Sultz & Young

Health Care USA, 8th Edition

Chapter 1 Lecture Outline

Chapter 1 Overview of Health Care: A Population Perspective

Learning Objectives

•Introduce major characteristics of the U.S. healthcare delivery system.

•Provide a broad overview of the U.S. healthcare industry—values, policymakers, priorities, and stakeholders—from a population perspective.

•Review changing trends, issues, challenges, and opportunities in the healthcare industry.

Major Themes

  1. The impressive accomplishments of the U.S.healthcare system have been offset by the persistent problems of unacceptable increases in costs, inexplicable variations in performance, and limited access for a significant number of Americans.
  2. The commercialization of the healthcare industry has replaced the historically charitable and social orientation of its institutions and providers with attitudes that are aggressively entrepreneurial and fiercely competitive.
  3. The historical failure of effective governmental reforms prompted the private sector to move with surprising speed to promote market-oriented changes, competition, and managed care.
  4. The privileged relationship between patient and physician that once was sacred in health care is now subject to scrutiny by insurers, payers, managers, and quality overseers.
  5. Patients entering the complex modern healthcare system are strongly advised to proactively participate in decisions about their health care.
  6. The paradigms for the natural history of disease and levels of prevention illustrate how healthcare interventions can prevent a disease or interrupt diseaseprogression at key points in its development.The paradigms also reflect the focus of American health care on curative rather than preventive medicine.
  7. The values, roles, and degrees of influence of major stakeholders in the healthcare system have had much influence on shaping the existing system. With the passage of the ACA, healthcare reforms, including early managed care concepts, have now repositioned stakeholders in the power structure of the system.
  8. The impressive advances in healthcare technology have had both positive and negative effects on healthcare costs, effectiveness, and risk to patients. The investment in and promotion of technology requires much more careful assessment of patients’risks and benefits in relation to new and existing technology developments.
  9. Among current and future issues of concern are: the aging of the U.S. population; the significant numbers of uninsured Americans; the variable quality of health care; conflicts of interest among providers; and the ethical issues that arise with new advances in medicine.

Chapter Outline

  • Introduction
  • Problems of Health Care
  • Understanding Health Care
  • Major Stakeholders in U.S. Health Care Industry
  • Rural Health Networks
  • Priorities of Health Care
  • Tyranny of Technology
  • Social Choices of Health Care
  • Aging Population
  • Access to Health Care
  • Quality of Care
  • Conflicts of Interest
  • Health Care’s Ethical Dilemmas
  • Continuing Challenges

Discussion Questions

  1. With so many different stakeholders in the healthcare system, many with powerful political lobbies, it is understandable that the government was unable, until the passage of the ACA, to address the problems of cost, access, and quality.
  • What are your views about government’s versus the market’s role in reshaping the system?
  1. Employers and the public have had deep concerns about the ever-increasing costs of health care. However, physicians, hospitals, and other providers continue to express displeasure with requirements and restrictions imposed by managed health plans.
  • In the reformed system, what combination of factors might promote the public’s freedomofchoice in healthcare providers, given opportunities with Health Insurance Exchanges?
  1. Hospitals and other healthcare institutions, whether voluntary or for-profit, need to be financially solvent to survive growing market pressures.
  2. How is this “bottom line” focus changing the nature of the U.S. healthcare system?
  3. The typical relationship of patient to physician used to be one of deference by the patient to a more knowledgeable authority.
  • Why is it now extremelyimportant for patients take a more proactive role in their medical care?
  1. Healthcare planners could be effective and efficient if they used the concept of the natural history of disease and the levels of prevention to design services that intervene at the weakest link in the chain of progression of specific diseases. Instead, most focus on high-tech solutions to preventable problems,even thoughexperts know that high-tech solutions do not address health disparities, the major causes of diseases and disabilities.
  • What characteristics of the medical care culture hinder the prevention focus?
  1. Increasing costs and declining populations caused many rural hospitals to shift from in-patient to ambulatory care and, sometimes, long-term care services. Regulations regarding staffing and other service requirements are relaxed in rural settings.
  • Is a two-tiered system of care being created that denies rural citizens access to the same quality of care available in urban areas?
  1. The practice of medicine has undergone dramatic change. Physicians are now accountable for costs and patient care outcomes by organizations that pay for care, and their performance track records are exposed to increasing public scrutiny.
  2. In your opinion, given these evolving developments, will the attractiveness of medicine as a career decline, stay the same, or increase?
  3. Consider the rationale for your opinion.

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