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Chapter 1

Introduction

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Constant Changes
Delivery mode

Treatment methods
Applications of technology

Payment mechanisms

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Constant Changes
In the 1900s
Patients were treated at home

Hospitals were places to die

Now, hospitals are

The preferred choice for care Places for medical training

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Health Care Providers

Physicians and hospitals Home health care agencies Nursing homes

Dentists
Rehabilitation organizations and therapists Chiropractors
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System Integration
Horizontal Integration
Similar services to broader area

Hospital mergers

Vertical Integration
Combine a wider range of services Health systems

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Health Care Payers

Prepaid care in the 1930s Employment-based health insurance Medicare and Medicaid

Retrospective payment to prospective

payment
(continued)
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 Managed Care
Case management Comprehensive care Efficient and effective Primary care physicians Health maintenance organizations

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Patients
Health care consumers Consumers make informed decisions about
Health insurance companies Hospitals Providers

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Change is Constant
Technology Policy Societal needs

Prevention
Personal preferences

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Population Health
Public health sector Community not individuals Chronic care issues

Lifestyle issues
Disparities

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Summary
Cost of care Evolution of payment mechanisms Health status of the U.S. population

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