,Purpose and Perspective of the Chapter
This chapter introduces the student to the economic way of thinking as it relates to the
study of the U.S. medical care system. It gives an overview of the Patient Protection and
Affordable Care Act (ACA) and discusses why—more than 10 years after it was passed—it
has solved some critical issues but has still left many unanswered questions. The chapter
then offers a brief summary of the emergence of the modern medical care system, recent
changes of medical care delivery and payment structures, and the basics of system design
and economic modeling. It ends with a discussion of the current framework for
implementing ACA; the bill’s history, both before and after passage; and how America is
succeeding on some of the major accomplishments of ACA while dealing with some
unintended consequences. The chapter also lays the foundation for the focus and
continuity throughout the book and introduces and defines 10 guiding principles.
Chapter Objectives
The following objectives are addressed in this chapter:
1. Understand the nature of the health care crisis in America.
2. Identify the important historical developments affecting health care delivery
and finance in the U.S. system.
3. Identify and explain the major reasons for the high and rising cost of medical
care.
4. Understand how the third-party payment mechanism and managed care
affect health care delivery.
5. Understand the Patient Protection and Affordable Care Act and its
importance to the U.S. health care system.
6. Understand the impact of the current health care reforms.
7. Recognize the relevance of economics in studying health care issues.
8. Understand the aspects of medical care that contribute to its uniqueness as
a commodity.
Complete List of Chapter Activities and Assessments
Chapter Activity/Assessment Source (i.e., PPT Duration
Objective slide)
1-1 Describe Additional Discussion Instructor’s 5–10 mins
the history of Questions #3, 4, and 6 Manual
health system Activity: Knowledge Check PPT slide 9 5–10 mins
reform in the 1 Activity
, Chapter Activity/Assessment Source (i.e., PPT Duration
Objective slide)
United States. Activity: Knowledge Check PPT slide 10 5 mins
2 Answer
Activity: Self-Assessment PPT slide 25 10–15 mins
1-2 Explain the Additional Discussion Instructor’s 5–10 mins
current health Questions #1 and 2 Manual
care Activity: Knowledge Check PPT Slide 11 5–10 mins
framework. 2 Activity
Activity: Knowledge Check PPT slide 12 5 mins
2 Answer
Knowledge Check 3 PPT slide 16 5–10 mins
Activity
Knowledge Check 3 PPT slide 17 5 mins
Answer
Activity: Self-Assessment PPT slide 25 10–15 mins
1-3 Evaluate Additional Discussion Instructor’s 5–10 mins
the progress Questions #5, 7, 8, and 9 Manual
made toward Activity: Game: Role Play PPT Slide 22 5–20 mins
system Activity
transformation. Activity: Polling Activity PPT Slide 24 5–10 mins
Activity: Self-Assessment PPT slide 25 10–15 mins
1-4 Summarize Additional Discussion Instructor’s 5–10 mins
changes made Question #10 Manual
since the Activity: Self-Assessment PPT slide 25 10–15 mins
passage of the
Affordable Care
Act (ACA).
Key Terms
Public option: A public health insurance plan comparable to Medicaid, designed to
compete with private insurance.
Uncertainty: A state in which multiple outcomes are possible but the likelihood of any one
outcome is not known.
Premium: A periodic payment required to purchase an insurance policy.
Group insurance: A plan whereby an entire group receives insurance under a single policy.
The insurance is actually issued to the plan holder, usually an employer or association.
Medicare: Health insurance for the elderly provided under an amendment to the Social
Security Act.
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