By Leiyu Shi, Douglas A. Singh
This undergraduate textbook outlines the elements of the U.S. future health care supply method, its historic origins, the outpatient and first care providers, inpatient care amenities, and the criteria at the back of escalating expenditures. The 3rd variation displays contemporary information and examine findings, and tackle
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Additional info for Delivering Health Care in America: A Systems Approach (3rd Edition)
18 Chapter 1 • A Distinctive System of Health Care Delivery High Technology The United States has been the hotbed of research and innovation in new medical technology. Growth in science and technology often creates demand for new services despite shrinking resources to finance sophisticated care. People generally want “the latest and the best,” especially when health insurance would pay for new treatments. Physicians and technicians want to try the latest gadgets. Hospitals compete on the basis of having the most modern equipment and facilities.
Theoretically at least, prices are negotiated between the payers and providers. In practice, however, prices are determined by the payers, such as managed care, Medicare, and Medicaid. Because prices are set by agencies external to the market, they are not governed by the unencumbered forces of supply and demand. For the health care market to be free, unrestrained competition must occur among providers on the basis of price and quality. Generally speaking, free competition exists among health care providers in the United States.
The term enrollee (member) refers to the individual covered under the plan. The contractual arrangement between the MCO and the enrollee—including the collective array of covered health services that the enrollee is entitled to—is referred to as the health plan (or “plan,” for short). The health plan uses selected providers from whom the enrollees can choose to receive routine services. This primary care provider—often a physician in general practice—is customarily charged with the responsibility to determine the appropriateness of higher level or specialty services.