Healthcare systems worldwide grapple with balancing cost, quality, and access. From single-payer to managed care models, governments and providers seek solutions to cover more people while controlling expenses. The U.S. stands out with its mix of public and private insurance, including Medicare, Medicaid, and ACA marketplaces.

Technology plays a growing role in healthcare delivery and management. Electronic health records improve coordination, while preventive care and health promotion aim to reduce long-term costs. These innovations shape how healthcare is financed, delivered, and experienced by patients across different systems.

Healthcare Financing Models

Single-Payer and Universal Healthcare Systems

• Single-payer system healthcare model where a single public entity, usually the government, pays for all covered healthcare services
• Typically funded through taxes and aims to provide universal coverage to all citizens
• Universal healthcare system where all individuals have access to necessary health services without financial hardship
• Can be achieved through various financing models, including single-payer, multi-payer, or a combination of public and private insurance (France, Germany)

Managed Care and Fee-for-Service Models

• Managed care healthcare delivery system that aims to control costs and improve quality by coordinating and overseeing patient care
• Includes health maintenance organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans
• Emphasizes preventive care, primary care gatekeeping, and negotiated fees with providers
• Fee-for-service traditional healthcare payment model where providers are reimbursed for each service rendered
• Incentivizes higher volume of services but lacks cost control measures and care coordination (United States)

Government Healthcare Programs

Affordable Care Act (ACA) and Health Insurance Exchanges

• Affordable Care Act (ACA) comprehensive healthcare reform law enacted in 2010 to expand coverage, improve quality, and control costs
• Mandates individuals to have health insurance or pay a penalty, with subsidies available for low-income individuals
• Prohibits insurers from denying coverage or charging higher premiums based on pre-existing conditions
• Established health insurance exchanges online marketplaces where individuals and small businesses can compare and purchase health plans
• Exchanges offer standardized plans with varying levels of coverage (bronze, silver, gold, platinum) and provide subsidies for eligible individuals

Medicare and Medicaid Programs

• Medicare federal health insurance program for people aged 65 and older, as well as some younger individuals with disabilities
• Consists of Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage)
• Funded through payroll taxes, premiums, and general revenue
• Medicaid joint federal-state program that provides health coverage to low-income individuals and families
• Eligibility and benefits vary by state, but all states must cover certain mandatory populations and services
• Funded through a combination of federal and state funds, with the federal government matching a percentage of state spending

Healthcare Technology and Services

Electronic Health Records and Health Information Technology

• Electronic health records (EHRs) digital versions of patient health information that can be shared across healthcare providers
• EHRs improve care coordination, reduce medical errors, and facilitate data analysis for quality improvement and research
• Health information technology (IT) encompasses a wide range of tools and systems used to manage and exchange health data
• Includes telehealth, mobile health apps, clinical decision support systems, and health information exchanges

Preventive Care and Health Promotion

• Preventive care healthcare services aimed at preventing illness, detecting diseases early, and promoting healthy behaviors
• Includes immunizations, screenings (mammograms, colonoscopies), and counseling on diet, exercise, and tobacco cessation
• Emphasized in managed care and population health management to improve outcomes and reduce long-term costs
• Health promotion initiatives that empower individuals and communities to adopt healthy lifestyles and create supportive environments
• Examples include workplace wellness programs, community-based health education, and policies to promote healthy food access and active transportation