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Health Care Financing and Information Technology: A Historical Perspective. HIM 3000. What is a “system”?. HEALTHCARE SYSTEM: A network of integrated components designed to work together coherently . Key Domestic Crises.

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Presentation Transcript
what is a system
What is a “system”?
  • HEALTHCARE SYSTEM: A network of integrated components designed to work together coherently
key domestic crises
Key Domestic Crises
  • 43.6 million people are uninsured and another 30+ million are under-insured
    • As healthcare gets more expensive, more people are left behind
  • Medicare – Under-funded and getting more costly
  • Medicaid – reliant on State’s Budgets
  • Torts; Malpractice Costs
  • New Healthcare Threats: Bio-terrorism
    • Vaccines; Infectious Disease; Response issues
financing
Health care expenses in the U.S. have nearly doubled from 1992- 2002

At current rate, expected that costs will double again by 2012

(source CMS, 2004)

Financing
reimbursement
Reimbursement
  • Multiple systems exist for reimbursement to providers (you) and hospitals:
    • Fee-for service (rare)
    • Discounted/negotiated fee-for-service
    • Capitation
so how good is this system
So how good is this system?
  • WHO (World Health Organization) rankings of countries health care system performance:
    • 1st: France
    • 2nd: Italy
    • 3rd: San Marino
    • …….
    • 35th: Dominica
    • 36th: Costa Rica
    • 37th: United States
    • 38th: Slovenia
what do we have in the u s
What do we have in the U.S.?
  • U.S. “SYSTEM”: Hodgepodge of financing, insurance, delivery, and payment mechanisms that remain unstandardized and loosely coordinated… The system is functionally fragmented because it is not subject to overall planning, direction, and coordination from a central agency.
prospective payment system
Prospective Payment System

Social Security Ammendments of 1983, Medicare pays hospitals a uniform national fixed payment per case based on about 468 diagnosis related groups (DRGs0

health maintenance organizations
Health Maintenance Organizations

1970’s-1990’s

Prepaid group practices, ie Kaiser Permanente

A group or practice or affiliation of independent practitioners that contracts with patients to provide comprehensive health care for a fixed period payment specified in advance

technology spending new incentives
Technology Spending new incentives
  • Incentives for purchasers and consumers to seek value and information
  • Incentives for health plans and providers to improve quality and to reduce costs
  • Potential incentives for providers to under serve patients
  • Incentive for health plans to attract the healthiest possible populations.