Health Care System Structure Chapter 13 Introduction Health

Health Care System: Structure Chapter 13

Introduction • Health care delivery in U. S. is different than all other developed countries • Other developed countries have national health care programs run or organized by government • Health care in U. S. delivered by an array of providers (health care facilities & professionals that provide care)

First question… Does the U. S. really have a health care system? Providers + Consumers (patients) = System?

Brief History of Health Care Delivery in the U. S. - 1

Brief History of Health Care Delivery in the U. S. - 2 Timeline Pre-1870 Today

Brief History of Health Care Delivery in the U. S. - 3 • Far behind Great Britain & Europe in both health care & medical education • Not grounded in science • Medical education was provided through apprenticeships Pre 1870

Brief History of Health Care Delivery in the U. S. - 4 • Health care provided in patients’ homes • Hospitals in large cities & seaports • Almshouses (poorhouse) to provide food, shelter & basic care for indigent Pre 1870

Brief History of Health Care Delivery in the U. S. - 5 • Health care moved from patients’ homes to physician’s office & hospitals • Health care based on more science Pre 1870 1900

Brief History of Health Care Delivery in the U. S. - 6 1 st health insurance Pre- 1900 1911 1870

Brief History of Health Care Delivery in the U. S. - 7 Flu epidemic Pre- 1900 1911 1918 -19 1870

Brief History of Health Care Delivery in the U. S. - 8 Spending 3. 9% of GDP on health Pre- 1900 1911 1918 1929 1870

Brief History of Health Care Delivery in the U. S. - 9 • Diagnosis, treatment, fee • WWII & medical advances • Hill-Burton Act Pre- 1900 1911 1918 1929 1930 s 1870 & 1940 s

Brief History of Health Care Delivery in the U. S. - 10 • Right or privilege • Overall shortage & maldistribution • 3 rd party system takes hold • Medicaid & Medicare Pre- 1900 1911 1918 1929 30 s/40 s 1870 1950 s & 60 s

Brief History of Health Care Delivery in the U. S. - 11 • Cost containment • Health planning agencies • HMO Act 1973 Pre- 1900 1911 1918 1929 30 s/40 s 1970 s 1870 50 s/60 s

Brief History of Health Care Delivery in the U. S. - 12 • Deregulation • New medical technologies Pre- 1900 1911 1918 1929 30 s/40 s 70 s 1980 s 1870 50 s/60 s

Brief History of Health Care Delivery in the U. S. - 13 • American Health Security Act of 1993 • Managed care • Costs hit $1 trillion 1990 s Pre- 1900 1911 1918 1929 30 s/40 s 70 s 1870 50 s/60 s 80 s

Brief History of Health Care Delivery in the U. S. - 14 • Medicare Modernization Act of 2003 • Health Savings Accounts • No patients’ bill of rights • GDP 16. 2% 90 s Pre- 1900 1911 1918 1929 30 s/40 s 70 s 80 s 2000 s 1870 50 s/60 s

Spectrum of Health Care Delivery - 1 • Spectrum of care refers to the type of health care practice • Population-based Public Health Practice (health promotion & disease prevention) • Medical Practice • Primary Care: clinical preventive services; 1 st contact; front-line • Secondary Care: specialized attention (acute & subacute care); e. g. , ERs • Tertiary Care: Subspecialty referral

Spectrum of Health Care Delivery - 2 • Long-term practice • Restorative care: intermediate follow-up • Long-term care: care for chronic conditions; personal care • End-of-life practice • Care provided in last six months of life: hospice care

Types of Health Care Providers - 1 • In 2005, 14 million health care workers; 9. 9% of workforce • 42% work in hospitals as compared to 63% in 1970 • Over 200 different careers in the health care industry • Six categories: independent providers, limited care providers, nurses, nonphysician practitioners, allied health care professionals, public health professionals

Types of Health Care Providers - 2 • Independent providers: health care professionals with the education & legal authority to treat any health problem • Allopathic providers: MDs; their remedies produce effects different from those of the disease • Osteopathic providers: DOs; their remedies emphasize the interrelationships of the body’s systems in diagnosis, prevention, & treatment

Types of Health Care Providers - 3 • Nonallopatic providers: independent providers who provide nontraditional forms of health care • Examples: chiropractors (adjusts spinal column), acupuncturists, naturopaths, herbalists, homeopaths • Five general categories of complementary & alternative medicine (CAM): Alternate medical systems, mind/body interventions, biologically-based therapy, manipulative methods, energy therapy

Types of Health Care Providers - 4 • Limited care (restricted care) providers: those who provide care for a specific part of the body • Examples: dentists, optometrists, podiatrists, & psychologists

Types of Health Care Providers - 5 • Nurses – Licensed Practical (Vocational) Nurses (LPNs): 1 -2 years of training & carry out nontechnical duties – Registered Nurses (RN): diploma or associate degree & state license – Professional nurses: Bachelor of Science in Nursing (BSN); prepared for additional activities involving independent judgment – Advanced Practice Nurses (APN): master’s or doctoral degrees; e. g. , nurse practitioners, clinical nurse specialists, certified nurse midwife

Registered Nurses Prepared for Advance Practice, 2004 © Department of Health and Human Services

Types of Health Care Providers - 6 • Nonphysician Practitioners (also known as nonphysician clinicians or midlevel providers or physician extenders • Examples: nurse practitioners (NPs) & physician assistants (PAs)

Types of Health Care Providers - 7 • Allied health care professionals – Provide services that assist, facilitate, & complement work of physicians & other health care specialists – Examples: dietitians, physical therapists, medical technologists, EMTs, speech therapists, & exercise physiologists

Types of Health Care Providers - 8 • Public health professionals – A health care worker who works in a public health organization – Examples: environmental health workers, public health administrators, epidemiologists, health educators, & biostatisticians

Health Care Facilities & Their Accreditation - 1 • Health care facilities: physical settings • Practitioner offices: privately owned practices • Clinics: no beds; tax-supported clinics for medically indigent called public health clinics or community health centers

Health Care Facilities & Their Accreditation - 2 • Hospital types – Provide secondary & tertiary care – Private (proprietary or investor-owned); specialty (provide mainly one type of medicine) – Public (government run or funded) – Voluntary (not-for-profit) – Types of service: full-service; limited-service

Health Care Facilities & Their Accreditation - 3 • Outpatient & ambulatory care facilities: those that provide a wide array of outpatient services; they can range from hospital-based facilities to independently owned freestanding facilities • Include: primary care centers, urgent/emergent care centers, ambulatory surgery centers, diagnostic imaging centers • Some found in nontraditional settings

Health Care Facilities & Their Accreditation - 4 • Rehabilitation Centers – Used to restore lost functions – Ambulatory & inpatient facilities • Long-term Care Options – Residential care (e. g. , nursing home & assisted living) – Home health care – Hospice, and home care

Health Care Facilities & Their Accreditation - 5 • Accreditation: process by which an agency or organization evaluates & recognizes an institution as meeting certain predetermined standards • Agencies/Organizations – Joint Commission on Accreditation of Health Care Organizations (JCAHO): 15, 000 facilities – Centers for Medicare & Medicaid Services (CMS): grants “deeming authority”

Health Care System: Structure Chapter 13 - The End