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U.S. health care system

Discussion in 'Pre-Medical - MD' started by jimjones, Oct 5, 2001.

  1. jimjones

    jimjones Senior Member
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    As a Canadian, I know embarrassingly little about the US health care system. I have interviews at US schools coming up, and obviuosly will need to know this. I don't know what an HMO is, what managed care means, etc. Can you guys give me a crash course? or point me to a good web site? THanks a ton. :)
     
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  3. none

    none 1K Member
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    Quite honestly, I'm thinking they're going to be interested in your take on socialized health care. Think about your answers regarding that very carefully.
     
  4. simpleton

    simpleton Senior Member
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  5. HairlessHeart

    HairlessHeart Member
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    I don't know a website, so here's a CRASH course.

    Managed Care in general refers to utilization control. This can take the form of simple case review by the insurance company or it can be much tighter. For example, requiring pre-approval for certain procedures or hospitalization and capitation (paying the physician a fixed rate per memeber per month). Managed care firms negotiate contracts with physicians and hospitals so they can receive discounts for their members.

    A HMO is usually characterized by the dreaded gatekeeper physician and extensive utilization control. The gatekeeper must approve all specialty referrals and hospitalizations. People enrolled in an HMO are only covered to see physicians who are members of their HMO. Not all HMOs use capitation, and not all are closed-staff.

    The range of health insurance from regular fee-for-service to closed-staff HMOs is very complex. A popular "mid-range" alternative is the preferred provider organization (PPO). This is basically fee-for-service except the insurance company contracts out a network of physicians to obtain discounts. There is no gatekeeper, and a member can see physicians outside the network if they choose, but it does cost extra to do so.

    I hope this basic information helps get you started. The system here is ridiculously complex and people could write for days on this topic.
     
  6. rhwave

    rhwave Junior Member
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    I agree that the US health care system is ridiculously complex...

    A couple web sites to check out: http://www.ncpa.org/pi/health/
    addresses the major issues involved in health care policy. There is a TON of information here...gets a little annoying because you have to go through about half a dozen menus to get to an actual article, but it's probably the best place to get background info and read up on current/proposed policy for most issues.
    http://www.pbs.org/healthcarecrisis/index.htm
    is the site that accompanies the PBS series about health care in America. It actually isn't as good as some stuff I've seen from PBS (it's heavy on patient stories and could use more discussion of the issues), but it is a place to start. The medicare section is good.

    and finally http://www.opensecrets.org/news/mcare/index.htm
    is a petty good discussion of managed care (HMOs).


    Good luck
    :)
     
  7. SMW

    SMW Grand Member
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    Thanks, simpleton, HH and rhwave! I appreciate the info and the links. :)
    Welcome to SDN, HH and rhwave!! You're going to love it here! :D
     
  8. SIXTHSENSE

    SIXTHSENSE Junior Member
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    I agree that they would be more interested in answers about socialized medicine rather than your take on HMOs. But you could probably check out the AMA's website and maybe even the DNC's website as well ;)
     
  9. E'01

    E'01 1K Member
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    Status:
    Medical Student
    Advantages:

    1. Cost containment
    2. Health care coverage for all
    3. Portable coverage among all provinces)
    4. Freedom of providers
    * A public system can remove financial barriers and does not necessarily mean that the government provide the services or control the institutions directly.

    Disadvantages:

    1. Less technology utilized (even though there's no evidence that high tech. care leads to higher quality care. Canada distributes it more appropriately and equitably though.

    2. Drug spending has increased due to the following: not all provinces have universal drug plans; the Canadian goverment has provided special status to the brand-name pharmaceuticals protecting them from competition; increased reliance on expensive drug therapy; there's a higher proportion of Canadian doctors versus U.S. doctors that are paid via fee-for-service. This leads to excess costs due to the financial incentive to provide more and costly services.

    Hope this helps :)
     

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