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Welcome to Exploring the U.S. Healthcare System. This open educational resource (OER) introduces students to foundational characteristics of the U.S. healthcare system. It begins with an overview of the healthcare system that includes a brief history and a description of the current state of health in the U.S. The second chapter describes health delivery systems, including inpatient ...
The health care system in the United States is complex. Some parts of the system are different in different states. This handout provides information to help you understand the health care system in the U.S. and at University of Washington Medical Center (UWMC). Learn how the health care system works so that you get safe care and avoid frustration.
The U.S. health system is a mix of public and private, for-profit and nonprofit insurers and health care providers. The federal government provides funding for the national Medicare program for adults 65 and older and some people with disabilities, as well as for various programs for veterans and low-income people,
- 168KB
- 2
- KAREN VALAITIS
- INTRODUCTION
- Thanks and Gratitude To:
- III. Providers
- Pre-authorization.
- Disease managemen
- Six Interconnected Dimensions of Wellness
- Life expectancy
- I. Key Terms:
- II. Education Access and Quality
- CHAPTER 2: DELIVERY SYSTEMS
- Knowledge Check
- II. Rehabilitation Facilities
- III. Skilled Nursing Facilities
- Skilled Nursing Facility (SNF)
- Home healthcare
- Adult day care
- Continuing care retirement communities
- 2.4.2 Hospice Care
- CHAPTER 3: HEALTH INSURANCE
- I. Plan Networks
- II. Types of Plans
- III. Payment Terms
- Usual, customary, and reasonable (UCR) charges.
- IV. Outpatient Prescription Drugs
- 3.1.3 Moral Hazard
- Point of service (POS)
- HMO
- I. Breadth of Coverage
- II. Military Health Service
- III. Veterans Afairs Healthcare System
- IV. Prison Healthcare System
- 3.5 CHAPTER SUMMARY
- What is DMAIC?
- 4.3.3 Measures of Quality
- I. Magnet Recognition Program
- IV. Accreditation
- 4.4.2 Cost Drivers
- CHAPTER 5: CURRENT ISSUES IN HEALTHCARE POLICY
- II. Commitment
- V. Patents
- VI. Market Power
- VII. Equity and Fairness
- 5.1.2 How Does the Government Intervene?
- I. Taxes and Subsidies
- II. Regulation
- III. Provision of Insurance
- 5.3.3 What are Value-Based Programs?
- Find the missing words in the word search below:
- 5.4 CHAPTER SUMMARY
- CHAPTER 6: TECHNOLOGY IN HEALTHCARE
- I. Electronic Health Records
- Standardization overview
- Benefits
- Challenges
- 1. Synchronous
- 2. Asynchronous
- V. Internet-Based Technologies and Services
- III. Safeguards
- IV. Threats
- 6.3.2 The Future of Health Information Technology
- de-identification
- 6.4 CHAPTER SUMMARY
- Glossary
- Dually eligible. People who are eligible for both Medicare and Medicaid.
University of West Florida Pressbooks Pensacola, FL
Welcome to Exploring the U.S. Healthcare System. This open educational resource (OER) introduces students to foundational characteristics of the U.S. healthcare system. It begins with an overview of the healthcare system that includes a brief history and a description of the current state of health in the U.S. The second chapter describes health de...
Thomas A Clobes, of California State University Channel Islands for creating the OER book, Introduction to the U.S. Healthcare System, from which this book was based. Thomas Rice, Pauline Rosenau, Lynn Y. Unruh, and Andrew J. Barnes for creating the book United States: Health System Review, from which this book was also based. Stephanie Clark, Dean...
Healthcare providers include all individual providers and organizations providing healthcare services to consumers.
A decision by a health insurer or plan that a healthcare organizations also give credentials to physicians in their network, again ensuring providers can demonstrate basic requirements to practice similar to those required by state licensing boards and the CMS. Hospitals at which physicians practice also regulate physicians through credentialing. H...
t. A comprehensiv e, integrated approach to care and reimbursemen
and services is that it is simultaneously an investment. The money a person spends on being healthy today will also benefit them in the future. The impact of our healthcare choices can be seen in terms of mortality rate and productivity.
Definition: “Life expectancy is defined as the average number of years that a person could expect to live if he or she experienced the age-specific mortality rates prevalent in a given country in a particular year” (Organization for Economic Cooperation and Development [OECD],
Clinical care: prevention, treatment, and management of illness and preservation of mental and physical well-being through services ofered by medical and allied health professions, also known as healthcare. Determinant: a factor that contributes to the generation of a trait. Epidemic: an increase, often sudden, in the number of cases of a disease a...
People with higher levels of education are more likely to be healthier and live longer. Healthy People 2030 focuses on providing high-quality educational opportunities for children and adolescents and helping them do well in school. Children from low-income families, children with disabilities, and children who routinely experience forms of social ...
Learning Objectives Examine the scope of services and the facility classifications for inpatient care. Examine the scope of services and the models for outpatient care. Explain the unique characteristics of post-acute care and differentiate it from other parts of the healthcare continuum. Summarize the continuum of long-term care. Describe the obje...
Match each statement to the correct center to complete the sentences. An interactive H5P element has been excluded from this version of the text. You can view it online here: assisted living residents live in communities with apartments and amenities such as group dining and medication assistance. Assisted living is not regulated by the Federal gov...
Rehabilitative care aims to cure, improve, or prevent a worsening of a condition. Examples are physical, occupational, speech, and other therapies following a stroke or physical therapy following orthopedic replacement surgeries such as hip or knee. Rehabilitation settings include outpatient centers, inpatient rehabilitation departments, freestandi...
Skilled nursing facilities (SNFs) provide services similar to IRFs but do so in a more home-like, less intensive setting. These facilities are licensed by the states to ensure a safe and suitable environment is maintained for those receiving care. SNF patients typically require more mild or moderate levels of care and receive one to two diferent ty...
Patients with moderate impairment requiring skilled nursing services and limited therapy services Requires a minimum stay in an acute care setting prior to admission Regular medical management, such as: -IV therapy -dialysis support -infectious disease -management -less intense/ frequent -rehabilitation services Providers Length of Service
Home healthcare is a formal, regulated program of care delivered in the home. It can include a range of services provided by skilled medical professionals, including skilled nursing care, physical therapy, occupational therapy, and speech therapy. In addition, home healthcare can also include skilled, non-medical care, such as medical social servic...
Adult day care is a group program designed to meet the needs of functionally and/or cognitively impaired adults and provide respite for family caregivers. Adult day care centers ofer a wide array of services that range from basic health services, meals, and activities to intensive health services for those who might otherwise have to be in a skille...
Continuing care retirement communities (CCRCs), also called life care communities, integrate diferent levels of service in one location. Many ofer independent housing (i.e., houses or apartments), assisted living, skilled nursing care, and memory care all on one campus. Residents can move from one area to another based on the level of service neede...
Definition: Hospice is a program that gives special care to people who are near the end of life and have stopped treatment to cure or control their disease. Hospice ofers patients and their families physical, emotional, social, and spiritual support. The main goal of hospice care is to control pain and other symptoms of illness so patients can be a...
Learning Objectives Review the terms and economic issues associated with health insurance. Examine the role of the private insurance sector in healthcare financing. Discuss the development and reimbursement methods commonly associated with managed care delivery models. Summarize the role of public programs in healthcare financing and the delivery o...
In-network. Healthcare providers (e.g., specialists, hospitals, laboratories) that have accepted contracted rates with the insurer are considered in-network. As a result, the insured person typically pays a lower price for using services within the network. Out-of-network. Healthcare providers who have not accepted contracted rates with the insurer...
Conventional indemnity plan. An indemnity that allows the participant the choice of any provider without efect on reimbursement. These plans reimburse the patient and/or provider as expenses are incurred. High deductible health plan (HDHP). This type of plan typically features a higher deductible and lower insurance premiums than traditional health...
Capitation. A fixed sum of money is paid to the provider per time unit (usually monthly) for each patient being treated by the provider. Coinsurance. This form of medical cost-sharing requires an insured person to pay a stated percentage of medical expenses after the deductible amount, if any, is paid. After any deductible amount and coinsurance ar...
Conventional indemnity plans operate based on usual, customary, and reasonable (UCR) charges. UCR charges mean that the charge is the provider’s usual fee for a service that does not exceed the customary fee in that geographic area and is reasonable based on the circumstances. Instead of UCR charges, PPO plans often operate based on a negotiated (f...
Formulary drugs. These are both generic and brand-name drugs approved by the healthcare provider. Drugs not approved by the healthcare provider are nonformulary drugs for which enrollees receive less generous benefits, such as a higher copayment per prescription. Brand-name drugs. These are drugs that once were or still are under patents. Generic d...
Another complicating element for insurance is the moral hazard: the idea that, after purchasing insurance, individuals may behave in riskier ways. For example, think about your likelihood of being in a car accident. The probability that you will have an accident depends on many things: road conditions, the actions of other drivers, luck, and many o...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
eHealth. The use of information technology and/or systems and electronic devices for healthcare service delivery (electronic health). Encryption. A method of converting an original message of regular text into encoded text. Electronic clinical decision support (CDS). Tools integrated into some electronic health records (EHR) to provide accurate and...
The opportunity to create free educational materials has been a rewarding experience. A free pdf form of this text is available for download. The authors of this book are registered nurses who have each worked 25 or more years in various roles and specialties within our healthcare system. There have been many changes throughout the years.
America’s health care system is neither healthy, caring, nor a system. —Walter Cronkite. Learning Objectives • Understand the general characteristics that differentiate the US healthcare system from the health systems of other countries. • Evaluate the “conundrum” of cost, quality, and access. • Understand the forces acting on the ...
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Jun 6, 2023 · It's rigorously researched and scrupulously unbiased yet written in a conversational and humorous tone that's a pleasure to read and illuminates the convoluted health care system and its many components. The book is essential reading for health professionals, health professions students, and anyone who interacts with the U.S. health care system ...
