The Health Care Industry
In the United States, cost containment and reimbursement pressures are driving a shift away from fee-for-service to value-based reimbursement. Medicare and Medicaid provide coverage to an increasing percentage of the population, but reimburse physicians at low rates relative to private-plan costs. As a result, independent hospitals and physicians are increasingly joining health systems and becoming salaried employees of hospitals. The shift to value-based reimbursement will not occur overnight. But it’s an inevitable outcome of an unsustainable health care system.
In a multidisciplinary health care system, clinicians from various disciplines devote significant time to a single patient’s health problem. The team views itself as part of a common organizational unit. During the course of treatment, the team takes on the responsibility of integrating patient education and engagement. The care team operates under a single scheduling and administrative structure, and a physician captain oversees the process. The health care system should also measure costs and outcomes across care settings, rather than focusing on the costs alone.
In the United States, the proportion of out-of-pocket health care spending by households is similar to the government’s share. In 2018, one-third of health care spending was borne by individuals. For those without health insurance, out-of-pocket spending represents ten percent of total spending on health care. Deductibles for health insurance policies vary greatly. In 2018, the average deductible for a single person was $1,846. In addition to deductibles, some health plans cover primary care visits before the deductible is met, while others require a copayment.
Measurements of quality have shifted to clinical indicators and processes that are easier to measure. However, in many cases, these metrics don’t measure quality, but instead capture compliance with practice guidelines. In diabetes care, providers measure the accuracy of LDL cholesterol tests and hemoglobin A1c levels. In contrast, patients care about the risk of amputation, dialysis, and vision loss. Therefore, a comprehensive set of health care outcomes is needed.
Several sectors comprise the health care industry. These sectors include hospital activities, medical practice activities, and “other human health activities” that includes allied health professionals. Global Industry Classification Standard (IICS) includes biotechnology and drug manufacturing. The definitions of these sectors are broad and varied, with each having its own meaning and applications. Further, healthcare includes several related industries. The health industry is made up of medical professionals, organizations, and the public.
The OECD countries have a correlation between healthcare spending and life expectancy. While it’s not an exact science, it does show a correlation. The amount of money spent on health care is often expressed as a percentage of GDP. In OECD countries, health care spending is a significant factor in life expectancy, but life expectancy alone is not an adequate measure of healthcare performance. Many countries have implemented various healthcare systems based on this theory.
Healthcare access is an important determinant of good health, but access varies from region to region and from person to person. Social, economic, and health policies all influence the availability of healthcare resources. Poor nutrition, too much high-fat fast food, lack of physical activity, and sexual irresponsibility limit access to good health care. Poor access to health care can be impacted by geographic and financial barriers, and may even affect the efficacy of medical treatments.
