The American Health Care System


Health Care Delivery

The United States is among the wealthiest nations in the world, but it is far from the healthiest. Although Americans' life expectancy and health have improved over the past century, these gains have lagged behind those in other high-income countries. This health disadvantage prevails even though the United States spends far more per person on health care than any other nation.

Institute of Medicine.  (January 2013). REPORT BRIEF U.S. Health in International Perspective: Shorter Lives, Poorer Health

"Making systems work is the great task of my generation of physicians and scientists. But I would go further and say that making systems work — whether in healthcare, education, climate change, making a pathway out of poverty — is the great task of our generation as a whole."

 

Atul Gawande: How do we heal medicine? - TED Talks 2/2012

"There are too many examples that show how our system can fail to meet patients' needs. These problems are not a reflection on the many doctors, nurses and other professionals who work tirelessly to deliver the highest quality care they can. Instead, they reflect a delivery system that's not always designed with the patient in mind."

Donald Berwick, Former Director of the Centers for Medicare and Medicaid Services 7/3/2011

 

What is the health care system? What is the medical care system? Are they systems? In this course we will discuss the AHCS as if it were a unified structure. At the same time we will point out the many ways in which it is not.  

Medical care is often understood as the more clinical aspects that take place in the traditional medical setting.

Health is a much broader concept. The health care system extends far beyond the exam room and we will see this in upcoming week.

For the purposes of this course we will use the term AHCS to refer to health services, health care delivery, public health, and traditional medical care

 

The following table gives you an idea of the complexities of health care delivery in our country. Note that it is divided into organizations (education/research and or managed care/integrated networks), individual suppliers, insurers, providers, payers, funders, and—last but not least—the government. We will be discussing all of these components over the course of this semester, so keep this chart handy.

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The American Health Care System as a Non-System


Though the American health care system is a far cry from being a well-oiled machine, it does have various components that are interdependent and share common goals. These components do fit into a systems model, despite all its limitations. Shi and Singh use this systems framework to illustrate some basic foundations that support the interaction between input (resources) and output (outcomes), as well as the underlying structure that supports the process dynamics, which evolve over time.

Surely, the American health care system is far from perfect, but, then, by now you probably realize that no perfect system exists anywhere. Americans have access to a patchwork of subsystems (like managed care, the Veterans Administration, and emerging IDSs) that characterize health care delivery in the US. However, the systems framework does give us at least a starting place to attempt in an organized fashion to understand an extremely convoluted, confusing, and costly health care system, and perhaps, a place to begin our quest to find acceptable solutions to our problems.

Atul Gawande is a surgeon and writer from the Boston area. Watch the video below for an academic and clinical perspective on our broken medical care systems. Focus in particular, to the questions below: 

 

Atul Gawande: How do we heal medicine?

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Consider the information taken from the first chapter of a recent IOM report entitled Best Care at Lower Cost: The Path to Continuously Learning Health Care in America: