Download prevention services

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:
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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 (3rd 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
• 19th century - began as state hospitals, with goal
of protecting the public
• 1940-50s: creation of National Institute of Mental
Health (NIMH; federal agency) and psychotropic
drugs
• 1960s: 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 3rd
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 the right to:
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diagnosis and treatment information
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 (AoA)
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:
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incidence of injury and illness
homicide and suicide
air and water quality
infectious and chronic disease prevalence such as HIV/
AIDS, H1N1 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/
DefaultPressRelease_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