HSCI 678 Intro to US Health System

Organization of the US Health Services System

Chapter 4

T L Koehlmoos, PhD, MHA

Adjunct Professor

Health Services Organization

• Central component of the Roemer Model

• Ministry of Health, Public Health, Private Market

• USA– No centralized Ministry of Health – Department of Health and Human Services– Regulation and Finance of some healthcare– Most personal care in Private Sector

Public Health

• Public Health = Population Health• Emphasizes: Prevention, Promotion,

Reporting, Environmental Factors, Collection of Vital Events

• Although some public health facilities deliver personal care (vaccines, STD, HIV/AIDS), most personal care is in the private sector.

Public Health: Nationally

• Department of Health and Human Services

• Cabinet-level position

• Public Health Service (PHS)– CDC, FDA, HRSA, NIH, SAMSHA, AHQR

• Public Health Service: “To prevent unnecessary disability and disease and to achieve a better quality of life for all Americans”

CDC

• Centers for Disease Control and Prevention• Atlanta, Georgia• Birth Defects and Disabilities• Chronic Disease and Health Promotion• Health Statistics, Global Health• Infectious Disease (STD/HIV/TB Prevention)• National Immunization Program• National Inst for Occupational Safety & Health• And much more!

Other Important DHHS Agencies

• Food and Drug Administration—– Food, cosmetics, drug, device safety

• Health Resources and Services Admins.– Development of healthcare workforce– National Practitioner Database

• National Institutes of Health– Biomedical Research/ Technology assessments– National Library of Medicine

More DHHS Agencies

• Substance Abuse and Mental Health Services Administration

• Indian Health Service• Agency for Healthcare Research & Quality

– Cost, Quality and Access– Patient Outcome Research Teams– Several National Databases

• CMS-Centers for Medicare and Medicaid Services (formerly HCFA)

State Level Public Health

• Vary widely from state to state• Funded by State and by federal block grants• Most likely to focus on:

– Vital Statistics– Public Health Education– Environmental Sanitation– Public Health Laboratories– Prevention & Control of Communicable Disease– MCH (if no other available)

Local Level Public Health

• City, county, multi-city or –county

• Wide variations

• Common functions:– Assess and monitor local health problems– Provide policy and leadership– Ensure high quality services– Protection of public health at the local level– Various means of financial support

Other Ministry Level Health Functions

• Department of Defense

• Department of Veterans Affairs

• Department of Justice

• Drug Enforcement Agency

• Department of Agriculture (WIC)

• Department of Labor

• Environmental Protection Agency

Voluntary Agencies

• Disease Specific– March of Dimes, ACS, AHA

• Population Specific– AARP, Children’s Defense Fund– Red Cross

• Professional Associations--AMA

• Philanthropic Foundations--RWJohnson

• Religious Groups

Enterprises in US Healthcare

• Enterprises: health functions sponsored by non-health businesses – Occupational Health Clinics– Fitness Centers at work– Substance Abuse programs at work

The Private Market

• In US most healthcare delivered in private sector

• Medical Equipment and Devices

• Pharmaceuticals and supplies (10% of US total healthcare expenditures)

• Health Insurance

• Training the Workforce (Public/Private)

Conclusion

• The US Healthcare System is complex and decentralized

• DHHS is the equivalent of a Ministry of Health in the Roemer Model

• Combination of national, state and local public health services

• Private Market is responsible for the delivery and production of most care in the US