National Healthcare Expenditures

National Healthcare Expenditures

• In 2014, the U.S. spent over $3 trillion on healthcare, accounting for 17.5% of the GDP
• Healthcare spending growth exceeds economic growth due to rising medical costs, aging populations, and system inefficiencies

Drivers of Healthcare Expenditures

• Aging populations needing chronic disease management and long-term care increases expenditures
• Advancements in technology and pharmaceuticals can increase expenses but may enhance treatment
• Focus on specialized treatment over primary care raises healthcare costs
• Lack of insurance coverage leads to delayed treatment and higher costs
• A shift towards value-based care models ties payments to patient outcomes instead of service volume
• The healthcare sector requires a large, costly workforce
• Inefficiencies, fraudulent claims, and unnecessary procedures cause billions in losses yearly

International Comparison of National Health Expenditures

• The U.S. spends a higher percentage of its GDP on healthcare but has worse health outcomes versus other developed countries
• Universal healthcare systems usually have lower costs and greater efficiency

Insurance

• Health insurance helps individuals cover medical costs
• Basic concepts include premiums, deductibles, co-pays, and out-of-pocket maximums

Private Health Insurance

• Private health insurance evolved from employer-sponsored plans to commercial insurers and managed care organizations

Managed Care

• Preferred Provider Organizations (PPOs) offer flexible provider choices but tend to be more expensive
• Managed care models were created to control costs and improve efficiency, leading to HMOs and PPOs
• Restrictions on specialist access and denial of necessary care caused consumer dissatisfaction and regulatory changes

Employer-Sponsored Health Insurance

• Most Americans get health insurance through employers
• Employers and employees share costs, but coverage varies based on company size and industry

Public Insurance

• Medicare is a federal program covering individuals 65+ and certain disabled individuals
• Medicare Parts include:
  • Part A (hospital insurance)
  • Part B (medical insurance)
  • Part C (Medicare Advantage)
  • Part D (prescription drugs)
• Medicare cost control began in the 1980s with the Prospective Payment System (PPS)
• Continued reforms include pay-for-performance and Accountable Care Organizations (ACOs)
• Medicaid is a state-federal program providing health coverage to low-income individuals
• The Children's Health Insurance Program (CHIP) covers children in low-income families who don't qualify for Medicaid
• The Indian Health Service (IHS) provides healthcare for Native American populations
• The Veterans Health Administration (VA) offers comprehensive healthcare for military veterans.

Uninsured Population

• Despite insurance options, millions remain uninsured because of high costs, employment gaps, or ineligibility

Future of Healthcare Financing

• The future involves a shift toward value-based payments, increased government regulations, and new insurance models

Healthcare Workforce

• The healthcare workforce includes physicians, nurses, allied health professionals, and administrators
• All are essential to healthcare delivery

Healthcare Professionals

• Interdisciplinary collaboration improves patient outcomes and system efficiency
• Medical decisions should be rooted in research, expertise, and patient preferences
• Licensing ensures healthcare providers meet standards and remain competent

Healthcare Occupations

• Physicians diagnose and treat illnesses, often specializing
• Nurses provide direct care, administer medication, and coordinate treatment plans
• Physician Assistants (PAs) work under physicians to diagnose, treat, and prescribe medicine
• Psychologists specialize in mental health and behavioral science

Allied Health Professionals

• Technicians and Technologists operate equipment and assist in diagnostics
• Therapeutic Science Practitioners include therapists
• Behavioral Scientists study mental health, public health, and human behavior

Factors Influencing Demand for Healthcare Professionals

• Rising chronic diseases needing long-term care creates more demand for specialists
• Primary care shortages can co-exist with specialty surpluses
• Technology creates new roles and replaces old ones
• Expansion of outpatient and home-based care drives demand
• Large healthcare systems are replacing independent practices, changing workforce needs

Emerging Trends in the Healthcare Workforce

• Efforts are being made to create a diverse and representative healthcare workforce
• Employee wellness programs aim to reduce burnout and improve work-life balance

Future of the Healthcare Workforce

• Expect continued shortages, increased technology use, and policy changes to address healthcare disparities

Ambulatory Care

• Ambulatory care is outpatient care that doesn't require hospitalization
• This sector has grown because of cost-efficiency and patient convenience

Private Medical Office Practice

• Most healthcare providers see patients in offices for routine care, diagnosis, and treatment

Integrated Ambulatory Care Models

• Patient-Centered Medical Homes (PCMHs) are a coordinated care model to improve patient outcomes

Hospital Emergency Services

• Hospitals provide 24/7 emergency care, but many non-emergency visits could be handled in urgent care centers

Non-Hospital-Based (Freestanding) Facilities

• Urgent Care Centers provide immediate care for non-life-threatening conditions
• Retail Clinics are in pharmacies and supermarkets for quick, routine medical care
• Ambulatory Surgery Centers perform same-day surgeries
• Federally Qualified Health Centers (FQHCs) offer affordable care to underserved populations