Chapter 2 Categories of Health Services Objectives After

Chapter 2 Categories of Health Services

Objectives After studying this chapter the student should be able to: • Describe the healthcare functions of private and public facilities, inpatient and outpatient services, military facilities, and volunteer facilities. • Identify the four major types of health services and their functions. • Compare the functions of the two major providers of managed care. • Name the major points of the Patient’s Bill of Rights. • Describe public health, hospital, ambulatory, and mental health services.

Overview Of The U. S. Healthcare System • The federal government provides very few direct health services (left up to private sector and state) – Veterans’ health (VA) – Military hospitals and clinics – Indian Health Service (IHS) – native population (note: Federal gov. monitors and contributes to Medicare/Medicaid) • The healthcare industry is a complex system of diagnostic, therapeutic, and preventive services. • Hospitals, clinics, government and volunteer agencies, pharmaceutical and medical equipment manufacturers, and private insurance companies provide these services.

Overview Of The U. S. Healthcare System • The healthcare system offers four broad types of services: – health promotion – disease prevention – diagnosis and treatment – rehabilitation.

Overview Of The U. S. Healthcare System • Health promotion services – teach people how to reduce risk of illness, maintain optimal function, follow healthy lifestyles – i. e. hospital prenatal classes, heart health classes offered in community • Illness (disease) prevention services – educational effort to involve consumer in their own care; teach about risk factors, how environment impacts health, occupational safety, etc.

Overview Of The U. S. Healthcare System • Diagnosis and treatment – most used service; waiting until you are ill – advances in this have increased cost of health care • Rehabilitation – restoration of a person to “normal” or near normal function after physical or mental illness – long process – chronic disability may require extra assistance.

Healthcare Facilities A wide variety of healthcare facilities are now available. The range includes: • Inpatient Facilities (hospitals, etc. private or public) • Outpatient Facilities • Community-based Facilities (defined clientele) • Voluntary Facilities • The National Association of Free Clinics (NAFC) • Government Facilities • Institutional Facilities • Comprehensive health maintenance agencies

Categorization of Hospitals • 1. Function or type of service provided – i. e. cardiovascular, cancer, etc. • 2. Length of stay: – short term: ave 5 day – long term: ave 4 -6 months • 3. Ownership or source of financial support – private, public – public, private, voluntary, religious

Hospitals: Funding • Private/proprietary – owned by churches, businesses, physicians, etc. ; typically for profit • Public – owned by a government agency (local, state or federal agencies); typically non-profit • Federally owned usually serve: military/veterans, Native American • State funded/operated – typically long term care, like mental institutions • Voluntary – typically religious affiliation; non-profit • Community – independent, citizen owned; non-profit

Hospitals: Development and Services • The hospital is the key resource and center of the U. S. healthcare system (3 rd largest business in U. S. ) • Hospitals not only deliver primary patient care, but also train health personnel, conduct research, and disseminate information to consumers. • They employ approximately 75% of healthcare personnel, with a collective payroll that accounts for at least 40% of the nation’s health expenditures. • Approximately 60% of federal health monies and 40% of all state and local health monies go to hospitals.

Hospitals: Development and Services The major forces affecting the development of hospitals include the following: • 1. Advances in medical science, most notably the discovery of antiseptic techniques and sterilization processes and the use of anesthesia. • 2. Advances in medical education, with predominant use of scientific theory and standardization of academic training for physicians. • 3. Transformation of nursing into a profession • 4. Development of specialized technology (i. e. imaging, blood testing, etc. )

Hospitals: Development and Services • In spite of the developments mentioned: – hospital resources continue to be concentrated on acute care, short-term, curable and special cases vs. – the current trend toward chronic, long-term illnesses (that most often affect the elderly)

Ambulatory Healthcare Services • Care that is provided outside of institutional settings is considered ambulatory care. • It is the most frequent contact that most people have with the healthcare system. – from simple and routine to complex and specialized – primary care, dental, mental health centers, pharmacies, vision centers, etc. • Hospitals are expanding their role to include ambulatory services (primary care, specialty, surgery)

Mental Health Services • 19 th century - began as state hospitals, with goal of protecting the public • 1940 -50 s: creation of National Institute of Mental Health (NIMH; federal agency) and psychotropic drugs • 1960 s: community mental health facilities were able to provide outpatient care • Few hospitals specialize in acute psychiatric illness patients go to ERs

Mental Health Services Mental health personnel involved in the delivery of mental health services include: • Psychiatrists (MD, DO) who make a mental diagnosis, prescribe medications, and may provide psychotherapy • Psychologists • Clinical social workers • Psychiatric nurses/NPs who have advanced degrees and who provide case management and/or psychotherapy

Mental Health Problem • One in 4 Americans suffers from a mental illness or substance abuse disorder per year – these are the a leading cause of disability and death • According to NIMH, in 2009 suicide was the 3 rd leading cause of death in 15 -24 yo • Physical health is more of a priority – should it be? (insurance limits, stigma) • Mental Health Parity and Addiction Equity Act (2008) – requires insurance to cover mental health services

Healthcare Teams There are two general types of health teams: functional and patient centered • Doctors • Nurses • Dietitians • Therapists • Other direct care providers

Healthcare Teams • Functional teams – formed to take care of specific problems (i. e. mental health teams or the coronary care team) • Patient-centered teams – include patients and their families who are involved in making healthcare decisions together with their doctor and other health care professionals.

Patient’s Bill of Rights • 1973 – developed by the American Hospital Association; some of the major tenets are that the patient (client) has the right to: – – – – diagnosis and treatment information on fees for services rendered refuse diagnostic and treatment procedures receive continuity of care privacy and confidentiality seek a second opinion change physicians/facilities if unsatisfied

Informed Consent • Informed consent is one of the patients’ most important legal rights. – the physician (or healthcare worker) must obtain permission from the patient to perform certain actions and procedures – must be obtained BEFORE beginning any invasive procedure, administering an experimental drug or entering the patient into a research project

Informed Consent (cont. ) For informed consent to be valid: • the patient must fully understand (language) • be of rational mind/sound judgment • must describe all the risks vs. benefits • alternatives to the procedure are explained • patient understands that participation is voluntary

Public Health Services • The most important federal agency concerned with health affairs is the U. S. Department of Health and Human Services (USDHHS). – This agency is responsible for Medicare, Medicaid, public health, biomedical research, food and drug safety, disease control and prevention, Indian health, and mental health services. • The focus of public health is the community vs. the individual and prevention vs. treatment of disease

Public Health Services The USDHHS programs are administered by 11 operating divisions, including eight agencies in the U. S. Public Health Service and three human services agencies: 1. Administration for Children and Families (ACF) 2. Administration on Aging (Ao. A) 3. Agency for Healthcare Research and Quality (AHRQ) 4. Agency for Toxic Substances and Disease Registry (ATSDR) 5. Centers for Disease Control and Prevention (CDC) 6. Centers for Medicare and Medicaid Services (CMS) 7. Food and Drug Administration (FDA) 8. Health Resources and Services Administration (HRSA) 9. Indian Health Service (IHS) 10. National Institutes of Health (NIH) 11. Substance Abuse and Mental Health Services Administration (SAMHSA)

Public Health Services Public health services deal primarily with four aspects of care: 1. Identifying diseases that cause death or debility 2. Assessing the factors of cause and method of transmission 3. Finding ways to control or cure diseases and methods to prevent spread 4. Educating the public to apply the findings effectively

Public Health Services Strategic goals for public health put forth by the USDHHS for 2007– 2012 are to: • Prevent the spread of infectious disease. • Protect the public against injuries and environmental threats. • Promote and encourage preventive health care, including mental health, lifelong healthy behaviors, and recovery. • Prepare for and respond to natural and man-made disasters.

Public Health Services • The Centers for Disease Control and Prevention (CDC) is responsible for monitoring the health of the nation. • The CDC monitors: – – incidence of injury and illness homicide and suicide air and water quality infectious and chronic disease prevalence such as HIV/ AIDS, H 1 N 1 flu, heart disease, cancer, and diabetes.

Health Care in the Twenty-First Century • Multibillion $ industry thousands of jobs, new professions, providing care to millions • The most pressing problem of this century will be to bring health care within the reach of everyone without sacrificing quality. • Preventive health care will play an important role in achieving health care for all

Healthy People 2020 http: //www. healthypeople. gov/sites/default/files/ Default. Press. Release_1. pdf • USDHHS health promotion and disease prevention plan • Sets (10 year) national goals/objectives and monitors progress • Prevent chronic disease decrease cost of health care