Transcript health care delivery system health care services health care

Health Care Systems and Health
Care Sub-culture
By
Kathleen Giuntoli, RN, MSN
HEALTH CARE
DELIVERY SYSTEM
“A NETWORK OF SERVICES”
AVAILABLE TO INDIVIDUALS SEEKING
TREATMENT OR PROMOTING OR
MAINTAINING HEALTH
HEALTH CARE SERVICES
HEALTH CARE SETTINGS
ORGANIZATION OF HEALTH
CARE DELIVERY SYSTEM
PRIVATE
SECTOR
•Provider’s
office -FEE
PUBLIC
SECTOR
•Local
FOR SERVICE
•State
•PPO
•Federal
•MANAGED
CARE
•International
VOLUNTARY
AGENGIES
•Non-governmental
•Not for profit
•Foundations
Private Sector
• Independent Practice
– Fee for service
– Free choice of
a provider
– Disease oriented with
limited illness prevention
(PEs, immunizations and
screenings)
– Private care in hospital
• Preferred Provider
Organization (PPO)
– Developed in 1980s
– Network of doctors and
hospitals agree to give the
sponsoring organizations
discounts for their services.
– PPOs do not exercise tight
management over
medical care.
– Criticism of PPO is
inability to control cost.
MANAGED CARE
Private Sector continued…
Health Maintenance Organizations (HMO)
– Delivers comprehensive care and treatment services for a
group of enrollees who pay pre-negotiated and fixed
payments.
• Example: Group Health or Kaiser-Permanente
– Provides care to maintain health (Prevention programs
“free and clear”)
– Health care is obtained by hospitals, doctors and other
providers who are participating with HMO.
– HMO is responsible to set standards of care (i.e.: NCQA)
– Goal is to : increase quality, increase access to health care
and decrease costs
– HEALTH PROMOTION, ILLNESS PREVENTION
CONTROLS COST
PUBLIC SECTOR
• Official and voluntary public agencies
operating at local, state, federal and
international level.
– Local health departments of a town, city
county district. There is a chief health officer
• Responsibilities: vital statistics,communicable
disease control, environmental health and safety,
personal health services like maternal child health
(MCH) and public health education
Public sector continued..
• State level
– State health officer in
charge of (DOH)
– Responsibilities in
policy, planning, and
coordination of
programs and services
for local units under
the jurisdiction.
• Federal Level
– US Department of Health
and Human Services
(DHHS) established in
1979, & concerned with
the health of the nation.
– Major functions: assisting
states and local
communities with the
development of health
resources, education and
regulation.
Federal level continued…
– Assisting with delivery of health services to
Americans. Medicare and Medicaid.
• Medicare (1965). -Social insurance program for people over
age 65.
• Medicaid- welfare program providing partial health care
services for low income people. Supported by Federal and
State governments. (Washington State: Health Options and
Basic Health Plan)
• Supporting and conducting research in health sciences and
protecting the people against impure and unsafe foods, drugs,
cosmetics and potential hazards, and providing national
leadership for communicable disease control.
Voluntary Sector
• Not for profit health
movement which began in
1882, stems from the good
will and humanitarian
concerns that are part of
the non-government, freeenterprise heritage of the
people in the United
States.
• Purpose:to provide public
and professional
educational programs to
improve services and
quality of facilities and
personnel.
• Funding comes from
citizens, business and
industry
– Examples: American Red
Cross(funded by
Rockefeller and Ford
Foundations) National
Prevention of Blindness,
National Association for
Mental Health.
– Professional
organizations: American
Medical Association
(AMA) or National
League of Nursing (NLN)
What Effects Health Care Costs?
• Death rate
• Lower birth rate
• Greater longevity
• Other effects on health care
costs
– Elderly: by 2010, 40
million Americans or
14% of population
will be >65 y/o, with
4.3 million over age
85. (People over age
85 are fastest growing
group in US)
– Family diversity- the
shrinking family (only 26 %
of American households
with children under 18 y/o
include married couples.
– Cultural diversity
– Lifestyle (cause of death:
heart disease, stroke, cancer
and COPD)
– Economic factors
– Affluence/Poverty
– Technology
HEALTH CARE SERVICES
Types of health care according to the needs
of the client.
• PRIMARY CARE
• SECONDARY CARE
• TERTIARY CARE
Primary Preventative Care
• Initial contact with family
practice provider in an
office or clinic.
• Primary care is directed
toward health promotion
and specific protections
against illness (such as
smoking cessation, car
safety restraints, dietary
controls, etc.)
• Teaching breast
self-exam
• Immunizations
• Accident prevention
education (child
safety locks, etc.)
• Family planning
Secondary Preventative
Care
• Focus on early
detection of
disease, prompt
intervention and
health
maintenance for
pts. experiencing
health problems.
• Includes referrals
to facilities for
additional testing,
consultation, and
diagnosis.
Examples of activities :
•Providing wound care, giving
medications, exercising arms and legs,
assessing children for normal growth and
development
•. Encouraging regular medical &
dental screenings.
-Primary care doctor refers you to
cardiologist for cardiac catheterization
after getting back your cholesterol tests,
hearing of your chest pain and noting
your SOB while ambulating up stairs.
Tertiary Preventative Care
• Begins after an illness
• Activities would include:
is diagnosed and
– Caring for the cardiac
treated & is aimed at
surgery pt. after surgery
– Teaching pt. w/diabetes
rehabilitating patient
how to recognize and
and restoring them to
prevent further
maximum level of
complications
– Referring a women to a
functioning.
support group after breast
removal (mastectomy)
– Teaching a brain stem
injured pt. to walk.
HEALTH CARE SETTINGS
WHERE DO WE GET OUR CARE?
INPATIENT SETTINGS:
HOSPITALS-function is to deliver patient
services, diagnostic and therapeutic for
particular general medical condition.
EMERGENCY DEPT/TRAUMA CENTER
-functions : triage care of acutely ill and
injured clients, 24 hours/day as well as
walk –in services for less acutely ill
clients.
Where do we get care?
In -patient Continued…
• Psychiatric facilities- function of inpatient facility
is to provide diagnostic and treatment services for
clients with psychiatric –related illnesses
• Rehabilitation centers- long term services offered
to clients who need additional therapy or
treatment for recovery from an injury or illness.
• Long term care (LTC) –range of services from
skilled nursing, adult family homes and assisted
living.
• Hospice- special services that addresses needs of
the dying patient
Outpatient
settings
• Physician offices
• Ambulatory care
centers
• Rural primary care
hospitals
• Emergency and
rescue systems
Community
Settings
• Adult day care
• Respite care
• Case management
programs
• School health clinics
• Industrial health
services
• Home health
• Neighborhood
community centers
• Free clinics
Health Care Trends
• Computer use –
emailing your doctor
• Health care in
shopping centers
• Decentralizing
services: birthing
centers, outpatient
surgery centers,
dialysis centers
• Emergency centers/
“doc in the box”,
walk in care
Health care team
(1 out of 10 Americans work in health care)
• Primary care
– Nurses, physicians,
physician assistants,
ARNPs.
– Allied memberstechnologists,
pharmacists, social
workers, alternative
practitioners, spiritual
and religious
personnel.
• Dietitians
• Respiratory therapists,
PT, OT, etc.
Summary
• Health care system
Network of services
available to individuals
seeking treatment for a health
problem or assistance with
maintaining or promoting
health
• Health care services
– Primary, Secondary or
Tertiary care
• Health care settings
– Inpatient
– Outpatient
– Community Settings
• Health care trendstechnology, “doc in the
box,” services,
decentralized services
• Health care team:
diverse professional
group that works together
to assist individuals with
attaining, maintaining and
regaining health.