Major Characteristics of the U.S. Health Care System Part 1

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In this video, Monika Wahi lectures to Laboure College students in her Fundamentals of the US Healthcare System class.
Want to follow along? Get “Essentials of the US Healthcare System” by Shi and Singh: https://www.amazon.com/Essentials-U-S-Health-Care-System/dp/1284126137
Want to download the slides? Go here: https://buff.ly/3KUeJHW

NOTE: I unfortunately had a mishap and accidentally put blurs where there should not be blurs. I could not remove them, I apologize. Please make sure you download the slides so you can see what it says behind the blur!

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I listed the links I mention below as they come up in the lecture. Enjoy!
00:16 How the two lectures over Chapter 1 relate to each other (this is the first video; here is the second: https://youtu.be/OsE_eliWyVQ )
01:12 Learning objectives
01:28 Introduction – definition of healthcare and health service delivery, and primary objective of healthcare systems
02:13 How the United States (US) healthcare system is different from other healthcare systems around the world in other countries – lack of “universal access”
03:01 Case study: What happens when an American tourist traveling in the Bahamas becomes injured and has to utilize healthcare services there?
03:57 Explanation of textbook used, timing of lecture, and “systems framework” – the system is not really connected
04:51 Subsystems in the US healthcare system – examples of system components
05:55 Managed care subsystem and as a philosophy.
06:46 Managed care organizations (MCOs) in the US operate like insurance companies
07:23 Financing in MCOs – capitation, discounted fees, insurance, delivery and payment
09:14 Terms in MCOs – enrollee and health plan, and the relationship between them
10:18 Graph of number of Americans on MCO plans in 2009 – HMOs, PPOs, POSs, and HDHPs – more information available here: https://www.ncsl.org/research/health/health-insurance-plan-types-and-definitions.aspx
11:06 Managed care integration of functions – diagram of moral hazard of provider-induced demand
12:22 The insurance sets up risk underwriting, capitations or discounts, and utilization controls
13:36 Case example: Hennepin Health: https://www.hennepinhealth.org/
14:07 Military US healthcare subsystem
14:53 Characteristics of the military US healthcare subsystem
15:26 Explanation of TRICARE: https://www.tricare.mil/ Includes treatment at military treatment facilities (MTFs) and civilian facilities
16:08 Explanation of the Veteran’s Administration (VA) system: https://choose.va.gov/
16:37 How the VA healthcare system is organized nationally into Veterans Integrated Service Networks (VISNs)
17:12 Explanation of the Bureau of Primary Health Care (BPHC): https://bphc.hrsa.gov/ …inside the Health Resources Services Administration (HRSA): https://www.hrsa.gov/ …inside the Department of Health and Human Services (DHHS): https://www.hhs.gov/
Also covers the populations served by BPHC.
18:31 Statistics about how community health centers supported by the BPHC served their populations in 2010
20:18 Public health insurance -statistics about Medicare, Medicaid and Children’s Health Insurance Program (CHIP)
22:50 Characteristics of the safety net healthcare system in the US
23:25 Case study: Pain patient who responds to acupuncture, but not medication, trying to use the safety net
24:33 Explanation of the problem of Medicaid not allowing cost-shifting (with example)
25:29 Case study: “Komen for the Cure” faced funding issues with Planned Parenthood (see https://buff.ly/33HbVO8 )
29:01 IDS case study: Allina Health https://www.allinahealth.org/
30:26 Long-term care (LTC) subsystem description – and the problem of disconnection from IDSs
32:49 Monika’s favorite subsystem – public health! Description of all the functions of public health – and how and why public is barely getting done in the US.
37:42 Case examples in US public health: The Centers for Disease Control and Prevention (CDC) develops our annual flu vaccine, and the Behavioral Risk Factor Surveillance System (BRFSS) monitors chronic disease in the population.
39:02 Information on accessing BRFSS datasets: https://dethwench.com/guide-to-downloading-brfss-data/
39:16 Conclusion – Subsystems are loosely connected through MCOs, the safety net subsystem, and IDSs
39:51 Repeat of learning objectives

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