Overview of U.S.

Health Care System

Volume 2, Issue 1 January 2011 On the organizational side, the U.S health care system has

MASA Consulting & Training Services

Mohamed Ali,
MASA Healthcare

moved from no organizational structure or government role in the 1800 to more organized structure of sub systems that are contributing to the main system in different ways with no to limited coordination with less effective outcomes. After WW II, the system has gone through important changes such as veterans care. The basic form of a health care system with the introduction of managed care as a way to make health care accessible and affordable. Over the past few decades, the health care system in the U.S. has gone through critical issues with more government involvement and more oversight as a way to control the cost and spending. The role of Medicare and Medicaid has become so valuable to the U.S. health care system, in the last two decades, as a result of the impact of baby boomers. Over the last few years, the rising cost of health care delivery has resulted in more government involvement since it is the main payer, in form of Medicare & Medicaid, pressured by public desire for controlling government spending. Health Insurance Reform has become a great issue in the last ten years to make healthcare more affordable and accessible. Also, the role of President Obamas New Health care Law has created a great impact on the U.S. health care system. It will take years to come to determine if such law has a positive or a negative impact on the U.S. health care system. The structure of U.S. health care System is closely connected to the privilege of having health care coverage. The U.S. health care system consists of sub systems that are contributing independently to the U.S. main health care system with no to limited coordination: 1- A subsystem for the young insured, under 65 years old who are in the workforce, which is mainly connected to their employment status with great
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The U.S. health care system has evolved in many ways over the past centuries as a result of different factors that impacted todays health care system. On the disease side, the health care system has moved from acute care system targeting epidemic infections to acute care setting that is focused on individualistic acute events. After World War II, the focus of the U.S. health care system has shifted from acute care model to chronic care model with targeting cancer, heart disease, stroke, and post war chronically ill patients. During the past few decades, the U.S. health care system targeted emotional & behavioral disease, obesity, child care, and elderly care. Todays health care system is, at large, acute care model with focus on chronic care management. The role of public health, prevention, and health promotion continue to be limited. However; the society has realized the importance of such role in health care organization, financing, and delivery. On the new technology side, around the 1800 the system used limited or no technology in clinical intervention. The system only relied on the basic medical knowledge that was known back then. With the role of WW II, more advanced technology, evidence based medicine in health care, and new clinical and medical technologies have been introduced to the system to care for post war medical conditions and acute care trauma. Over the past few decades, the U.S. health care system has gone through rapid changes in how services are being delivered with the most advanced, expensive, and somewhat ineffective new technologies. Such new technology contributed greatly to the rising cost in health care services.

Overview of U.S. Health Care System

role of managed care organizations that their employers contracted with. They tend to have better access and better care but they also tend to pay more for such privilege. 2- A subsystem for the uninsured in form of Medicaid for those who receive certain government subsidy and who have certain income level that is very connected to poverty level in the country or poor social status. 3- A subsystem for Military Veterans and Active Duty Military that is running and is being financed by the government. It is considered the only successful form of government run health care system. 4- No subsystem dedicated to the uninsured who are under the age of 65 but retirees or those who above the poverty level but cant get health care through their employers. Those two groups tend to obtain their health care services through emergency services or by purchasing very costly health care plans.

legislations, and financing Is the U.S. healthcare system well run? Looking at the U.S. health care system makes it hard to say the U.S. has a well run health care system. The matter of fact, the U.S. has subsystems and sub organizations that are contributing to the health care delivery in the U.S. in different uncoordinated ways. That contribution comes in form of delivering different services to patients such as: 1- General Hospitals 2- Specialty Hospitals 3- Ambulatory Centers 4- Primacy Care Centers 5- Physicians Groups 6- Pharmaceutical Services 7- Dental Services 8- Long Term Care & Hospices Facilities 9- Public Health Offices 10- Rehabilitation Centers 11- Emergency Medical Centers 12- Home Health Services Each one of those organizations has an independent role

The U.S. Healthcare system is being delivered and organized around five major players. Those players play a very important role in health care delivery, organization, and financing. 1- Patient is the main consumer of health care services 2- Providers, in form of organizations, are involved in direct and indirect patient care 3- Payers such as Medicare, Medicaid, private insurance, and employers 4- Vendors represents pharmaceutical companies, medical technology industries, and other suppliers of services and goods 5- Government is involved in form of regulations,

and contributes separately to the U.S. health care System. One organization might be seen as a health care system where it combines different services or multiple

organizations under one entity such as Johns Hopkins Health Systems. Even in that case there is a lack of coordination between different providers within the one system. The U.S. healthcare system has evolved in different forms over the past centuries, and continues to evolve with the current public policy. The U.S. healthcare system continue to need a great amount of coordination among multiple system to come the optimal well run health care system.
Reference: Bittle, M. (2010, Fall). Healthcare and Business. Lectures presented at Carey Business School, Johns Hopkins University.

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Overview of U.S. Health Care System