Cost, Access, Quality
• National Health Expenditure was $8,086 per person in 2009
which equals a total of $2.5 trillion.
Allocation of Funds
• The total spending for Medicare totaled $502.3 billion in
• The total spending for Medicaid totaled $373.9 billion in
• The total spending for private insurance totaled $802.1
billion in 2009.
• The total spending for out of pocket payments totaled
$299.3 billion in 2009.
(Source: U.S. Department of Health & Human Services)
1. Insurance companies
2. The government
3. Paying out of pocket
Payment - Insurance Companies
• The cost of health insurance will depend on your age, how
healthy you are, where you live, your income and your job
• There is a fee that must be paid monthly to the insurance
company called a premium
• For those who are employed typically have their health
insurance paid for by their employer.
• If you are self-employed you must pay for your own
insurance and the price of the premium will depend on what
health insurance plan you choose.
• “On average the annual premium was $2,985 for a single
person and $6,328 for a family” (Bihari, 2). That’s $250 a
month for a single person and $530 for a family per month
just to have insurance, not to actually receive healthcare.
Payment - The Government
• Helps to pay for insurance for the elderly and those below
the poverty line through Medicare and Medicaid.
• Medicare provides health insurance to people who are at
least 65 years old.
• Medicaid is a health program for those with low incomes and
resources. It is jointly funded by the state and federal
• "The poverty rate in 2010 was 15.1 percent—up from
14.3 percent in 2009. This was the third consecutive annual
increase in the poverty rate. Since 2007, the poverty rate
has increased by 2.6 percentage points, from 12.5 percent
to 15.1 percent" (DeNavas-Walt, Proctor & Smith, 14).
Payment - Out of Pocket
• Two options: to buy health insurance or to hope they do not
need to use the healthcare system.
• Many choose not to pay for insurance and cannot afford
health care at regular clinics.
• “The average expense for a physician's office visit was
$155. For primary care physicians—general practice, family
medicine, internal medicine and pediatric physicians—the
average was about $100,for a cardiologist $232, for an
orthopedist, $210, or the $206 average cost of seeing an
ophthalmologist” (Blythe, 1).
• As a result, the emergency room of the hospital is abused
because it cannot turn people away due to lack of insurance
or ability to pay.
Public VS. Private
Institutions - Public
• The government is the main public institution that
helps to cover the cost of health care.
• Hospitals take advantage of the government being a
"faceless consumer" and will charge more than they
charge insurance companies for the same treatment.
• In 2007, federal spending on health programs cost
$808.6 billion with 77% being attributed to Medicare
and Medicaid (Jenson, 2).
Institutions - Private
• Private institutions refer to private insurance or private
payers of health care.
• Insurance companies use diagnosis-related groups (DRGs) in
order to determine the reimbursement rate for a specific
diagnosis. Hospitals must then negotiate with insurance
companies to set rates.
• Private insurance accounts for 35% of total health
spending within the United States.
•Bihari, M. (2010, April 02). Cost of health insurance. Retrieved from
•Blythe, S. (2009). What is an "office visit," anyway?. Retrieved from
•DeNavas-Walt, C., Proctor, B. D., & Smith, J. C. U.S. Department of Commerse,
Economics and Statistics Administration. (2010).Income, poverty, and health insurance
coverage in the united states: 2010. Retrieved from
•Jenson, J. Domestic Social Policy Devision, (2008). Government spending on health care
benefits and programs: a data brief. Retrieved from
•Primary Care Doctors Account for Nearly Half of Physician Visits but Less Than One-Third
of Expenses. AHRQ News and Numbers, April 25, 2007. Agency for Healthcare Research
and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn042507.htm
Access to Care
1.Right to Access
2.Knowledge of the System/Transparency
Access-Right to Access
• Market-driven health care industry: profit is the #1 priority
o Accessibility suffers as a result
• Key factor to health care access is good health insurance
o Mostly obtained through employment
• 3 main categories of individuals to consider:
2."Working Poor" (little access to care)
(Bodenheimer & Grumbach,
Access- Knowledge of System and
• US health system is very complex and hard to understand
• Without a high level of education and literacy, you cannot
effectively understand the health care system
• A lack of knowledge of the system can create barriers to
health care access and can cause inequalities as well
• Lack of understanding by minorities causes health care
access issues (Betancourt & Green, 2011)
Access- Socioeconomic Status
• More than 49.9 million uninsured Americans (US Census
• More than 60 percent of the uninsured are in low-income
families (Adler & Newman, 2002)
• Large majority of the uninsured are from racial/ethnic
minority groups (US Census Bureau, 2011)
o Cannot afford private health insurance
o Do not qualify for public health insurance program (e.g.
Since the United States healthcare system is a capitalistic
system, healthcare providers may practice wherever they
* However, many providers choose to live in cities or
areas, which creates a problem for poor and rural
The dispersion of healthcare frequently limits accessibility to
* People in rural communities have poorer health status and
greater needs for primary health care, yet they are not as
well served and have more difficulty accessing healthcare
services than people in urban centers.
* Additional health care concerns have included quality of
care, specialization of services, ambulatory care, and
emergency treatment, all factors that have definitetly
impacted the health of rural persons.
Access- Medical Decisions
Medical decisions in the United States are often rationed
based on price and ability to pay.
* If one cannot afford private health insurance, they are
frequently unable to access healthcare unless covered by
a government program.
* Medical decisions are not always based on whether
one patient needs a particular treatment more than
another; it is determined by who will pay for it.
* Example: If one can afford a private health insurance plan
that will cover heart surgery, that person will have
to heart surgery.
Access- Medical Decisions
Regardless of whether or not they are medically qualified,
health insurance companies also make medical decisions.
* Although health insurance companies are not making
diagnosis, they determine whether or not a treatment
* Health insurance companies are not trained in the
field, yet they have a lot of control over patients'
Adler, N.E., & Newman K. (2002). Socioeconomic Disparities In Health: Pathways And Policies. Health Aff.
Betancourt J.R., Green A.R. (2011). Chapter e4. Racial and Ethnic Disparities in Health Care. In: D.L.
Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of
Internal Medicine, 18e. Retrieved October 23, 2011 from http://www.accessmedicine.com
Bodenheimer TS, Grumbach K. (2011). Chapter 3. Access to Health Care. In: T.S. Bodenheimer, K.
Grumbach (Eds), Understanding Health Policy: A Clinical Approach, 5e. http://www.accessmedicine.com.
US Census Bureau. (2011). Income, Poverty, and Health Insurance Coverage in the United States, 2011.
1. Health Indicators
2. Focus of Care
3. Technology/ Treatment
* Global Rating: 37
* Life Expectancy: 78 years and 2 months
* Infant Mortality: 6.42 deaths per 1,000 live births
* Gross Domestic Product (GDP) spent on healthcare: 16%
Focus of Care
* Primary Care
* Secondary Care
* Tertiary Care
Focus of Care
* Usually the first point of contact for a patient
* Typically provided by general practitioners/family doctors,
dentists, pharmacists, midwives, etc
* Most preventative health and early diagnosis can be
* Involves communicating with patients, going out into the
community, using outreach programs for promoting good health
and preventative strategies, and more
* Extremely cost-effective
Focus of Care
* Usually when a primary care person such as a doctor
a patient to a specialist
* Typically do not have continuous contact with patients
like primary care providers, but address more complex
* Specialized consultive care, often hospital care
* Often abused and most expensive
Focus of Care
The United States health care system is mainly focused on
secondary and tertiary care.
* Allocation of Funds
* Insurance coverage
Focus of Care
* In the United States, much lower in number
* Family physician
* In the United States, higher is number
* Requires additional schooling, more "prestigious," paid
* Pediatrician, Cardiologist, Surgeon
* The United States emphasizes research in comparison to
* The USA is the world leader when it comes to medical
innovation as well as converting new ideas into workable
Cowen, Tyler. "Poor U.S. Scores in Health Care Don't Measure Nobels and Innovation." The
New York Times. N.p., 5 Oct. 2006. Web. 22 Oct. 2011.
Jones, Andrew M., Nigel Rice, Silvana Robone, and Pedro R. Dias. "Inequality and Polarisation
in Health Systems’ Responsiveness: A Cross- Country Analysis ." Health, Econometrics, and
Data Group. The University of York, Oct. 2010. Web. 22 Oct. 2011.
Shah, Anup. "Health Care Around the World." Global Issues. N.p., 22 Sept. 2011. Web. 22 Oct.
"WHO Issues New Healthy Life Expectancy Rankings." Press Releases 2000. WHO, June
2000. Web. 22 Oct. 2011. <http://www.who.int/inf-pr-2000/en/pr2000-life.html>.
* More money per person is spent on healthcare in the USA
than in any other country in the world.
* To see a doctor in the United States (not in the ER), one
must have health insurance.
* Due to the emphasis on new technology advancements
and lack of emphasis on primary care, the USA has a
global rating of 37.