Transcript File - Dr. Moss Health Sciences

Chapter 2
Current Health Care Systems
and Trends
Today’s Health Care Industry
• Largest service employer in U.S.
• Americans spent $2.9 trillion on health care
in 2013
– Projected to grow 5.7% annually between 2013
and 2023
Technological Advancements
• Health care changed very gradually until
beginning of 20th century
• Progress now increases rapidly
• Infectious diseases previously major
causes of death
– Now largely under control
Question
• True or False:
– Penicillin and antibiotics were discovered in the
mid-1800s.
Answer
• False
• Penicillin and antibiotics not discovered
until 20th century
Technological Advancements
• Recent advancements:
– Organ transplants
– Microscopic and robotic surgery
– Gene therapy
– Targeted drug therapy
Question
• The purpose of targeted drug therapy is to
_____ .
A. Prevent drug abuse
B. Destroy cancer cells
C. Create personalized pharmaceutical products
Answer
• B. Destroy cancer cells
• Targeted drug therapy aims to destroy
cancer cells or prevent them from dividing
Highlights of Health Care History
• Ancient and medieval times
– Early beliefs in supernatural causes
– Hippocrates
• Physician in ancient Greece
• Considered father of medicine
– Plagues during Middle Ages killed majority of
population
Question
• Chronic illnesses were rare in ancient times
because _____ .
A. The average person did not live longer than
35 years
B. The environment did not contain synthetic
chemicals as it does today
C. Physicians were unable to diagnose most
diseases
Answer
• A. The average person did not live longer than 35
years
• Chronic illnesses are most common in older
adults
Highlights of Health Care History
• Renaissance
– Brought interest in science
– Experiments and observation
Highlights of Health Care History
• 1700s
– Surgery became respected form of treatment
– Body functions still poorly understood
– Technique of vaccination discovered by Jenner
Highlights of Health Care History
• 1880s
– Building of large hospitals
– Dentists introduced anesthesia
– Pasteur proved that bacteria caused certain
diseases
– Advancements in public health and preventive
medicine
Question
• Elizabeth Blackwell, the first female
physician in the U.S., opened the first
_____ .
A. Hospital
B. Nursing school
C. Treatment center for mental illness
Answer
• B. Nursing school
• Blackwell opened first school of nursing in
1860
– Enabled nursing to become established
profession
Highlights of Health Care History
• 1900s
– Many discoveries
• E.g., blood groups, vitamins, penicillin and
antibiotics, synthetic drugs to treat specific problems
– Health care specialties developed
• E.g., physical and occupational therapy
– Great advances in surgical techniques
– Emphasis on scientific approach to medicine
Hopes for the 21st Century
• Vaccine to prevent human
immunodeficiency virus (HIV)
• Cure for acquired immune deficiency
syndrome (AIDS)
• Cure for obesity
• Organ cloning
Hopes for the 21st Century
•
•
•
•
Cures for cancer and heart disease
More effective treatment for mental illness
Less invasive treatments
Drugs with fewer side effects
Specialization
• Effects on health care:
– Improved diagnosis and treatment
– More technical and fragmented medical
practice
– Increased health care costs
– Breakdown of patient-provider relationships
– Increased job opportunities for health care
professionals
Aging Population
• Life expectancy increase
– 1900
• 47 years
– Today
• 79 to 81 years
• Large number of “baby boomers”
becoming older adults
Aging Population
• Older adults
– Heaviest users of health care services
• Needs of older adults:
– Long-term care facilities
– Home care services
– Treatment for chronic conditions
Question
• True or False:
– “Chronic” describes a health condition
experienced as a result of aging.
Answer
• False
• Chronic
– Conditions and illnesses that cannot be cured
quickly
• Persist over period of time
Increasing Costs of Health Care
• Costs increasing dramatically
– Technological advances
– Increased use of services due to aging
population
– Rising costs of pharmaceutical products
– Increased use of expensive diagnostic tests
– Lack of competition in some areas
Increasing Costs of Health Care
• Costs increasing dramatically
– Rising expectations of patients
– More effective treatments
• Therefore, more patients seeking care
– Poor geographic distribution of health care
providers
Costs of Health Care
Sources of health care dollars, 2004
Costs of Health Care
Uses of health care dollars, 2004
Health Care Facilities and Services
• Wide variety of health care facilities
• Many patient services for different needs
• Range in size from private individual offices
to national organizations
• Many employment options available for
today’s health care professionals
Hospitals
• Traditional health care setting
– Now high-tech facility limited to patients who
need sophisticated treatment and 24-hour care
• Costs have increased dramatically
– Major challenge:
• Controlling expenses
Hospitals
• Various levels of care provided
– Trauma center
– Emergency department (ER)
– Intensive care unit (ICU)
– Cardiac care unit (CCU)
– General unit
– Transitional care unit (TCU)
– Rehabilitation unit
Question
• A patient who is hospitalized following a
myocardial infarction (heart attack) would
most likely be cared for in the _____ .
A. CCU
B. ICU
C. Trauma center
Answer
• A. CCU
• Cardiac care unit (CCU)
ER VISITS
• Emergency departments used by some for
routine care
• Extremely expensive
• Patient Protection and Affordable Care Act
may alleviate the overuse of ERs
• Patient education necessary on use of
insurance
Accreditation of Health Care Facilities
• The Joint Commission
– Private, non-profit organization
– Encourages high standards
– Provides guidelines
– Performs on-site inspections
– Accreditation voluntary
• But may be required to qualify for Medicare
reimbursement
Ambulatory/Outpatient Services
• Patients do not require hospitalization
• Most surgeries today are outpatient
• Majority of ambulatory services performed
in physicians’ offices
Ambulatory/Outpatient Services
• Facilities that offer outpatient services:
– Adult day care
– Dental offices
– Diagnostic centers
– Emergency and urgent care centers
– Health care services in companies, schools,
and prisons
Ambulatory/Outpatient Services
• Facilities that offer outpatient services:
– Medical offices
– Rehabilitation centers
– Specialty clinics and offices
– Surgical centers
– Wellness centers
Long-Term Care Facilities
• Individuals do not need hospital
– But unable to live at home
• Fastest growing area of health care services
Long-Term Care Facilities
• Nursing home
– Skilled nursing facility
– Intermediate nursing facility
• Adult foster home
• Assisted living residence
• Continuing care community
Home Health Care Services
• Provide care to patients in their homes
• Tremendous growth in need for services
• Factors contributing to its growth:
– Shorter hospital stays
– Increase in older population
– Medical equipment that can be used at home
– Desire of individuals to stay at home
Home Health Care Providers
• Examples of professionals who provide
care at home:
– Nurses
– Physical therapists and assistants
– Occupational therapists and assistants
Home Health Care Providers
• Examples of professionals who provide
care at home:
– Speech therapists
– Medical social workers
– Nursing assistants and home health aides
Hospice
• Palliative care and support for dying
patients and their families
• Team of professionals and volunteers
• Medical, emotional, and spiritual support
• Make patient’s last days as pain-free and
meaningful as possible
Question
• True or False:
– Palliative care provides comfort and pain relief,
but does not offer a cure.
Answer
• True
• Palliative care relieves
– But does not cure
Consolidation of Health Care Services
• Combines facilities under one ownership to
control costs
– Buy supplies in large quantities
– Share expensive equipment
– Avoid duplication of lab and diagnostic services
– Share knowledge and management expertise
– Consolidate services
Consolidation of Health Care Services
• Provides more consistent and coordinated
care for patients
– But reduces competition
• Thus, patients have fewer choices
• Can result in higher prices and lower quality
New Types of Facilities
• Expanded functions for pharmacies
– Immunizations, mini-clinics
• Medical malls
– Cluster of services in vacated retail malls
Government Health Services
• Supported by taxpayers
• Conduct research, regulatory, and
educational activities
Government Health Services
• Examples of federal agencies:
– National Institutes of Health (NIH)
– Centers for Disease Control and Prevention
(CDC)
– Occupational Safety and Health Administration
(OSHA)
Question
• Which of the following service is provided
by the National Institutes of Health?
A. Make health care available for the uninsured
B. Control the spread of diseases
C. Conduct medical research
Answer
• C. Conduct medical research
• Role of National Institutes of Health:
– Conduct medical research
Government Health Services
• Examples of state services:
– License personnel and facilities
– Provide laboratory services
– Establish health data systems
– Conduct public health planning
Government Health Services
• Examples of local government services:
– Collect vital statistics
– Conduct sanitary inspections
– Screen for diseases
– Provide immunizations
Trends in Health Care
• New approaches:
– Search for alternatives to surgery and drugs
– Desire to use natural products
– Belief in mind-body connection
– Focus on prevention rather than cure
– More personal responsibility for health
– Patient access to information
– Desire for humanization of medicine
Wellness
• Promotion of health through preventive
measures and practice of good habits
• Leading causes of death influenced by
lifestyle habits
Wellness
• Wellness centers
– Routine physicals
– Immunizations
– Exercise and nutrition classes
Expanding Consciousness
• Theory developed by Margaret Newman
• Wellness is more than the absence of
disease or disability
Question
• True or False
• Wellness means not having an illness or
injury.
Answer
• False
• Wellness means more than the absence of
disease or injury. It includes the practice of
good lifestyle habits and promoting good
health through preventive measures.
Complementary and Alternative
Medicine
• Complementary medicine
– Used together with conventional medicine
• Alternative medicine
– Used instead of conventional medicine
Complementary and Alternative
Medicine
• Integrative medicine
– Conventional used with nonconventional
practices for which there is scientific evidence
of effectiveness
Complementary and Alternative
Medicine
• Whole medical systems
– Homeopathic
– Naturopathic
– Traditional Chinese
• Including acupuncture
– Ayurveda
Complementary and Alternative
Medicine
• Mind-body medicine
– Patient support groups
– Meditation
– Prayer
– Guided imagery
– Creative activities
– Yoga
Complementary and Alternative
Medicine
• Biologically based practices
– Aromatherapy
– Herbs
– Dietary supplements
– Natural products
• E.g., shark cartilage
Complementary and Alternative
Medicine
• Manipulative and body-based practices
– Chiropractic
– Osteopathic
– Massage therapy
– Reflexology
– Relaxation exercises
Question
• Which of the following health care practices
involves manipulating the spine to relieve
pain or correct dysfunction?
A. Naturopathy
B. Acupuncture
C. Chiropractic
Answer
• C. Chiropractic
• Chiropractic care
– Based on belief that pressure on nerves
leaving spinal column causes pain and
dysfunction
Complementary and Alternative
Medicine
• Energy therapies
– Biofield
• Qi gong
• Reiki
• Therapeutic touch
– Bioelectromagnetic
Complementary and Alternative
Medicine
• Susceptible to fraud
• Signs of fraudulent products:
– Claims to cure variety of problems
– Claims to be miraculous and/or secret
– Uses terms for which no definitions exist
– Provides undocumented case histories
– Requires payment in advance
Holistic Medicine
• Expanded view of traditional medicine
• Emphasizes prevention of disease and
personal responsibility for health
– Reduce stress
– Proper nutrition
– Physical activity
– Positive attitude
Holistic Medicine
• All aspects contribute to health
– Physical
– Mental
– Emotional
– Spiritual
Challenges in Health Care Today
• Providing affordable care
– Patient Protection and Affordable Care Act of
2010
• Subsidies for lower-income individuals
– Problem of high cost remains
– Some Medicare recipients cannot afford
supplemental insurance
Challenges in Health Care
Today
• Providing long-term care
– Increased need
– Costs increasing
– Medicare covers only certain short-term stays
– Funding may be inadequate
Challenges in Health Care Today
• Social conditions
– Poverty
– Homelessness
– Violence
– Substance abuse
– Spousal, child, and elder abuse
– Malnutrition
Challenges in Health Care Today
• Maintaining quality of care
– High costs encourage cutting expenses
– Amount of care may be decreased
– Decisions made by insurance companies
rather than health care providers
• Preauthorization
Question
• There is concern about the quality of care
in the U.S. because of the
• A. poor training of physicians
• B. high cost of providing health care
• C. lack of government support for health
care research
Answer
• B. The high cost of health care sometimes
influences the quality of care provided.
Treating Alzheimer’s Disease
• Progressive disease marked by dementia
• 6th leading cause of death in U.S.
• Cost of care
– Estimated to be $1.2 trillion by 2050
Challenges in Health Care Today
• Public health concerns
– Pandemics
• Influenza
• Ebola
Challenges in Health Care
Today
• Medication adherence
– Failure to take medication results in expensive
preventable health conditions
– May be due to high cost of drugs and/or side
effects
– Providers must explain importance of
medications
Challenges in Health Care
Today
• Prescription drug overuse
– Painkiller prescriptions quadrupled since 1999
• Almost 2 millions Americans abusing
– Deaths from overdose tripled since 1999
Challenges in Health Care
Today
• Preventing prescription drug overuse
– Create prescribing guidelines
– Regulate pain clinics
– Identify fraudulent prescriptions
– Teach other pain control methods
– Educate patients about risk
– Improve access to antidotes
Challenges in Health Care
Today
• Preventing antibiotic resistance
– Only effective against bacteria
– Bacteria can adapt so drugs are ineffective
– Can result from over and inappropriate use
– Considered a serious public health threat
Question
• Patients who request prescriptions for
antibiotics when they have a cold are
• A. contributing to the problem of antibiotic
resistance
• B. practicing good health habits
• C. likely to get well quickly
Answer
• A. Colds are caused by viruses and
antibiotics are not effective against viruses.
Taking unnecessary antibiotics leads to
their being ineffective when needed.
Challenges in Health Care Today
• Personal responsibility for health
– Lifestyle choices influence incidence of heart
disease, cancer, and stroke
– Healthy habits should be encouraged
Implications for Health Care
Professionals
•
•
•
•
Stay informed about important issues
Contribute to delivery of high-quality care
Model good health habits
Provide effective patient education