The Highest Level

OK... sorry for the delay getting started here, but other pressing matters reared their heads.

For this post, I wanted to give people a general overview of our big complicated healthcare system in the US. And it is big... and complicated... So how to do this in a simple couple paragraphs?

First start with these statements basically culled from wikipedia (where you can find the references for the comments I'm making)

• The United States is the only industrialized nation without national healthcare (we provide and pay for care through a hodge-podge of public and private entities)...
  
• We spend more per capita on healthcare than any other country in the world (according to the government, in 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person)...
  
• According to the World Health Organization (WHO), the healthcare we receive is mediocre at best (in 2000 the U.S. health care system was 1st in terms of responsiveness and expenditure, but 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study)...

So let's take each of these three topics as a post over the next few days...

Starting with the players in the healthcare system and how they relate to each other. These are the key players

• Providers: Provide the actual hands on-care
  
• Payors: Pay for the care given
  
• Vendors: Develop and sell the technology that supports care
  
• Overseers: Watch over the quality of care provided

Providers include: Hospitals (which can be public or privately owned; for-profit or not-for-profit; teaching or non-teaching; rural-, community- or big city-based), Specialty Care Clinics (such as Surgery Centers, Urgent Care Clinics, OB/GYN and others) and Long Term Care Facilities (including all sorts of nursing homes and rehab facilities, including hospice care centers). We also have non-public governmental provider systems (VA, DoD and Indian Health Service - all of which include hospitals, clinics and long term care facilities)

Payors include: Government-run insurance programs (Medicare for the elderly and Medicaid for the poor), private insurance (much of which is paid for by employers) and charity payors.

Vendors include: all entities that provide the tools, equipment, software, medicine and nutritional support products to make the system work.

Overseers include: governmental and non-governmental organizations tasked with accrediting, policy-setting and generally ensuring the quality of the system. There is a whole alphabet soup of these organizations. The key ones are:

• JCAHO - Joint Commission for Accreditation of Healthcare Organizations
• CMS - Centers for Medicare and Medicaid Services
• USP - United States Pharmacopoeia
• AHRQ - Agency for Healthcare Research and Quality

So this gives you an idea of who the players are. Next post will look at how these players interact...

-Charles