Delivery Systems

8/25
• Public health is preventative health services, services intended to preserve and enhance health, water supply, FDA, restaurant sanitation, assessing the environment in a general sense, education
• Restorative health: direct intervention in the body, medicines, procedures, injections, “touching”
• Interventions and restorative health are more costly, some studies show if people exercise we can reduce need for restorative health
• Migrating from medical model to public health is difficult, clinical intervention associated with restorative health
• Preventive: whole is greater than sum of the parts
• PA’s and NP’s to extend primary care, about improving access and slowing cost curve increase
• States are the primary vehicles for licensure for healthcare personnel, states need to expand the scope of practice
• Managed care: managed cost, in 1980s there was financial disincentives for referring to specialists
• Public health very small effort of maintaining health
• Institution: doctors, payors, hospitals, insurance, technology, pharmaceuticals, taxpayers, professionals, communications,
• free market vs. gov. control: history founded on individual rights and liberties, we are a society and there are needs greater than any of us as individuals, works for other countries that don’t have a culture of individualism
• Most hospitals are not for profit, for-profit chains are low percentage, VA, military, state hospitals aimed at behavioral health
• Cost, Quality, Access: Interwoven quality and access closely related, buyer is not
• Hospitalcompare.gov
• Remind him about my question on people who opt-out
• Medicare:
A) Hospitalization: get it when turn 65, financed by payroll tax, federal, passed in 1965
B) Ambulatory services: Voluntary, 99% sign up for part B, financed by premiums and general fund subsidy, pays for partial