The United States Health Care System

The United States Health Care System

World History of Health Care

U. S. Health Care History Pre-1900

• 1700 - Heroic medicine
• Blood letting
• Medications using arsnic and murcury.
• 1800 - Public is hesitant about seeking care from Doctors.
• Lack of standards and education.
• Formation of the American Medical Association (AMA) in 1845 (American Medical Association (AMA), 2014)
• The American Civil War 1861 - 1865

• Advent of Vaccines by Edward Jenner in 1796 (Dranguet, 2014).
• William T.G. Morton introduces anithetics in 1846 (Robinson & Toledo, 2012).
• Standards of Cleanliness improve and antiseptics introduced (Antibiotics and Anti-infective Drugs, 2001).

In 1700s America heroic medicine was the popular practice for those that professed to administer health care. This method of doctoring involved blood lettings, blistering and arsenic or mercury based medication. During the 1800s much of the general public sought holistic care though shamans or lay healers due to lack of trust in the medical profession, largely due to a lack of standards in the field anyone could claim to be a doctor despite having no training or education. Only around 400 doctors at the time had a formal education in their field despite nearly ten times as many individuals reporting to be doctors. Partly in response to the resounding lack of public confidence because of the absence of standards and education as well as a rise in disease the American Medical association is founded in 1845 by a young doctor Nathan S. Davis. The American Civil War began before the AMA made a substantial impact on the education of doctors and unsanitary operating procedures lead to the deaths of many soldiers. Despite the amount of deaths due to infection doctors were now painfully aware of the importance of sanitation for the first time. The Civil War also saw the advent of the Ambulance and the rise of the general hospital. American Public Health Association (APHA) was started by Dr. Stephen Smith in 1872 was committed to improving public health by educating them about safety standards and communicable diseases. The APHA helped to develop health departments in the federal and local governments. These organizations helped to make connections between sanitation and the spread of disease during the 1918 flu out break that killed hundreds of thousands of people.

In 1796 Edward Jenner first introduces the idea of the vaccinating against contagions, he was able to successfully vaccinate a young boy against small pox. In 1846 William T.G. Morton introduced the first way to dull pain during medical procedures by using ether. During the early 20th century sanitation practices began to improve drastically while use of antiseptics was on the rise reducing the spread of infection. The first sulfur based anti-biotic, prontosil rubrum was introduced in 1935.

Leah McGrath

HCA 205 Introduction to Health Care

Instructor Jon Lasell

March 23, 2015

The US vs. France

The French Health Care System

The US vs France

Problems

• Who Pays for It
• Mandatory taxes
• Employees, Employers, and Self-employed
• Government Subsidies
• Those that seek care
• Accessibility
• Primary Care
• Specialized Care
• Emergency Care
• Hospital Care
• Pharmaceuticals

• Financial Strain
• Taxes Allotment Not Enough
• Escalating Reliability on General Tax Fund

Health Care Legislation

Cost: Reimbursement Method

The French health care system is funded by a mandatory tax levied against the salaries of every citizen. The government also provides some of the funding for the program with earmarked taxes and from the general tax fund. Each individual that seeks care must pay a small portion of the cost of some procedures, however there are exemptions for children, the poor, and those with chronic health conditions or that are disabled. French citizens can choose any general practitioner that they want for their primary care needs and the cost is 23 Euros, a little under $25 in United States, with a maximum charge of 50 euros for after hours or weekend visits. However all but 6 euros is refunded by the national insurance (The Common Wealth Fund, 2013).

• Fee-for-Service
• Discounted Fee-for-Service
• Capitation

Cost: Managed Care Organizations

• Vaccination Requirements for Public School Attendance
• Eliminating Non-Medically Necessary or Personal Exemption
• Washington, Oregon, California, and Vermont

The largest problem with the system is that often times the taxes levied against the salaries of the people are not enough to cover the cost of the program on their own. The system is often more and more dependent not only on the taxes that are earmarked for it but also on additional funding from general taxes.

Modern Health Care in the U.S.

1950 to the Present

• Health Maintenance Organization (HMO)
• Gatekeeping
• HMO Staff Model
• Preferred Provider Organization (PPO)
• Point of Service Plan (POS)

This reimbursement method applies to specialists as well as long as the individual has been referred to the specialist by their GP. Although this is the preferred process the French do not need to have a referral in order to see a specialist, if they are willing to pay the cost without being refunded they may see any doctor they chose regardless of the type of practice. Emergency services like EMS care or ambulance transportation are also covered under this statutory health insurance system (Rodwin, 2003). French hospitals are divided into two categories state run and privately run, most of these regardless of their affiliation are covered by the national care plan and only charge their patients what would amount to $19 a day for care, with the rest of the charge being absorbed by the state insurance. When it comes to pharmaceuticals the national insurance reimbursement system changes slightly. When a French citizen needs to fill a prescription instead of paying the full charge and waiting to be reimbursed they simply pay their portion of the fee to the pharmacist.

Health Maintenance Organization Act was passed in 1973 in order to limit the rising cost of health care. Managed care organizations are divided into three categories. Health Maintenance Organizations (HMO) is a not for profit plan that provides both health insurance and maintenance. HMOs reduce costs through the practice of gatekeeping, a system in which a patient must have a referral from their GP in order to see a specialist. HMOs use capitated contracts with providers in order to compensate providers. In the HMO staff model practitioners see only HMO patients and they receive a fixed salary.

Preferred Provider Organizations (PPO) operate very similarly to an HMO in that they have a network of providers that are under a contract with the insurer. The primary different with a PPO is that they do not practice gatekeeping. In this plan patients can choose their provider, but if they are out of the network then the patient will pay a higher fee to see them.

Point of Service Plan (POS) is essentially all of the benefits of an PPO and an HMO combined.

Recently there has been resurgence in many preventable illnesses among unvaccinated children, this is largely due lingering paranoia that vaccinations cause developmental disabilities, despite this being debunked time and time again, or that vaccinations cause unwanted illness and subsequently weaken a strong immune system. There are many vaccinations that a child is required to have before they can attend public schools and this system has all but eliminated many of devastating diseases like whopping cough. As long as these laws have been in existence there have always been medically necessary exemptions for children that are unable to have the vaccinations and for those that have a non-medically necessary religious or personal objection to the process. Because of the mounting paranoia surrounding vaccinations more and more parents are using the personal objection loop holes to exempt their child from having the inoculations. Many states are now considering closing this loophole and protecting their students states like Washington, California, Oregon, and Vermont (Blad, 2014).

Fee-for-Service method pays the health care provider for ever one of the services that are done, because of this fee-for-service is easily abused in order to see greater profit some less scrupulous clinicians will perform some otherwise unnecessary procedures. Insurance providers sometimes use a discounted fee-for-service where the insurer pays the provider for ever service provided based on a predetermined discounted rate comparable to the rates of others in the area.

In the Capitation method of reimbursement does not pay the provider for every service like with previous method however it compensates the provider based on a previously arranged monthly payment. This payment is calculated on the amount of individuals enrolled in the plan and the amount of services required in the previous year. In this plan the amount of the monthly payment is not dependent the services provided or the amount of care provided.

Innovations in Health Care 1950 to Present

The Patient Protection and Affordable Care Act

• Improvements in Vaccinations
• The first pacemaker is introduced 1952
• Artificial Organ Transplants
• Stem cell Research
• Small Pox Eradicated 1980
• HIV/AIDS Epidemic

• Affordable Health Care for Millions
• Free Preventative Care
• End of Discriminatory Practices
• No Annual or Lifetime Caps

In March of 2010 the Patient Protection and Affordable Care Act was signed into law (Patient Protection and Affordable Care Act, 2015). Under this new law power was given back to the patents and affordable health care became a reality for millions. This new law provides free preventative health care and puts an end to discriminatory practices like denial of coverage or higher premiums due to preexisting conditions which happened to include simply being female. It also eliminated annual and lifetime caps on care. This was the largest change in health care law sense the inaction of Medicaid.

The first pacemaker is introduced 1952 by Paul Zoll, helping millions to survive heart bear irregularity.

Artificial Organ transplants are started in 1957 with a heart transplanted into a dog which then survived for a full hour and a half. This was then continued in 1982 when a man survived an additional 112 days with the assistance of an artificial heart.

Stem cell research took a huge leap in the early 2000s when stems cells from cord blood were used to create a small liver and scientists where able to fashion stem cells out of skin cells.

Improvements in vaccinations leading to preventative treatment of; polio (1955), measles (1964), mumps (1967), rubella (1970), chicken pox (1974), pneumonia (1977, meningitis (1978), hepatitis B (1981), hepatitis A (1992), and Lyme disease (1998). Thanks to these advancements the average life expectancy of first world populations has drastically increased.

According to the World Health Organization Small pox, a disease with a high mortality rate, was officially considered eradicated in 1980.

HIV/AIDS Epidemic starts with the identification of the HIV virus in 1983 (Bowen, 2013). The epidemic gravely affected those that required blood transfusions and those that engaged in unprotected sex. This epidemic led to an increase in regulations regarding blood borne pathogens and blood donations like improved testing and screening techniques as well better education about safe sexual practices (Dubin & Francis,2013).

Technology and Cost

• Increased Cost of Equipment
• Increased Cost for Provider
• Increased Cost for Patient

References

Rolls In Health Care

• Healthcare Professionals
• Clients
• Political Figures
• Schools

As technology progresses the cost of medical care increases making it nearly impossible for the average person to afford health care costs without the aid of insurance plans. There are many reasons for this increase in cost, partially it is due to inflation like clinician’s salaries or general cost of supplies, but one of the largest costs is the price of technology. An MRI machine can cost millions of dollars and facilities end up passing a fraction of that price on to the patient who utilizes this particular diagnostic service.

Thank You!

• American Medical Association (AMA). (2014). Encyclopædia Britannica,
• Antibiotics and Anti-infective Drugs. (2001). Oxford Illustrated Companion to Medicine (p. 49). Oxford University Press, 2001.
• Blad, E. (2014). Some States Overhauling Vaccine Laws. (Cover story). Education Week, 33(31), 1-23.
• Batnitzky, A., Hayes, D., & Vinall, P.E. (2014). The U.S. healthcare system: An introduction. San Diego, CA: Bridgepoint Education, Inc
• Bowen, E. A. (2013). AIDS at 30: Implications for Social Work Education. Journal Of Social Work Education, 49(2), 265. doi:10.1080/10437797.2013.768116
• The Common Wealth Fund. (2013) International Profiles of Health Care Systems, 2013.
• Dubin, C., & Francis, D. (2013). Closing the circle: a thirty-year retrospective on the AIDS/blood epidemic. Transfusion, 53(10pt2), 2359-2364. doi:10.1111/trf.12374
• Dranguet, C. J. (2014). Edward Jenner. Salem Press Biographical Encyclopedia,
• Patient Protection and Affordable Care Act. (2015). Salem Press Encyclopedia,
• Public Health USA. (2001). Oxford Illustrated Companion to Medicine (p. 691). Oxford University Press, 2001.
• Robinson, D. H., & Toledo, A. H. (2012). Historical Development of Modern Anesthesia. Journal Of Investigative Surgery, 25(3), 141-149. doi:10.3109/08941939.2012.690328
• Rodwin, V. G. (2003). The Health Care System Under French National Health Insurance: Lessons for Health Reform in the United States. American Journal of Public Health, 93(1), 31–37.
• World Health Organization. (2000) The World Health Report 2000 Health Systems: Improving performance. The World Health Organization retrieved from http://www.who.int/whr/2000/en/whr00_en.pdf

Healthcare Professionals and clients are the two parties we think of when we consider healthcare. The client needs to be seen so they call their doctor’s office, speak with a nurse, make an appointment with a health care administrator, and eventually see their doctor who may refer them to a specialist. This is the front line of care, those that see and enact change first.

Political figures can have a drastic effect on the types of health care that an individual can get, how readily accessible that care is and how much that care costs. The Impact that political figures have on health care is easy to see when we look at laws like the Affordable Care Act or the implementation of Medicaid.

School’s have two different perspectives on health care and the change that effects it; it could be the school that trains the health care professionals or insuring that the general public are educated about personal hygiene, diet, and exorcise.

Why The US Should Adopt This System

• #1 in the World according to the WHO
• Over 90% Enrolment
• Acceptance

Cost: Medicaid and Medicare

Cost: Private Insurance

The Future of Health Care

The Next 10 Years

According to the World Health Organization’s World Health Report, published in 2000 when judged objectively the French health care system is rated number one in the world. To put this in perspective the US health care system was rated number 37 (World Health Organization, 2000).

Unlike in the US in France the over 90% of its citizens are enrolled in the public health care system.

Despite some of the problems with the system all most all French citizens understand the benefits of the system far outweigh the cost and that it needs to be maintained.

• Gene Therapy
• More Cost Transparency
• Refinement of PPACA

• Customer Pays Insurer and Insurer Pays Practitioner
• 100% of Coverage not used
• Risk Pooling

• Medicare
• Part A
• Part B
• Part C
• Part D
• Medicaid

With more and more money and minds being applied to the human genome project it is very likely that gene therapy will gain acceptance and research will advance. Gene Therapy could lead to a suppression of genes that cause us to be predisposed to any number of illnesses, like heart disease or dementia. Because there the cost of health care can very drastically from once city to another and even from one facility to another I predict that technology that gives more transparency to the cost of that care will be overwhelmingly supported by the general public. It is inevitable that the ACA will need refinement due to gaps that don’t limit insures from dictating how much of a specific kinds of care an individual seek.

Client pays insurer a premium for an arranged level of coverage and insurer compensates provider in turn for any care that is covered under this plan. Not likely that it will utilize 100% of their coverage netting a profit for the company. Risk Pooling is a common practice that also helps private insurers to maximize their profits. Insurance companies will look at risk factors unique to the individual, like smoking for instance, and charges them according to their risk level. By insuring a large group of people with a range of risk levels they can spread their risk out.

The Medicare and Medicaid programs were approved in 1965 and help to provide free or reduced cost health care for the poor and elderly. Medicare is a federally funded and controlled program and consists of four different types of care. Medicare Part A provides basic coverage, Part B helps to supplement part A, Part C covers everything that both A and B cover plus it provides more choices for providers, and part D covers prescription medication.

Medicaid covers anyone under the age of 65 who meets the income requirements or is considered medically needy determined by large medical bills that when calculated with the individuals income makes them eligible. Under the ACA primary care providers are reimbursed 100% for their work.

Modern Health Care in the United States 1900 to 1950

• Formation of the American Public Health Association (APHA) (Public Health USA, 2001)
• Health Departments
• 1918 Flu epidemic.
• Rise of Health Insurance
• Metropolitan Life Insurance Company (Batnitzky, Hayes & Vinall, 2014)
• Congress Supports Disease-focused Medicine (Batnitzky, Hayes & Vinall, 2014)
• Social Security Act
• Hill–Burton program
• Centers for Disease Control and Prevention (CDC)
• The National Institute of Mental Health (NIMH)

American Public Health Association (APHA) was started by Dr. Stephen Smith in 1872 was committed to improving public health by educating them about safety standards and communicable diseases. The APHA helped to develop health departments in the federal and local governments. These organizations helped to make connections between sanitation and the spread of disease during the 1918 flu out break that killed hundreds of thousands of people. Health insurance had been around for some time, but they did not gain popularity until 1911 when England passed their National Insurance Act. In 1914 Metropolitan Life Insurance Company started a plan for employees and General Motors joined them in 1928. In 1937 thanks to the American Cancer Institute, congress began to support disease-focused medicine by funding research organizations like National Foundation for Infantile Paralysis to the tune of $76 million dollars distributed among 3,100 groups. Franklin D. Roosevelt signed the Social Security Act in 1935, this helped the elderly to remain independent. After World War II the Hill–Burton program helped to revamp older hospitals and build new ones. Centers for Disease Control and Prevention (CDC) was formed as a federal entity to monitor, catalog, and gather data on contagious disease and prevent outbreaks and study diseases. Prior to the CDC the Office of Malaria Control in War Areas was enacted to help prevent malaria infections in soldiers as they trained in the southern United States. The National Institute of Mental Health (NIMH) was started prior to the Second World War and it called for a reform of the mental health care system in order to improve patient care and conditions inside asylums. In 1968 the NIMH became part of what would become the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)