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The US Healthcare System and the Roemer Model. Lecture 2 Tracey Lynn Koehlmoos, PhD, MHA HSCI 609 Comparative International Health Systems. Organization of the US Health Services System. Ever shifting mix of public/government sector, private sector and voluntary services.

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the us healthcare system and the roemer model

The US Healthcare Systemand the Roemer Model

Lecture 2

Tracey Lynn Koehlmoos, PhD, MHA

HSCI 609 Comparative International Health Systems

organization of the us health services system
Organization of the US Health Services System
  • Ever shifting mix of public/government sector, private sector and voluntary services.
  • 16% of GDP spent on health services (2005)
  • The US government now:
    • Major payer for care: Medicare, Medicaid
    • Provider of healthcare for special populations like Tricare, Indian Health Services, VA
    • Major supporter of education and training of many types of care providers
introduction to the roemer model
Introduction to the Roemer Model
  • Developed by Milton I. Roemer, MD, MPH
  • WHO, UCLA School of Public Health
  • Pioneer in international health systems research
  • Roemer Model of Health Services System (1984) allows for clear understanding of health systems

Clear understanding = Meaningful comparisons

roemer model

MANAGEMENT

RESOURCE

PRODUCTION

ORGANIZATION OF

PROGRAMS

DELIVERY

OF

SERVICES

ECONOMIC

SUPPORT

Roemer Model
five parts to the model
Five Parts to the Model
  • Organization of the Program
  • Management of Health Services System
  • Economic Support of Health Services
  • Production of Health Services Resources
  • Delivery of Health Services
part 1 organization
Part 1: Organization
  • Ministry of Health—all levels
  • Other Public Agencies
  • Voluntary Agencies
  • Enterprises
  • Private Market
part 2 management
Part 2: Management
  • Planning
  • Administration
  • Regulation
  • Legislation
part 3 economic support
Part 3: Economic Support
  • Personal Households
  • Charity
  • Insurance (voluntary)
  • Social Security
  • Governmental
  • Revenues
  • Foreign Aid
part 4 production of resources
Part 4: Production of Resources
  • Manpower
  • Facilities
  • Commodities (drugs, DME, equipment, etc.)
  • Knowledge
part 5 delivery of services
Part 5: Delivery of Services
  • Primary Care—Prevention
  • Primary Care—Treatment
  • Secondary Medical Care
  • Tertiary Medical Care
  • Care of Special Disorders and Populations
applying roemer at home
Applying Roemer at Home
  • Part I: Organization of Health Services:
  • US health system is DECENTRALIZED
  • Department of Health and Human Services (DHHS) instead of MoH
  • DHHS regulates and finances many health services
  • Services delivery primarily occurs in private sector
part i organization
Part I: Organization
  • Public Health at the national level
  • Centers for Disease Control and Prevention
  • Food and Drug Administration
  • Centers for Medicare and Medicaid
  • National Institutes of Health
  • Agency for Healthcare Research and Quality
part i organization13
Part I: Organization
  • Voluntary Agencies
  • Gap fillers
    • Disease or interest group specific

ACS, ARC, AARP

    • Professional associations

APHA, AHA, AMA

    • Philanthropic and religious organizations

Robert Wood Johnson

part i organization14
Part I: Organization
  • Private Market
  • Most health services provided in the private market
  • Most health insurance provided in the private market
  • Pharmaceuticals and supplies (developed and sold)
  • Health professional training
part 2 management15
Part 2: Management
  • Planning: No centralized national-level planning authority
  • Administration: More applied in nature at project or program level
  • Legislation: all government units have authority to enact laws (budgeting process, restriction and limitations, new programs
  • Regulation: Implementation of laws, licensure, certification, accreditation
part 3 economic support16
Part 3: Economic Support
  • Private Health Insurance (voluntary and employment related) largest source of funds (34%) to US health services
  • ~70% of <65 have some type of health insurance
  • Household/Out of Pocket: 15%
  • Medicare: 17%
  • Medicaid: 16%
  • $1.3 trillion in 2000
  • 16% of GDP in 2005
part 3 economic support17
Part 3: Economic Support
  • Where does the money go?
  • 33% hospitals (50% of this from Fed.)
  • 23% physician services
  • 10% drugs
  • 9% other personal care
  • 7% nursing homes
  • 6% program administration
  • 3% research and construction
  • 2% home health care
part 4 production of resources18
Part 4: Production of Resources
  • Manpower: Health Services Industry
    • Largest Industry in US: 11.9 million workers
    • 800,000+ physicians
      • 270.6 per 100,000 population
      • 2:1 Specialist to Generalist practitioners
      • Medicare subsidized training (GME/residencies)
    • 2 million+ nurses: shortage, training variations
    • Pharmacists, dentists, RT, OT, PT
    • Health Administrators
part 4 production of resources19
Part 4: Production of Resources
  • Hospitals:
    • Various categories (I, II, III) & structures
    • Merge and integrate to expand scope
    • Financial challenges, cost shifting
    • Prospective Payment, negotiated rates
  • Biomedical Research and Technology:
    • US most advanced on planet/ cost driver
    • Drugs developed in private sector/FDA approval
    • Most research publicly funded (via NIH)
    • No clear chain of dissemination/assessment
part 5 delivery systems
Part 5: Delivery Systems

Continuum of Care

  • Prevention and Promotion: Public Sector
  • Early Detection: Public and Private
  • Primary Care: Private sector; PCP
  • Secondary Care: Specialists/hospitals
  • Tertiary Care: Academic Health Center
  • Long Term Care: Medicaid is big payer
  • Palliative Care: Home or Hospice Medicare $ for 80%
  • Outside the continuum: chronic mental illness
roemer model21

MANAGEMENT

RESOURCE

PRODUCTION

ORGANIZATION OF

PROGRAMS

DELIVERY

OF

SERVICES

ECONOMIC

SUPPORT

Roemer Model
conclusion
Conclusion
  • Applying the Roemer Model to the US Healthcare System gives us a means to understand the system and make meaningful and direct comparisons.
  • Skyrocketing costs, an aging population & a high percent of uninsured are issues of concern
  • Quality-Access-Cost remain the overarching values of concern for the US healthcare system