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U.S. Health Care and Government Role in Health Care

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Tami Bland

on 31 July 2014

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Transcript of U.S. Health Care and Government Role in Health Care

U.S. Health Care and the
Government Role in Health Care

Tami Bland, DNP, CPNP
U.S. Department of Health and Human Services
Agency for Healthcare Research and Quality
(AHRQ)
Centers for Disease Control and Prevention
(CDC)
Health Resources and Services Administration
(HRSA)
Substance Abuse and Mental Health Services Administration
(SAMHSA)
National Institues of Health
(NIH)
Indian Health Services
(IHS)
Food and Drug Adminstration
(FDA)
Centers for Medicare and Medicaid Services (CMS)
Administration for Children and Family
(ACF)
Indirect Care
health care planning
resource development
research
health care planning
regulatory oversight
health care resource planning
provides access to health care for the un- and underserved
involved in direct patient care through community-based health centers
funds training of health care personnel
HIV programs
leads the effort on research to improve health care quality, reduce costs, improve patient safety, and improve access
Center for Global Health
Nat'l Center on Birth Defects and Developmental Disabilities
Nat'l Center for Chronic Disease Prevention and Health Promotion
Nat'l Center for Injury Prevention and Control
Office of Infections Diseases (includes Nat'l Center for Immunization
Office of Public Health Preparedness and Response
Office of Surveillance, Epidemiology, and Laboratory Services
Administers state and federal welfare programs
Administers Head Start
Coordinates and funds community based programs for substance abuse and mental health
establishes and enforces safety standards for food, drugs, and cosmetics
oversees Medicaid and Medicare
oversees CHIP
funds and conducts research
National Center for Nursing Research
direct patient care to American Indians and Alaskan Natives
Secretary of Health and Human Services
(cabinet position)
Surgeon General
Reports to the Office of the Assistant Secretary for Health
"America's Doctor"
an advisory and educational role
no authority or power of establishment of health care policy
oversees the operations of the commissioned core of the U.S. Public Health Service
U.S. Public Health Service
One of America's 7 uniformed services
fight disease and poor health conditions
serve as public health leaders and workers in federal agencies
emergency response teams
Federal agencies primarily involved in indirect services
Ten Great Public Health Achievements 2001-2010
Vaccine Preventable Diseases
Prevention and Control of Infectious Diseases
Tobacoo Control
Maternal and Infant health
Motor Vehicle Safety
Cardiovascular Disease Prevention
Occupational Safety
Cancer Prevention
Childhood Lead Poisoning Prevention
Public Health Preparedness and Response
Judicious use of the legal system through taxation and regulatory action has become an increasingly important tool in public health practice.
creates policy and allocates the resources to implement it
agencies i.e. HDs act within the scope of legislative authority to implement legislation and enforce health policy
interpret laws and resolve legal disputes. Great impact on health policy by determining the boundaries of government power.
Overview of Government in Public Health
Role of Federal Government in Assuring Population Health
direct management of services
Basic Features of U.S. Health Care System
U.S. spends more resources on health care than most countries
Private parties deliver care to those they chose; public systems care for the poor
Care is decentralized; local, state, & federal governments share responsibilities
How Much Do Americans Spend?
Gross Domestic Product (GDP) is a measure of all goods and services sold in the U.S.
Figure 4-2 (p. 88)
Health Care Costs 1950-2020
Fig 4-1 (p. 87)
17.6%
Evolving
Health
We're #24!! (and #1 & #32)
#1 Japan
#2 Australia
#3 France
#4 Sweden
#5 Spain
#6 Italy
#7 Greece
*8 Switzerland
*9 Monaco
*10 Andorra
#13
#17
#4
#7
#24
#11
#30
#2
#12
#23
HEALTH EQUALITY
RANKING SPENDING OF CHILD SURVIVAL
(WHO, 2010)
Health Care Is Seen as a Business
The consumer is the client who is the focus of care
Profits and services are competing goals
Some professionals may refuse to provide care to clients living in poverty
Direct and Indirect Services
Direct
Delivered to an individual
Provided by personnel (nurses, etc.)
Variety of settings
Indirect
Not personally received by an individual
Health planning
Environmental inspections
Benefit of a National Health Care System
National (universal) health insurance coverage supported by ANA
Cost savings
Improved quality of care
Single-Payer System
Government pays
All citizens covered
Private health insurance no needed
Financed by taxes
All-Payer System
Multiple sources, public & private, pay for care
Most likely to work for U.S. health care reform
Benchmarks for Fairness in a Health Care System
Good public health
Democratic accountability & empowerment
Universal access
Equitable: Ability to pay
Value for money: Clinical efficacy
Fair & efficient costs
Patient autonomy & choice
Comprehensive & uniform benefits
Summary
U.S. health care system is fragmented
Illness care has been the focus
Need cost-containment strategies
Need reasonable standard of care for all
Health care is rationed by ability to pay
Poverty is linked to poor health, limited access, & delay in seeking services
The PP&ACA is designed to increase access to health care and quality of health care
Health Care Reform
Nationwide, the ACA will expand Medicaid coverage to millions of people and substantially decrease the number of people without health insurance coverage. However, the impact of the law will vary by geographic region depending on current coverage patterns and socio-demographic/economic factors, among other things.

The Zoom In interactive maps allow you to zoom in on your area and see how the number and composition of individuals enrolled in Medicaid or without insurance coverage could change
if your state expands Medicaid
.
http://kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/#map
#3
#17
#12
#28
#11
#14
#6
#10
#30
#25
policy making
financing
public health protection
collecting and disseminating information about U.S. health and health care delivery systems
capacity building for population health

Health systems
are defined as comprising all the organizations, institutions and resources that are devoted to producing health actions.

A
health action
is defined as any effort, whether in personal health care, public health services, or through intersectoral initiatives, whose primary purpose is to improve health.”
(WHO)
Health Care System
Abundant Resources
Free Market/
Laissez faire
Dentralization
Working Families
Accountable Care Organization (ACO)
Group of health care providers working together to provide quality, timely, and cost effective care
Grew out of the PPACA
The ACO may share in any savings that result in the coordinated care
5 TN ACOs are part of the Medicare Shared Savings Program
http://www.npr.org/player/v2/mediaPlayer.html?action=1&t=1&islist=false&id=4774542&m=4774543
http://www.knoxvilleareaprojectaccess.org
Full transcript