The US Healthcare System: Complex and Unequal (original) (raw)
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The US Healthcare System 2.1 Introduction This chapter briefly describes the US healthcare system and some of the most important of its many problems. This is a complex topic that I cannot adequately cover in a short, introductory book, so I have provided a number of suggested supplemental readings. For a very complete and detailed discussion of the topics raised here (and others) I suggest the Institute of Medicine 1 publication The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary which is available for purchase or free download. 2 Some readers may wonder why I devote an entire chapter to a topic filled with structural, policy, economic and even political issues in what is, after all, a health informatics book. Based on my prior experience, I know that many readers may have little background in the US healthcare delivery system. My distinguished former Georgia Tech industrial engineering colleague, Dr. William Rouse, describes US healthcare as a complex adaptive system. Paraphrasing him, such a system is (a) nonlinear and dynamic and does not inherently reach fixed-equilibrium point so it may appear to be random or chaotic and (b) composed of independent agents whose behavior is based on physical, psychological, or social rules rather than the demands of system dynamics. Because agents' needs or desires are not homogeneous, their goals and behaviors are likely to conflict. In response to these conflicts, agents tend to adapt to each other's behaviors. Agents are also intelligent so, as they experiment and gain experience, agents learn and change their behaviors accordingly. Thus overall system behavior inherently changes over time and may range from valuable innovations to unfortunate accidents. An article in the January 11, 2006 NY Times provides a clear
The American Journal of Medicine, 2019
Unlike most western democracies, health insurance in the United States is provided by a haphazard mix of employer-based plans, Medicare for those over 65 or on social security disability or chronic renal failure, Medicaid under varying state-dependent rules for some low-income recipients and no insurance for tens of millions. Administrative costs, which include both the direct costs of the insurers and the indirect costs imposed on physicians and hospitals, make up nearly 25% of our bloated national health care expenditures. This high cost adds no proven value to health care outcomes. Our current system of covering health care expenditures is both inefficient and unfair. Changes must be made.
Philos Ethics Humanit Med, 2008
(second edition, 2007) offers a lucid and informative overview of the U.S. health system and the dilemmas policy makers currently face. Barr has provided a balanced introduction to the way health care is organized, financed, and delivered in the United States. The thirteen chapters of the book are quite comprehensive in the topics they cover. Even those knowledgeable about the U.S. health care system are likely to find much to stimulate their thinking in the text. The book can also appropriately serve as a basic text for a health policy course or in the medical or nursing school curriculum.
Health care reform in the United States
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Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format ECO/WKP(2009)6 Unclassified English -Or. English ECO/WKP(2009)6 2 ABSTRACT/RÉSUMÉ Health Care Reform in the United States
The American Journal of Medicine, 2019
Unlike most western democracies, health insurance in the United States is provided by a haphazard mix of employer-based plans, Medicare for those over 65 or on social security disability or chronic renal failure, Medicaid under varying state-dependent rules for some low-income recipients and no insurance for tens of millions. Administrative costs, which include both the direct costs of the insurers and the indirect costs imposed on physicians and hospitals, make up nearly 25% of our bloated national health care expenditures. This high cost adds no proven value to health care outcomes. Our current system of covering health care expenditures is both inefficient and unfair. Changes must be made.