Structure of the U.S. Healthcare System

Instructor: Anthony Santillanes

I'm Anthony with a Bachelor's in Health and Wellness, a Master's in I/O Psychology, and have led multiple adult training events.

This lesson focuses on the stakeholders in the U.S. Healthcare System and gaining an understanding of their relationships with one another. Emphasis is also aimed at defining health, community, and health services administration.

The U.S. Healthcare System

The U.S. healthcare system (USHS) is a complex, $3.2 trillion machine consisting of several components that when combined, provide healthcare services for the 300+ million Americans living here today. You've participated in this system anytime you went to the doctor, dentist, bought health insurance, or received any other health treatment. When you scheduled the visit, completed the examination or care, spoke with your insurance company, and if required, spoke with your employer regarding your care, you interacted with all of the stakeholders of the USHS. Before we get too deep into the stakeholders, let's first review a few definitions and then discuss the major components of the USHS.

Community, Health, and Health Services Administration

It is important to understand how community, health, and health services administration are defined as it relates to the USHS. Community refers to a group of people who either through close proximity to one another and/or shared characteristics, are considered similar and for healthcare purposes, carry similar health risks. We tend to belong to multiple communities due the nature of this definition. For example, you belong to the community in which you're physically located. You carry similar health risks to those physically located around you due to shared public water providers, grocery stores, public venues, proximity to medical resources, and weather conditions. You also belong to communities in which you share ideals or beliefs. You may share values with a community of people who don't believe in consuming particular foods and beverages, or engaging in certain activities and thus, you share similar health risks with them.

Health can be described as the physical and mental state of an individual or community; it can also be defined as a general lack of poor health condition(s). Health services administration (HSA) applies to those activities to promote health at the individual and community levels. HSA occurs from the moment you call to schedule an appointment to the final payout for services either by you or your insurance provider. A number of people are involved in HSA that include receptionist, doctors, specialists, nurses, administrators, attorneys, quality management professionals, consultants, and you. There are also multiple organizations involved including hospitals and treatment facilities as well as insurance providers. It is the goal of health service administrators and those organizations that are apart of it to promote the health of individuals and communities in order to increase their well-being and reduce future medical expenses.

The Stakeholders of the USHS

The stakeholders in the USHS are: the patient; the provider; the employer; and the payer. Assuming you're not a doctor providing medical care to yourself, you will most often times fall into the patient role. This role is seeking care and so is most interested in care and cost effectiveness. That is, you want to know that the care you're receiving is going to cure/prevent/reduce your current ailment and/or future conditions first, then at the lowest cost possible.

Providers are those individuals providing care in roles such as doctors, dentists, and nurses. This group is more often concerned with quality of care rather than costs. They are interested in ensuring the diagnosis and subsequent treatment(s) are accurate and effective. This is not to say that they aren't interested in costs at all, but only that the priority for this group is effective care of the patient.

Many employers today provide insurance options for full time employees and so they are considered a significant stakeholder as well. An employer is any person or organization that pays for services from an individual that provides insurance coverage as well. If you think about your car as an employee that transports you to and from locations (e.g. success, profitability, new customers) you can quickly see why the employer tends to focus on the expedient and low cost recovery. You don't want your car in the shop for any longer than it has to be and you don't want to pay for repairs that aren't necessary or effective and neither does the employer.

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