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Relationship Between Public Health & U.S. Healthcare

Instructor: Daniel Murdock

Daniel has taught Public Health at the graduate level and has a Ph.D. in Behavioral Sciences & Health Education.

This lesson explores the interface between public health and the U.S. healthcare system. We examine the role of public health in healthcare organization, financing, and delivery in the United States.

Public Health

What comes to mind when you hear the term 'public health'? Some of us may hear this term and think about vaccination programs. Others may hear it and think about sanitation and clean water initiatives or health services for the poor. In fact, public health has a wide range of real-world applications.

Public health is the science of promoting health and preventing disease and injury at the population level, from local neighborhoods to entire countries and regions of the world. The public health approach relies on systematic data collection to monitor population health and identifies underlying causes of disease. Public health professionals use this information to develop evidence-based health policies and intervention programs.

In this lesson, we'll examine the relationship between public health and the U.S. healthcare system. We'll explore the role of public health in the organization, financing, and delivery of healthcare in the United States.

A doctor gives a child a vaccine
Doctor and child

Healthcare Organization

The U.S. healthcare system is structured as a mixed health system, in which healthcare services are provided through a mix of public and private systems. Most U.S. healthcare professionals practice independently or in groups. Most hospitals and other healthcare facilities in the U.S. are privately owned organizations. Some publicly operated healthcare facilities, such as military hospitals and Veteran's Administration facilities, also provide care in the U.S. system.

The largely privatized and decentralized nature of the U.S. healthcare system carries significant public health implications. The U.S. system is more heavily influenced by market forces compared to other systems that exercise more centralized government control.

An advantage of this system is that it encourages healthcare innovation by promoting competition among health service providers. This can lead to the development of new health technologies, such as health screening tools, that can be used to address public health concerns.

A disadvantage of this system is that market forces can create healthcare disparities between different population groups. Healthcare disparities refer to differences in our access to or the availability of healthcare facilities and services.

This can happen in two ways. First, patients without health insurance are often unable to access care from private providers. Second, the new health technologies that arise from market competition often prioritize 'profitable' health conditions and the healthcare needs of populations with access to private care.

Healthcare Financing

U.S. healthcare is financed by a mix of government programs, private insurance, and out-of-pocket expenses. Most U.S. residents receive primary healthcare coverage through private insurers, most often in the form of employer-sponsored health insurance. Approximately one-third of U.S. residents are covered under public insurance programs like Medicare and Medicaid.

In 2015, government spending on Medicare and Medicaid accounted for the largest share of U.S. healthcare spending (20% and 17%, respectively). Private health insurance accounted for a third of U.S. health spending in 2015, while out-of-pocket expenses accounted for 11%.

President Lyndon Johnson signs the Medicare bill in 1965
President Lyndon Johnson signs Medicare

So, why does the government spend so much on public insurance that only covers a third of U.S. residents? Medicare and Medicaid are public health programs that were established to address healthcare disparities among low-income, elderly, and disabled Americans. These programs cover populations that are, on average, older and sicker than the U.S. population as a whole. Older and sicker people tend to use more healthcare, which leads to higher per-person insurance costs.

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