Welcome to the series on the U.S. Healthcare. The following notes will be adapted from the coursera.com course titled "Understanding and Improving the U.S. Healthcare System" taught by Dr. Matthew Davis of the University of Michigan.
There are some important players in the game of healthcare.
- users of the healthcare system
- includes sick and well
- infant mortality, a general measure for a country's healthcare success, in the US has been steadily decreasing. However, there is a disparity between whites and blacks
- life expectancy is also another general measure for a country's healthcare success. In the US, life expectancy is rising but there are still problematic disparities, such as Hispanics having the highest life expectancy
- this includes physicians, nurses, etc.
- overall, our proportions of providers per capita is less than and more than some other countries
- geographic distributions per unit of population shows that there are some areas in the US that have low provider coverage
- not all providers accept all kinds of healthcare insurances
- includes insurance companies (e.g. Genesage - life insurance platform), government programs, etc
- insurance terms
- premium: the price of an insurance plan
- paying for something in advance before it happens, but hoping that you'll pay less than what it will really cost
- deductible: it is deducted from what the insurance company has to pay. The amount of money you have to pay before the insurance kicks in.
- copay/coinsurance: flat amounts for each event or encounter
- coverage: the extent to which a person has health protection
- the goal is to create a system that the payers, providers, and everyone else in the system wins
- between the 40s and 60s, the US saw a lot more payers of private healthcare, but specific vulnerable groups had low participation (e.g., elderly) and were thus served by government programs
- one major goal of the US Healthcare system is to increase coverage. About 1 in 6 americans do not have coverage.
- in the late 1800s in Europe, workers who became sick on the job had a deduction in their wages. Labor unions at the time put together benefit packages to support the workers through compensation. These illness plans gained popularity and Prussia took notice and this became a government institution
- today, we have a mix of private payers and public (government; medicare, medicaid) payers
- a major way that the landscape of diseases has been altered
- public health has been the source of many innovations (e.g., vaccinations, clean water supply, tracking swine flu)
- often works from prevention, meaning that many people in the US may not recognize its value or operation
Interactions between these groups
- patients and providers
- consider cardiovascular disease; this has been the #1 killer in the US each year despite rates declining steadily as a result of patients and providers interacting to ensure maximal care distribution (e.g., proper care in the first few minutes of their symptoms). In order to deliver high quality care, some providers have implemented the use of different technologies such as the ones at https://www.foreseemed.com/medicare-risk-adjustment
- nonetheless, provider assimilation of the latest medical research has been slow and some patients actually receive more care than needed. Note that each type of care carries risk, so superfluous care is unwarranted and expensive.
- payers and public health
- consider water cleanliness; fluoride in water decreases cavities and improves the situation for other players in the system
- however, some communities are not fluorinating water, causing ripple effects to all four players in the healthcare system
- common to receive vaccines in clinics
- costs are covered by private and public sources
- providers are responsible for following rapidly-changing guidelines for vaccination and for encouraging the use of vaccines and disputing scientifically disproven rumors
- with success from all healthcare players, vaccines can have an extremely positive effect
- Affordable Care Act (ACA) (a.k.a. Obamacare)
- signed into law in March 2010
- emphasis on expanding coverage for patients (i.e., more affordable plans, expanded medicaid programs)
- several provisions on public health, which makes it stand out from other reforms in the past 50 years, such as training workers to care for disadvantaged patients and emphasizing treatment
- ultimately, the success of ACA will depend in large part on these four main players and their interaction