MMI 401 - American Health Care System

Course Description:

This course served as an introduction to elements of the American Health care system including the provider components, the financing of health care, the basic structure of public policy making and public health systems, comparative analysis of the American system to the health care systems of other countries, and the legal and regulatory framework within which the American health care system functions. In addition to the structural components of the system, the course will review some of the current issues within the American health care system including public health, preparedness, quality of health care, pay for performance, and consumerism.

Professor: Margaret F. Schulte, DBA, FACHE, CPHIMS Editor, Frontiers of Health Services Management
Term: Winter 2010
Grade: A
Text: Health Care Delivery in the United States, 9th Edition by Anthony R. Kovner, PhD and James R. Knickman, PhD, 2005 Springer Publishing Co., Inc.

Learning Objectives:

  • Organizational structure of a healthcare organization
  • Tax exempt status of healthcare organizations/community benefit
  • Electronic Health Records
  • Healthcare Reform
  • Pharmaceuticals
  • The Medical Home
  • Emergency Transfer and Active Labor Act (EMTALA)
  • Healthcare for the uninsured/underinsured
  • Medical Malpractice
  • Workers Compensation
  • Ethical issues in financial management
  • Fraud and abuse
  • Disruptive behavior in the clinical setting
  • HIE’s
  • Issues of integration and interoperability in healthcare IT
  • Other healthcare IT issues
  • HIPAA/Privacy and Security
  • Health status and impact of financing mechanisms on the health status
  • Sarbanes/Oxley and its impact on healthcare financial reporting
  • Medicare Part A | Medicare Part B | Medicare Part C | Medicare Part D
  • Medicaid
  • Financing care for veterans
  • Balanced Budget Act of 1997
  • Philanthropy in healthcare financing
  • Coding
  • Medical Savings Accounts
  • Consumer driven health plans or High Deductible Health Plans
  • Certificate of need (CON)
  • P4P initiatives
  • Financing of long term care in nursing homes
  • Financing of rehabilitation services
  • Financing of home health care
  • Hospice care
  • Long term care insurance
  • Prospective payment, changes in it, and impact on providers
  • DRGs
  • Ethics issues
  • Global issues in healthcare delivery
  • Health Reform

What I Learned:

My journey into Medical Informatics began with this class.  I was new to the healthcare industry, and I had little perspectives beyond that of a consumer of healthcare services. This class helped me quickly realize how naive my assumptions was in thinking that the United States was a leader in healthcare, to which the world looked upon as an example. As I progressed through the class, I discovered that in fact, things are quite the contrary.The class helped me understand the fragmented delivery system that persists, opening my eyes to the challenges that exist in the U.S. healthcare system.For example, our nation is among one of the worst in terms of money spent per capita on healthcare, and one of the lowest in terms of utility given back for every dollar spent. Additionally, it was in this class that I internalized what it means to "improve patient outcomes".

Students coming into the program with a previous technical background but no clinical expertise were introduced to the clinical perspective through two introductory clinical thinking classes. Conversely, clinically-grounded students with no technical background were required to take classes in computer networking and databases.   These two separate tracks laid the foundation for convergence between the technical and clinical worlds so that students from either could work effectively together to understand the broad landscape of medical informatics. This is significant because I believe that perspectives from both worlds are necessary to ensure that delivery of healthcare services in the U.S. is efficient, of better quality, cost-effective, more accessible, and timely.

The curriculum for the course was well-defined by Professor Schulte and provided a structured approach to learning about healthcare in the United States. The course begins by studying the historical aspects of the U.S. healthcare delivery system. I found this fascinating, since I work on the Payer side, and thus I gained a better understanding of the historical role played by Payers, and how it has contributed to our current state. One of the most impactful readings was from an American Physician by the name of Atul Gawande with his article entitled "The Cost Conundrum: What a Texas Town can teach us about health care". From here, I dove deeper into the healthcare continuum to understand the structural aspects of our delivery system. I learned about the professional roles undertaken by nurses, physicians, clinicians, and how institutional providers interact with one other in the workforce.  Furthermore, I explored the financial dimensions of healthcare including public and private funding sources from Federal and State organizations that includes Medicare, Medicaid and all their parts, as well as payers, employers, and individuals. I also learned about the complexity of providing services to uninsured/underinsured and indigent populations.  Finally, my understanding of healthcare delivery would not have been complete without exploring deeper the legal barriers to healthcare such as the legislative and regulatory impacts imposed by Federal and State governments.

Building upon these foundational elements, I was able to take my newfound knowledge and write a comparative analysis paper between the U.S. healthcare system and that of another country.Having friends in Europe, I chose to seek an understanding for how their delivery system was setup.  Consequently, I wrote an analysis of "Healthcare in the United Kingdom".I learned that socialized healthcare differs greatly from what we have in the United States. For me, this offered a unique perspective on "Public Health" in comparing it from the United States to the United Kingdom. While it is accessible to everyone, it is not timely. Indeed, there is not a wholesale replacement that can be done without trading one set of problems for another. This paper helped me see that a hybrid approach is needed to solve all the problems by understanding the pros and cons of healthcare delivery across the world. In having this broader perspective, I believe we can learn from one another and land on a solution that is better by improving upon the weaknesses and strengths of other approaches. Each student presented their individual research papers, and collectively we gained a broader perspective to healthcare delivery across the globe.

Another written research assignment was done on a current topic within healthcare. I chose to pursue "Caps on Malpractice".Like the country research, each student presented, and as a class, we gained a broader perspective of current issues in healthcare.

We then were formed into groups for a term project.Student groups were allowed to choose from a list of approved topics, I chose to work with John Goss and Scott Marriott, and the topic we researched was "Personal Health Records (PHRs)". This type of student teaming was one of the best aspects of the MMI program at Northwestern, especially given the caliber of students with whom you get to interact, notwithstanding the synchronous format which allows for shared learning through an interactive means.

In conclusion, this class laid the critical foundation for the rest of the program. While it is required for students entering the program from a technical track, I believe it would be of equal benefit to the clinically focused student, too. Throughout the remaining classes in the MMI program, I found myself often coming back to articles and the textbook from this class as it helped establish the imperative behind the Medical Informatics and how the latter can help to address the enumerable challenges facing the U.S. healthcare system.

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