Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Chapter 9 Health Care Delivery Systems Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 • 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 services Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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, children • World Health Assembly • Expanded initiatives to promote, coordinate social, economic efforts to promote general health, welfare of all people Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 rights • Emphasized that social, economic development were key to supporting health care initiatives Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 revenues • United Kingdom, Canada, Japan adopted this model Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Challenges of Health Care Delivery in the 21st Century (cont’d) • Health Care Funding – Mandated insurance model • Requires compulsory universal health care insurance • Nonprofit insurance funds provide resources for persons, employers to purchase health insurance • Germany, Brazil, Italy, Jamaica, South Africa adopted this model Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Challenges of Health Care Delivery in the 21st Century (cont’d) • Health Care Funding – Entrepreneurial insurance model • Consists of voluntary health insurance coverage that relies on purchase of health insurance by individuals • Employers provide group coverage, employees pay part of insurance premium • United States, China, South Korea, Mexico, Nigeria, India adopted this model Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 • Medicare • Medicaid Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 2020 • Projected growth of elderly, aging workforce • Increased need, use of nurse practitioners for primary care services because of high cost Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question • Which agency helped to expand the belief that health care is a fundamental human right? A. United States government B. American health care agencies C. World Health Organization D. Pharmaceutical companies Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Selected Current Health Care Delivery Systems • U.S health care delivery system – American health care system influenced by European models – 1873: formal nursing education began – 19th century: most American physicians had only high school education, minimal apprenticeship – Early American hospitals were places where socially marginal fragments of society resided Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Selected Current Health Care Delivery Systems (cont’d) • Scientific advancements – Mid-to-late 1800s: scientific discoveries revolutionized health care • Anesthesia, antisepsis, germ theory, improved hygiene • Thermometer, ophthalmoscope, laryngoscope • Gastroscope, cystoscope, hypodermic needle, sphygmomanometer • Hospitals became places of healing rather than death Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The American Health Care Delivery System • Health care becomes flourishing industry – Hospital-owned schools of nursing – Apprenticeship approach dominated nursing, medical education – Medical education moved to university settings Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 them • Public institutions met health care needs of poor Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 education • Eliminated competition from other people as health care providers Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The American Health Care Delivery System (cont’d) • Health care in early 20th century – Impact of illness on worker productivity • Montgomery Ward and Company: first insurance plan, provided group insurance for illness, injury Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The American Health Care Delivery System (cont’d) • Health care in early 20th century – Effects of war, poverty • Increased governmental provision, funding of health care • Accident and life insurance, first hospitalization insurance plan, Blue Cross, The McCarran– Ferguson Act, antibiotics, blood transfusions, rehabilitation Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The American Health Care Delivery System (cont’d) • Health care in mid-to-late 20th century – Information explosion – Chronic disease prevalence with development of complex regimens to control them – Department of Health Education and Welfare • Formed to provide mechanism to coordinate health research, service programs – Emphasis on research, technology led to specialization, depersonalization Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The American Health Care Delivery System (cont’d) • Health care in mid-to-late 20th century – Increasing health care costs • Prospective payment set prearranged reimbursement amount by diagnosis-related groupings (DRGs) • Increased profits could be made resulting in business approach to health care • Managed care Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 loss • Consolidated Omnibus Budget Reconciliation Act (COBRA) – Health care expenditures rose close to twice rate of inflation in 1990, 1995, 2001, 2002 • Expected to increase to 19.3% of gross domestic product (GDP) by 2019 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins American Health Care Costs • Health Care Costs in the United States Today – Currently over 15% of US’s GDP goes toward health care – Health care expenditures fall into these categories: • Health-related research, facility construction, payment for personal health care services, supplies Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Provider Costs • American hospital costs surpass those of all developed nations – Increased use of highly technical equipment, expensive medications – Threat of malpractice suits – Physician income in United States (on average) is 1.5 to 3 higher than physicians in other developed countries • Services rendered by APRN’s cost substantially less, consumers report high satisfaction Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Insurance • 2011 Census – 49.9 million uninsured persons in United States • 249 million Americans were underinsured – Employer based health insurance coverage fell to 55.3% in 2010 Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Protection and Affordable Care Act of 2010 • Federal and state governments assume a larger role in providing health insurance • Bundled payment • Medical home • Accountable Health Care Organization • Insurance exchange • Comparative effectiveness research Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 everyone • Canada Health Care Act of 1984 resulted in provincial administration of health care programs • All Canadians have equal access to specific list of health care services under provincial policy plans Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Canadian Health Care Delivery System (cont’d) • Principles – Public, nonprofit authority administers provincial health insurance plans, answers to provincial government – Each plan covers all medically necessary services citizens may need from physicians, hospitals – Plans provide reasonable access to health services without discrimination Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Mexican Health Care Delivery System • Mexicans have equal access to health care services but there is disparity between affluent, poor – Affluent purchase health care – Workers covered through social security system or employer-based plan – Poor rely on public services system • Emphasis shifted to health promotion rather than disease treatment for public health services – Increased access to health care services for poor Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Comparing and Contrasting the Selected Health Care Delivery Systems • Health care concerns vary by country – Developing nations • Malnutrition, infants and children mortality, communicable diseases • Wealthy, developed nations • Diseases of affluence (obesity, chronic diseases such as diabetes mellitus and degenerative joint diseases) Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Comparing and Contrasting the Selected Health Care Delivery Systems (cont’d) • United States – Highest concentration of physicians, pharmacists, managerial, and support staff • Canada – Highest concentration of nurses • Citizens of United States, Canada tend to be satisfied with health care services they receive Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Care Delivery Settings • Primary care options • The hospital industry • Integrated health care delivery systems: A choice for today’s consumer Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Interdisciplinary Health Care Team Client Pharmacists Third-party payer Board of Directors Paramedical personnel Utilization review Chief Executive Officer Social Workers Spiritual support services Medical staff Therapists Human resources Nursing staff Health Information Service Foundation Case manager Business manager Alternative care Dietitians Central product services Linen services Biomedical engineering services Housekeeping services Quality Management Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 models – Case – Functional – Team – District – Primary – Case management – Client-focused care Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Challenges Related to Health Care Delivery Systems • Practical Challenges • Nursing Shortage • Ethical challenges Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Summary and Significance to Practice • Health care delivery systems – Massive structural change, reorganization • Raises multiple ethical, practical considerations • Nurses – Assume leadership in shaping future health care delivery by using cognitive skills, compassion so all people will have access to optimal health care services Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins