DELIVERING HEALTH CARE IN AMERICA

  Chapter 1 The primary reason for employers to purchase insurance plans to provide health benefits to their employees is to attract and retain talented employees. Offering health insurance as part of the employee benefits package helps employers compete in the job market and promotes employee loyalty. It serves as an incentive for employees to stay with the company and can improve job satisfaction and productivity. Despite public and private health insurance programs, some U.S. citizens are without health care coverage due to various reasons. These include: a) Affordability: Health insurance premiums and out-of-pocket costs can be prohibitively expensive for many individuals, especially those with low incomes or who are unemployed. b) Ineligibility: Some individuals may not qualify for public health insurance programs like Medicaid due to income or other eligibility requirements. Additionally, those who work for small businesses may not have access to employer-sponsored health insurance. c) Lack of Awareness: Some individuals may be unaware of the available health insurance options or how to navigate the enrollment process. d) Immigration Status: Undocumented immigrants are generally ineligible for public health insurance programs, creating a significant coverage gap. Managed Care refers to a system of organizing and delivering healthcare services in a way that aims to control costs, improve quality, and promote efficient use of resources. It involves coordinating medical care, managing utilization, and negotiating contracts with healthcare providers. Managed care organizations (MCOs) often use tools such as provider networks, utilization review processes, and financial incentives to manage healthcare delivery and control costs. Chapter 2 The Blum Model identifies four key determinants of health that have implications for healthcare delivery: a) Environment: The physical, social, and economic environment in which individuals live can significantly impact their health. Access to safe housing, clean air and water, and healthy food are crucial for overall well-being. b) Lifestyle: Personal behaviors and lifestyle choices play a significant role in determining health outcomes. Factors such as diet, exercise, tobacco use, alcohol consumption, and adherence to preventive measures can influence an individual’s health status. c) Human Biology: Genetic factors and individual biological characteristics can contribute to health disparities and influence disease susceptibility and response to treatment. d) Healthcare Organization: The structure and organization of the healthcare system impact access to care, quality of care, and health outcomes. Factors such as availability of healthcare facilities, healthcare workforce distribution, and health insurance coverage influence healthcare delivery. The main cause of the dichotomy between the way physical and mental health issues have traditionally been used by the healthcare delivery system is the historical separation of physical and mental health services. Historically, mental health has been stigmatized and treated separately from physical health. Separate funding streams, limited insurance coverage for mental health services, and fragmented delivery systems have perpetuated this dichotomy. However, there has been a growing recognition of the importance of integrating mental health services into primary care settings to address this gap. American society’s cultural beliefs and values have influenced healthcare delivery in various ways: a) Individualism: The emphasis on individual rights and autonomy has shaped the healthcare system to prioritize patient choice and provider competition. This has led to a fragmented system with varying quality and accessibility. b) Capitalism: The profit-driven nature of the American healthcare system has contributed to rising costs, disparities in access, and the dominance of private insurers and pharmaceutical companies. c) Biomedical Model: The cultural belief in technological advancements and scientific progress has heavily influenced healthcare delivery, leading to an overemphasis on medical interventions and reliance on pharmaceuticals. d) Diversity: American society’s multiculturalism has highlighted the need for culturally competent care and recognition of diverse healthcare beliefs, practices, and languages. e) Consumerism: The cultural value of consumerism has influenced healthcare delivery by promoting patient-centered care, transparency in pricing and quality information, and increased patient engagement in decision-making. These cultural beliefs and values have shaped the U.S. healthcare delivery system by influencing policies, regulations, payment models, and patient expectations.  

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