Introduction Radical changes in health care delivery related to Explosion of scientific knowledge Integration of technology in health care Emphasis on health promotion Resource limitations Shortages of health care professionals ID: 731461
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Slide1
Chapter 9
Health Care Delivery SystemsSlide2
Introduction
Radical changes in health care delivery related to:
Explosion of scientific knowledgeIntegration of technology in health careEmphasis on health promotionResource limitationsShortages of health care professionals
Health care delivery systems provide:
Primary care for health promotion, illness prevention
Secondary care for treatment toward early detection, cure of illness
Tertiary care for chronic rehabilitative, end-of-life servicesSlide3
Challenges of Health Care Delivery in the 21st Century
Health Care Access
World Health Organization (WHO)Established as United Nations Unit (UN) whose efforts included:Eradication of infectious diseases, provision of health services for mothers, childrenWorld Health Assembly Expanded initiatives to promote, coordinate social, economic efforts to promote general health, welfare of all peopleSlide4
Challenges of Health Care Delivery in the 21st Century (cont’d)
Health Care Access
WHO and UNICEF Affirmed that health, health care were fundamental human rightsEmphasized that social, economic development were key to supporting health care initiativesSlide5
Challenges of Health Care Delivery in the 21st Century (cont’d)
Health care funding
National health service model Funds health care by guaranteeing access to health care services through national health insurance plan usually funded by general tax revenuesUnited Kingdom, Canada, Japan adopted this modelSlide6
Challenges of Health Care Delivery in the 21st Century (cont’d)
Health Care Funding
Mandated insurance model Requires compulsory universal health care insuranceNonprofit insurance funds provide resources for persons, employers to purchase health insuranceGermany, Brazil, Italy, Jamaica, South Africa adopted this modelSlide7
Challenges of Health Care Delivery in the 21st Century (cont’d)
Health Care
FundingEntrepreneurial insurance model Consists of voluntary health insurance coverage that relies on purchase of health insurance by individualsEmployers provide group coverage, employees pay part of insurance premiumUnited States, China, South Korea, Mexico, Nigeria, India adopted this modelSlide8
Challenges of Health Care Delivery in the 21st Century (cont’d)
United States
Federal-, state-sponsored programs provide access to all citizens who lack resources to buy health insurance MedicareMedicaidSlide9
Challenges of Health Care Delivery in the 21st Century (cont’d)
Health care work force
World Health Report Critical shortages of physicians, nurses, midwives by 2020Projected growth of elderly, aging workforceIncreased need, use of nurse practitioners for primary care services because of high costSlide10
Question
Which agency helped to expand the belief that health care is a fundamental human right?
United States governmentAmerican health care agenciesWorld Health OrganizationPharmaceutical companiesSlide11
Answer
C. World Health Organization
Rationale: WHO and UNICEF held a joint conference at Alma-Ata during which a declaration was issued that affirmed that health and health care were fundamental human rights. Slide12
Selected Current Health Care Delivery Systems
U.S health care delivery system
American health care system influenced by European models1873: formal nursing education began19th century: most American physicians had only high school education, minimal apprenticeshipEarly American hospitals were places where socially marginal fragments of society residedSlide13
Selected Current Health Care Delivery Systems (cont’d)
Scientific advancements
Mid-to-late 1800s: scientific discoveries revolutionized health careAnesthesia, antisepsis, germ theory, improved hygieneThermometer, ophthalmoscope, laryngoscopeGastroscope, cystoscope, hypodermic needle, sphygmomanometer Hospitals became places of healing rather than deathSlide14
The American Health Care Delivery System
Health care becomes flourishing industry
Hospital-owned schools of nursingApprenticeship approach dominated nursing, medical educationMedical education moved to university settingsSlide15
The American Health Care Delivery System (cont’d)
Health care in early 20th century
Physicians High profits made by providing services to wealthy, private patients who could afford themPublic institutions met health care needs of poorSlide16
The American Health Care Delivery System (cont’d)
Health care in early 20th century
American Medical Association (AMA)Restructured, to assure physicians financial security, power through their own organization, reform of medical educationEliminated competition from other people as health care providersSlide17
The American Health Care Delivery System (cont’d)
Health care in early 20th century
Impact of illness on worker productivityMontgomery Ward and Company: first insurance plan, provided group insurance for illness, injurySlide18
The American Health Care Delivery System (cont’d)
Health care in early 20th century
Effects of war, povertyIncreased governmental provision, funding of health careAccident and life insurance, first hospitalization insurance plan, Blue Cross, The McCarran–Ferguson Act, antibiotics, blood transfusions, rehabilitationSlide19
The American Health Care Delivery System (cont’d)
Health care in mid-to-late 20th century
Information explosionChronic disease prevalence with development of complex regimens to control themDepartment of Health Education and WelfareFormed to provide mechanism to coordinate health research, service programs Emphasis on research, technology led to specialization, depersonalizationSlide20
The American Health Care Delivery System (cont’d)
Health care in mid-to-late 20th century
Increasing health care costsProspective payment set prearranged reimbursement amount by diagnosis-related groupings (DRGs)Increased profits could be made resulting in business approach to health careManaged careSlide21
The American Health Care Delivery System (cont’d)
Health care in mid-to-late 20th century
Economic downslide of 1980s led to job loss, insurance lossConsolidated Omnibus Budget Reconciliation Act (COBRA)Health care expenditures rose close to twice rate of inflation in 1990, 1995, 2001, 2002Expected to increase to 19.3% of gross domestic product (GDP) by 2019Slide22
American Health Care Costs
Health Care Costs in the United States Today
Currently over 15% of US’s GDP goes toward health careHealth care expenditures fall into these categories: Health-related research, facility construction, payment for personal health care services, suppliesSlide23
Provider Costs
American hospital costs surpass those of all developed nations
Increased use of highly technical equipment, expensive medicationsThreat of malpractice suitsPhysician income in United States (on average) is 1.5 to 3 higher than physicians in other developed countriesServices rendered by APRN’s cost substantially less, consumers report high satisfactionSlide24
Insurance
2011 Census
49.9 million uninsured persons in United States249 million Americans were underinsuredEmployer based health insurance coverage fell to 55.3% in 2010Slide25
Patient Protection and Affordable Care Act of 2010
Federal and state governments assume a larger role in providing health insurance
Bundled paymentMedical homeAccountable Health Care OrganizationInsurance exchangeComparative effectiveness researchSlide26
The Canadian Health Care Delivery System
Canada adopted different forms of health care delivery
Historical development: Rising health care costs resulted in federal efforts to provide coverage for health expenditures for everyoneCanada Health Care Act of 1984 resulted in provincial administration of health care programsAll Canadians have equal access to specific list of health care services under provincial policy plansSlide27
The Canadian Health Care Delivery System (cont’d)
Principles
Public, nonprofit authority administers provincial health insurance plans, answers to provincial governmentEach plan covers all medically necessary services citizens may need from physicians, hospitalsPlans provide reasonable access to health services without discriminationSlide28
The Mexican Health Care Delivery System
Mexicans have equal access to health care services but there is disparity between affluent, poor
Affluent purchase health careWorkers covered through social security system or employer-based planPoor rely on public services systemEmphasis shifted to health promotion rather than disease treatment for public health servicesIncreased access to health care services for poorSlide29
Question
Is the following statement true or false?
Malpractice litigation and physician’s income are factors that have driven the increased cost of health care services in the United States.Slide30
Answer
True
Rationale: Increased profits resulted in a business approach to health care, threat of malpractice suits, and physician income have all created an increase in health care costs in the United States. Slide31
Comparing and Contrasting the Selected Health Care Delivery Systems
Health care concerns vary by country
Developing nationsMalnutrition, infants and children mortality, communicable diseasesWealthy, developed nationsDiseases of affluence (obesity, chronic diseases such as diabetes mellitus and degenerative joint diseases)Slide32
Comparing and Contrasting the Selected Health Care Delivery Systems (cont’d)
United States
Highest concentration of physicians, pharmacists, managerial, and support staffCanadaHighest concentration of nursesCitizens of United States, Canada tend to be satisfied with health care services they receiveSlide33
Health Care Delivery Settings
Primary care options
The hospital industryIntegrated health care delivery systems: A choice for today’s consumerSlide34
The Interdisciplinary Health Care Team
Client Pharmacists Third-party payer
Board of Directors Paramedical personnel Utilization reviewChief Executive Officer Social Workers Spiritual support servicesMedical staff Therapists Human resourcesNursing staff Health Information Service Foundation Case manager Business manager Alternative care
Dietitians Central product services
Linen services Biomedical engineering services
Housekeeping services Quality ManagementSlide35
Nursing Care Delivery Models
System used by nurses to organize and deliver nursing services to best meet client needs
Comparison of nursing care delivery system modelsCaseFunctional TeamDistrictPrimaryCase management
Client-focused careSlide36
Nursing Challenges Related to Health Care Delivery Systems
Practical Challenges
Nursing ShortageEthical challengesSlide37
Summary and Significance to Practice
Health care delivery systems
Massive structural change, reorganizationRaises multiple ethical, practical considerationsNursesAssume leadership in shaping future health care delivery by using cognitive skills, compassion so all people will have access to optimal health care services