies favorable to employer health insurance • Fund physician training © 2015 Springer Publishing Company, LLC. 3 The Role of State Governments in Health Care • Fund Medicaid programs • Administer Medicaid programs • License health care providers • Provide care (operate facilities for mentally ill) © 2015 Springer Publishing Company, LLC. 4 The Role of Local Governments in Health Care • Own & manage public hospitals • Operate public hospitals • Develop & enforce public health codes © 2015 Springer Publishing Company, LLC. 5 Health Policy Milestones in the U.S. • 1965: Creation of Medicare & Medicaid • 1986: COBRA enacted • 1996: HIPAA enacted • 1997: SCHIP enacted • 2003: Medicare expanded (prescription drugs) • 2010: Affordable Care Act enacted © 2015 Springer Publishing Company, LLC. 6 © 2015 Springer Publishing Company, LLC. 7 © 2015 Springer Publishing Company, LLC. 8 © 2015 Springer Publishing Company, LLC. 9 © 2015 Springer Publishing Company, LLC. 10 © 2015 Springer Publishing Company, LLC. 11 © 2015 Springer Publishing Company, LLC. 12 The Diverse U.S. Health Care Workforce Inpatient Care Ambulatory Care Long-Term Care Delivery Hospitals Doctors’ offices Hospitals Clinics Nursing homes Home health care Assisted living Focus of Services Acute care Preventive care Acute care Chronic care Chronic care Registered nurses (38%) Nursing aides (14%) Technicians (13%) Physicians and surgeons (7%) Licensed practical nurses (6%) Health care services managers (5%) Therapists (5%) Physicians (17%) Other practitioners (12%) Technicians (12%) Registered nurses, nurse practitioners (11%) Medical assistants (11%) Therapists (5%) Health care services managers (4%) Nursing and personal care aides (60%) Registered nurses (15%) Licensed practical nurses (11%) Health care services managers (3%) Social workers (3%) Therapists (2%) Technicians (1%) Workforce © 2015 Springer Publishing Company, LLC. 13 © 2015 Springer Publishing Company, LLC. 14 U.S. Health Care Quality, Cost, and Value • Quality – Advanced in science, technology, & facilities – Poor system design & lack of coordination – Agency for Healthcare Research and Quality • Cost and Value – Patients focus on copay, not total cost & value – Costs vary by hospital, region – Cost information can be difficult to obtain – Value is difficult to determine © 2015 Springer Publishing Company, LLC. 15 Chapter 3: Government and Health Insurance: The Policy Process Michael S. Sparer and Frank J. Thompson Learning Objectives • Review the evolution of government’s role in the U.S. health insurance system • Describe the roles of public and private stakeholders in the health policy process • Explore key issues on the government’s health policy agenda, including the enactment and implementation of the Patient Protection and Affordable Care Act of 2010 © 2015 Springer Publishing Company, LLC. 2 The Government as Payer: The Health Insurance Safety Net • 1800s – Social welfare a local responsibility – Almshouses & public hospitals treated the poor – Allopathic physicians became dominant – U.S. hospital industry & costs grew rapidly • 1920s – Blue Cross created to fund care for middle class – Private insurance industry emerged © 2015 Springer Publishing Company, LLC. 3 The Government as Payer: The Health Insurance Safety Net (cont’d) • 1940s & 1950s – Employer-sponsored health insurance grew – Major federal investment in research & hospitals – President Truman called for universal coverage – “Welfare medicine” bill passed • 1965 – Medicare & Medicaid passed under Johnson © 2015 Springer Publishing Company, LLC. 4 Medicaid • Collection of 50 state-administered programs • Health insurance for low-income residents • Covered 60 million Americans in 2012 • Enrollment & costs skyrocketed in 1990s • Cost containment measures enacted in 2000s • Expansion of program mandated in ACA • Supreme court converted mandate to option © 2015 Springer Publishing Company, LLC. 5 Medicare • Social insurance for the aged & disabled • In 2013, covered: – 43.5 million people over 65 years – 9 million young people with disabilities • Administered by federal officials • Funded by federal government • Limited benefits package © 2015 Springer Publishing Company, LLC. 6 Medicare (cont’d) • Part A (1965): inpatient hospital care • Part B (1965): outpatient care • Part C (1997): managed care program • Part D (2003): prescription drug coverage © 2015 Springer Publishing Company, LLC. 7 Helping Those Who Remain Uninsured • Early 2000s: 46 million Americans uninsured • Decline in coverage by employer-sponsored insurance • Employer mandate strategy failed • Focus on coverage for children (SCHIP in 1997) • SCHIP reauthorized & expanded in 2009 • Number of uninsured continued to rise • Health care reform debated in 2008 campaign © 2015 Springer Publishing Company, LLC. 8 The Enactment and Implementation of the ACA • Goals of ACA – Reduce number of uninsured – Pay for coverage without increasing deficit – Slow rising cost of health care – Encourage more efficient delivery system • Strong opposition to ACA by Republicans • ACA enacted in March of 2010 © 2015 Springer Publishing Company, LLC. 9 Key Components of the ACA • Individual mandate • Expansion of Medicaid • Creation of state insurance exchanges • Employer mandate • Elimination of discrimination based on preexisting conditions © 2015 Springer Publishing Company, LLC. 10 Key Characteristics of Policy Processes 1. Each health program has distinct subsystems 2. Fragmentation of government institutions makes enactment of health policy difficult 3. Implementation of policy is critical 4. Establishment of programs reconfigures policy subsystems & political factors, affecting durability © 2015 Springer Publishing Company, LLC. 11 The Dynamics of Program Expansion: Medicaid • 1965-1980: Welfare medicine & incremental politics of long-term care • 1981-1992: Triumph of congressional entrepreneurship • 1993-2008: Rise of executive federalism • 2009-2015: Health reform & contentious federalism © 2015 Springer Publishing Company, LLC. 12 Medicaid Rising: Overview and Future Challenges • Factors leading to support/growth of Medicaid – Open-ended funding formula – Formation of intergovernmental lobbies – Defense by providers dependent on program – Improved image as for working & middle classes – Skilled policy entrepreneurship by Democrats – Rise of waivers & executive federalism © 2015 Springer Publishing Company, LLC. 13 Medicaid Rising: Overview and Future Challenges (cont’d) • Factors that could lead to reduction of Medicaid – Public mood – Election results – Ideological changes in Congress – Changes in administration – Republican efforts to decrease spending © 2015 Springer Publishing Company, LLC. 14 Chapter 4: Comparative Health Systems Michael K. Gusmano and Victor G. Rodwin Learning Objectives • Understand the difference between NHI and NHS systems • Highlight key features and issues in the health systems of Britain, France, Canada, and China • View the U.S. health system from an international perspective © 2015 Springer Publishing Company, LLC. 2 Looking Abroad to Promote Self-Examination at Home • Comparison to OECD nations & China • NHS countries: United Kingdom • NHI countries: Canada & France • BRIC nations: Brazil, Russia, India, & China © 2015 Springer Publishing Company, LLC. 3 Health System Models • NHS systems – Based on UK model devised by Lord Beveridge – Found in UK, Sweden, Norway, Finland, Denmark, Portugal, Spain, Italy, & Greece – Public & government managed – Most financing from general revenue taxes – Some private funding (especially in Italy & Spain) © 2015 Springer Publishing Company, LLC. 4 Health System Models (cont’d) • NHI systems – Based on model devised by Bismarck – Found in Germany, Canada, & France – Most financing from payroll taxes – Significant variations in financing & organization • Private & market-based systems – U.S & Switzerland © 2015 Springer Publishing Company, LLC. 5 Methods of Providing Health Services • Public – National (VHA) – State (mental hospitals) – Local (municipal hospitals) • Private not-for-profit • Private for-profit © 2015 Springer Publishing Company, LLC. 6 Methods of Financing • General revenue through fiscal tax system • Compulsory payroll tax (Social Security) • Voluntary premiums to private insurers • Individual out-of-pocket payments • Direct employer contributions • Philanthropic funds © 2015 Springer Publishing Company, LLC. 7 Characteristics of the U.S. Health System • Based on actuarial principles – Private insurance premiums based on estimated risks • Not an NHS or NHI system • Patchwork of public & private insurance – Social insurance for older adults (Medicare) – Social welfare for low-income people (Medicaid) – Subsidized employer-based private insurance – Elements of socialized medicine (VHA) © 2015 Springer Publishing Company, LLC. 8 Health Systems in England, Canada, France, and China • Movement away from family, philanthropy, religious institutions, employers, & local governments • Increased role of national government • 1950s & 1960s: growth years of health sector • 1970s: rationalization & cost containment • China (exception): increased privatization © 2015 Springer Publishing Company, LLC. 9 Provider Payment • England: 75% capitation, 20% FFS • Canada: FFS + blended capitation schemes • France: negotiated fee schedule + extra billing • China – FFS (half) – Pay-for-performance (local governments) – Expansion of private health insurance – Kickbacks (medical device & pharma companies) © 2015 Springer Publishing Company, LLC. 10 Coordination of Care • France: 3.3 doctors/1,000 population • England: >1 million workers, >2,500 hospitals • Canada – Specialists paid FFS, work in community & hospitals – Hospitals: private, non-profit, publicly financed • China – Lack of doctors in rural areas – Reduced subsidies to state-owned hospitals © 2015 Springer Publishing Company, LLC. 11 Workforce and Information Technology • Primary care vs. specialty care balance – U.S.: only 30% of physicians are in primary care – Most OECD systems: at least 50% in primary care • Workforce shortages/surpluses – U.S., France, & China: shortage of clinicians – UK: surplus • Push for electronic medical records & IT – May or may not improve quality & cut costs © 2015 Springer Publishing Company, LLC. 12 Health System Performance • Access to services across income groups • Cost • Quality © 2015 Springer Publishing Company, LLC. 13 Health Care Expenditure as a Share of GDP: Selected Countries, 2011 Health Expenditure as a Share of GDP, 2011 United States 17.7% France 11.6% Canada 11.2% United Kingdom 9.4% OECD Average 9.3% China 5.2% © 2015 Springer Publishing Company, LLC. 14 Lessons • Universal coverage requires: – Legal compulsion to obtain coverage – Increasing government subsidies (ability-to-pay) – Economic evaluation of health technology – Price regulation & systemwide budget targets © 2015 Springer Publishing Company, LLC. 15 Chapter 5: Population Health Pamela Russo Learning Objectives • Understand the differences between the medical and population health models of health services delivery • Explain how the two models lead to different strategies for interventions to prevent disease and improve health • Learn about the differential importance of various health determinants © 2015 Springer Publishing Company, LLC. 2 Learning Objectives (cont’d) • Review the evidence regarding social and physical environmental influences on behavior and on health outcomes • Variation in health and life expectancy between counties and between countries • Describe innovative synergistic approaches that integrate the clinical and population models © 2015 Springer Publishing Company, LLC. 3 The Population Health Model • Studies the causes of health discrepancies • Analyzes health patterns among groups • Identifies factors leading to poor outcomes • Employs integrative model (multiple factors) • Views health as result of many determinants • Considers outcomes that affect determinants (reverse causality) © 2015 Springer Publishing Company, LLC. 4 The Population Health Model (cont’d) • Domains of health determinants – Social & economic environment – Physical environment – Genetics – Medical care – Health-related behaviors © 2015 Springer Publishing Company, LLC. 5 The Medical Model • Focuses on individuals • Explores pathophysiology • Searches for cellular mechanisms of disease • Attempts to find a cure • Views risk factors in disease-specific pathways • Considers how biological systems interact • Tends to be “reactive” to disease © 2015 Springer Publishing Company, LLC. 6 © 2015 Springer Publishing Company, LLC. 7 Comparing The Medical and Population Health Models: Obesity Medical Population Health • Family history • Focus on obesity epidemic • Diet & activity history • Race, income as risk factors • Lab tests to rule out: • Reasons for noncompliance – Hormonal causes – Other physiological causes – Diabetes • Multiple factors • Zoning law changes • Referral to nutritionist • Menu labeling • Diet & exercise prescription • Challenging food industry • Bariatric surgery • Education © 2015 Springer Publishing Company, LLC. 8 Causes of Obesity Epidemic Identified by the Population Health Model • Prevalence of fast food in low-income areas • Presence of vending machines in schools • Subsidized school lunches high in calories, fat • Decrease in physical education & recess • Less walking or bicycling to school • No safe places to play or walk near home • Lack of grocery stores with healthy options © 2015 Springer Publishing Company, LLC. 9 Comparing The Medical and Population Health Models: Tobacco Medical Population Health • Focus on individuals who smoke or chew • Explores influence of: • Behavioral change • Cessation counseling • Nicotine replacement – Tobacco production – Advertising – Distribution – Patterns of use by groups • Interventions – Smoke-free laws – Tobacco taxes – Regulation of advertising – Targeting specific groups © 2015 Springer Publishing Company, LLC. 10 The Influence of Social Determinants on Health Behavior and Outcomes • Socioeconomic status & morbidity/mortality – Education – Income – Occupational status or grade (Whitehall study) – Class – Race/ethnicity © 2015 Springer Publishing Company, LLC. 11 © 2015 Springer Publishing Company, LLC. 12 © 2015 Springer Publishing Company, LLC. 13 Health Policies and Returns on Investment • U.S. expenditures on health care: – Two thirds spent treating preventable diseases – 5% spent on prevention of these diseases – 95% spent on direct medical care • Education vs. medical services • Community-based prevention programs • Health impact assessments • Community benefits from nonprofit hospitals © 2015 Springer Publishing Company, LLC. 14 Evidence of Growing Importance of Population Health Science in U.S. • Large number of peer-reviewed articles • NIH & CDC funding of related research • Numerous IOM review committees & reports • IOM roundtable on pop. health improvement • Interdisciplinary pop. health centers • MacArthur Research Network • National commissions (Robert Wood Johnson) • County Health Rankings © 2015 Springer Publishing Company, LLC. 15 Chapter 6: Public Health: A Transformation for the 21st Century Laura C. Leviton, Paul L. Kuehnert, and Kathryn E. Wehr 1 Learning Objectives • Contrast defining characteristics of prevention-oriented public health & treatment-oriented health care • Describe state, federal, & local authority for public health law, regulation, & services • Identify how challenges & opportunities are transforming public health © 2015 Springer Publishing Company, LLC. 2 Who’s in Charge of Public Health • Public health – “What society does collectively to assure the conditions for people to be healthy” (IOM) – Science, practice, & art of protecting & improving health of populations – Historically focussed on sanitation & environment – Later on communicable diseases, health behavior – Late 20th cen., last-resort provider of indigent care – With ACA, new focus on prevention © 2015 Springer Publishing Company, LLC. 3 Public Health in Every Day Life • Recommendations on healthy sleep • Safe, fluoridated water supply • Preventive dental care • Sewer and waste disposal services • Nutrition labels • Regulations on food processing & safety • Flu shots & other vaccinations © 2015 Springer Publishing Company, LLC. 4 Public Health in Every Day Life (cont’d) • Hand-washing guidelines • Travel precautions • Educational programs on STIs & condom use • Smoking cessation programs • Community exercise programs • Safety belt regulations • Occupational safety regulations © 2015 Springer Publishing Company, LLC. 5 © 2015 Springer Publishing Company, LLC. 6 Divided Responsibilities and Issue-Specific Organizations • Factors leading to complexity of public health – Decentralization of government (states’ authority) – Problem-specific focus of laws & organizations – Heavy reliance on nongovernmental organizations – Vague goals & debate over how to achieve them © 2015 Springer Publishing Company, LLC. 7 A Healthy Population Is in the Public Interest • Public health focuses on: – Entire populations, not individuals – Incidence, prevalence, & distribution of health problems – Action at community or collective level © 2015 Springer Publishing Company, LLC. 8 The Public Interest Justification • Historical effectiveness of collective action • Utility (greatest good for greatest number) • Human rights & social justice • Inadequacy of private & nonprofit orgs • Concerns of opponents of public health focus: – Loss of individual liberty – Abuse of power – Improper role of government © 2015 Springer Publishing Company, LLC. 9 A Collective Focus on Disease Prevention and Health Promotion Type of Public Health Endeavor Description Health promotion Improving health by addressing behavior & lifestyle Prevention: Level Primary Helping people avoid onset of a health condition or injury Secondary Identifying & treating people with risk factors or preclinical disease Tertiary Treating people with an established disease to restore function, mi ...
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Fleming51
School: Duke University

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Running head. HEALTH DELIVERY SYSTEMS

Health delivery systems
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HEALTH DELIVERY SYSTEMS

Question one
Different countries use various models of health care each with its own merits and
demerits. In England, the Beveridge Model of health care is used. In this type of health care
service, the government finances the health care. Moreover, the government is also the
provider of health (Cichon, 2012).
The government is able to raise funds for health financing through payment of taxes
just like other sectors such as public library and police force. Many, but not all, hospitals and
clinics in England are owned by the government. The private doctors collect their fees from
the government. There are no direct doctor’s charges to the patient. The Beveridge system
therefore has low costs per capita since the government is the sole payer and it decides what
the doctors can charge or do.
As opposed to England, Canada combines both Bismarck and Beveridge models, the
national health insurance model. The health providers are the private sectors who are paid by
the government. The government operates an insurance program that every individual in
Canada is subscribed to. The universal insurance in this case is cheaper as there is no
marketing or financial motive to deny claims. The merit of this model is that the government,
being the single payer has negotiated for lower prices for most of the health services (Cichon,
2012).
In the United States, the private insurance model is used. Here, the citizens are covered by
either by their employers or by a private policy, or in the worst case scenario,...

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