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Diagram of the U.S. Health Care System

For Health Law: Finance and Delivery Class, Georgia State University College of Law
by

Erin Fuse Brown

on 11 January 2018

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Transcript of Diagram of the U.S. Health Care System

Facilities
Workforce / Providers
Suppliers
Education/Research
Financing
Hospitals
Outpatient clinics
Rehab
Skilled nursing facilities
Specialty hospitals
Physicians
Nurses
Physicians Assistants
Technicians
Pharmaceuticals
Durable medical equipment
Supplies
Medical devices
Equipment - MRI, CT scanner, etc.
Academic medical centers
Universities
Private research sponsors
Government
Private Insurance
Federal
State
Local
Employer
Individual
Out-of-Pocket
Self-pay
Co-payments
Deductibles
Premiums
Payment $
Fee for Service
Capitation
Other (quality incentives)
Fee for service
Capitation
Bundled payment
Payment $
Employment
Contract
Mental health providers
Train workforce
Investigators
Sponsors research
Contracts with
Purchase
Conduct
The U.S. Health Care System
Provide services
Bills for services
Liability
Coverage
Utilization management

Provider-patient relationship
Liability
Bills for services provided
Ambulatory surgery centers
Ownership
Medical staff
U.S. Department of Health &
Human Services

Centers for Medicare &
Medicaid Services

Food and Drug
Administration

National Institutes
of Health

Centers for Disease
Control & Prevention

Others: HRSA,
SAMHSA, IHS, etc.

Social Workers
Patient
Payment $
Premiums
Ownership Types & Tax Status:
Private, nonprofit (tax-exempt)

Private, for-profit (taxable)

Government-owned (federal, state, county, hospital authority, etc.)
Department of Justice
Internal Revenue Service
Federal Trade Commission
- Regulates tax-exempt organizations (hospitals, managed care companies, etc.);
- Handles premium subsidies
- Enforces the individual mandate
Federal antitrust enforcement
Enforcement of:
- Federal antitrust laws
- False Claims Act
- Others (Stark, Anti-kickback, HIPAA, etc.)
Office of Civil Rights (OCR)
HIPAA Privacy & Security Rules: investigation, enforcement
Federal Anti-kickback Statute

Office of the Inspector General (OIG)
Center for Consumer Information and Insurance Oversight (CCIIO)
- Affordable Care Act insurance rules
- Healthcare.gov
- Exchanges
Stark Law (Physician Self-Referral) Enforcement
Full transcript