1.National health insurance is a tax-supported mechanism in which the government guarantees a basic package of health services to all citizens. The government finances health care through tax dollars, but the actual care is delivered by private providers. In a national health system, in addition to financing a basic health package, the government also manages the infrastructure for the delivery of medical care. Under such a system, most of the medical institutions are operated by the government; health care providers, such as physicians, are government employees. Essentially, a national health system is a national health insurance program, but it goes one step further in managing the infrastructure as well
2.These characteristics are: 1) no central governing agency; little integration and coordination 2) technology driven and focusing on acute care 3) high on cost, unequal in access, and average in outcome 4) quasi/imperfect market conditions 5) government as subsidiary to the private sector 6) market justice vs. social justice: conflict through health care 7) multiple players and balance of power 8) quest for integration and accountability.
3. The first goal is to propose a holistic approach to health care delivery that focuses on curative medicine, health promotion, and disease prevention. The second goal is to further explore the issue of equity in the distribution of health services using the contrasting theories of market justice and social justice in U.S. Health Care Delivery.
4.Discuss the definitions of health presented in this chapter in terms of their implications for the health delivery system
Within the framework of the medical model, health has been viewed as the absence of illness or disease. Alleviation of symptoms is often the goal of medical interventions. The implication is that the health delivery system emphasizes diagnosis and treatment rather than prevention of disease. Similarly, health promotion would not be considered a responsibility of the health delivery system. A person's ability to perform social roles and tasks is sometimes viewed as health. However, a person may be able to perform certain social tasks in spite of being sick. On the other hand, when there is a concern that a sick individual may infect others or make his or her condition worse, the individual is generally asked to stay home from work or school and seek medical attention. After an illness or disability, people can generally return to work or school only with a physician's approval. In this case, health is generally associated only with physical well-being. Placement of emphasis on both physical and mental aspects of health would result in a better balance in the delivery of both physical and mental health services. The definition proposed by the World Health Organization (WHO) goes beyond the medical and social models in emphasizing a complete state of well-being. From the health delivery perspective, it advocates achieving a balance between the physical, mental, and social aspects of life. Since the social aspects of health extend beyond the individual level, this definition implies that the health care delivery system would go beyond individual health and take responsibility for the health of entire communities and populations. The holistic view of health adds a fourth dimension of spiritual well-being to the definition proposed by WHO. A person' s spirituality can have a positive impact on the individual's overall health. This dimension has become important in several areas of health care delivery such as end-of-life care and long-term care. Caregivers need to recognize this aspect of health and respect a patient's religious and spiritual beliefs. The holistic approach to health also alludes to the need to incorporate alternative therapies into the predominant medical model.
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