United States Health Care System Overview

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1980s Medicare Changes

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Medicare shifted to a prospective payment system based on diagnostic-related groups (DRGs).

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Prospective Payment System (PPS)

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A payment model that minimizes the length of stay through utilization management.

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Diagnostic-Related Groups (DRGs)

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A system to classify hospital cases for payment purposes.

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Managed Care Organizations (MCOs)

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Organizations that provide health care plans like HMOs, PPOs, and POS.

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Preferred Provider Organizations (PPOs)

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A health plan that offers more flexibility in choosing doctors and hospitals.

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Open Access Plans

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Health plans that allow members to see specialists without a referral.

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Health Care Access Inequities

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Continuing increased costs and inequities in health care access.

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Cost Containment in Health Care

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Efforts to control the expenses of health care services.

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Utilization Management

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A process to ensure that health care services are used appropriately.

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The Affordable Care Act was signed into law in 2010.

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2010