You're best off skimming Paul Starr's Social Transformation of American Medicine, but I'll give this a shot. Let's start with insurance:
Medicare is a state and federal program created in 1965 to provide health insurance for anyone 65 and older (and those in kidney failure, bc some politician's son/daughter had it and made a big deal about it, so it covers that too). It has two parts, one of which is mandated and the other which is "optional." Medicaid is a state and federal program for the poor ("poor" might vary from state to state and is probably based on the FPL, you may want to check on that). Medicare is by far the largest purchaser of health care services today - thus, if someone tells you that we don't have a government run health care system, they're wrong; government run health care plays a tremendous role in our hc system. So those are the two government run health insurance programs... variations include CHIP and other state programs (for instance, NJ has NJFamilyCare).
So what do you do if you're not poor enough to qualify for Medicaid or old enough to qualify for Medicare? You go through the private market and get managed care coverage. (Since everyone needs health insurance, employers decided it would be best for insurers to go through them - this gave employers tax benefits and also kept workers healthy) Managed care evolved as early as WWII but really took off in the late 1970s due to escalating hc costs. Until the rise of commercial health insurers (which was linked to the idea that one could actuarilly predict health expenditures for an individual based on demographics, past medical history, etc) doctors were paid on a FFS (fee-for-service) basis using indemnity insurance. This meant that doctors could get reimbursed by your insurance company for all tests provided. Doctors, who saw green, ran up costs by ordering full workups. If you went in for a broken leg, you could get a chest xray and all sorts of blood work done while you were at it. So this was all happening when the economy started going sour in the 70s. Economy bad = employers not doing so well, and meanwhile they have these absurdly high hc costs to pay for their workers. Enter commercial insurers. Employers and consumer groups put pressure on the government to do something about health care costs. In 1983, the government decided payment under Medicare (remember, this is the largest consumer) would be based on prospective payment, or DRG (diagnostic related group). Physicians would get a certain amount of money, revised every yr by the fed govt., for each condition, and that's it. Well you better believe this got doctors shipping patients out of hospitals damn quickly. DRGs were sucessful in intially cutting hospital costs and length of stay in hospitals. (on a side note, most studies indicate that quality of care was not lowered post DRGs). In addition to DRGs, insurance companies began doing utilization reviews (did this pt really need this test you ordered doc? if not, we're not gonna pay you as much) and requiring referrals from primary care physicians for tests ("gatekeeping"). HMOs, and variations thereof (based on flexibility in seeing specialists, premiums, etc) were tremendously successful at lowering costs. Initially. But administrative costs eventually soared and people caught on. Premiums (the amount you pay to your insurer every month in return for insurance) have now begun to skyrocket, meaning managed care is no longer successful at maintaining costs. This is probably bc people are getting older and sicker, as well as many other contentious issues relating to drivers of high cost health care (pharma, mktg, excessive use, etc). We are now in the midst of the "managed care backlash" which began in the late 1990s. 40M+ ppl (the entire population of Spain) are uninsured in America, but most of them are employed, meaning their employers aren't offering health care. Those that are unemployed aren't poor enough to qualify for Medicaid. Some state laws require hospitals to care for patients regardless of insurance status. ALL hospitals must provide emergent care to patients regardless of hospital status. Almost every study indicates the uninsured are sicker.
So that skims insurance.. I think they might ask you about malpractice. Directly, malpractice doesn't contribute significantly to health care costs, but it might indirectly. The problem is that there is a significant lag between when a doctor's malpractice premiums increase and when he/she can pass that cost on to patients, bc health insurers won't immediately cover increased costs. So this basic supply-demand problem leads to a shortage in certain specialties (OB and neuro i think). Malpractice is a cyclic problem, it comes and goes as a political issue every 10 yrs or so. The bigger problem is the affect it is having on doctor-pt relationships. Most hospitals cover malpractice insurance for their doctors, i think.
Finally, they might ask you about pharma. This is a loaded topic, you can look into it on your own. Basically, they spend as much or more on marketing as R&D. One can argue they need to, otherwise no one would no abt these drugs, which begs the question of whether the FDA should be informing physicians about drugs instead of pharma doing it and increasing the cost to pts. Pharma also does a lot of dirty things with patent extensions, which you can look into. Medicare didn't cover prescription drugs, which is why Bush signed into law the prescription drug modernization act. it has its +'s and -'s, although most academics think more -'s. It encourages overuse and has a big gap in coverage after a certain amount of money is spent on drugs. Also, it's confusing as hell for old folk.
So insurance, malpractice, and pharma... thats pretty much all they can ask you on the health care system and expect you to know. Other stuff you obviously have to formulate your own opinion (Terry Shavio sp?, etc). PM me if you have questions. Hope this helps
