Health Care Systems and Health Care Sub-culture

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Health Care Systems and Health Care Sub-culture

• By Kathleen Giuntoli, RN, MSN

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HEALTH CARE DELIVERY SYSTEM A NETWORK OF
SERVICES AVAILABLE TO INDIVIDUALS SEEKING
TREATMENT OR PROMOTING OR MAINTAINING HEALTH
HEALTH CARE SERVICESHEALTH CARE SETTINGS
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ORGANIZATION OF HEALTH CARE DELIVERY SYSTEM

• PRIVATE SECTOR
• Providers office -FEE FOR SERVICE
• PPO
• MANAGED CARE

• PUBLIC SECTOR
• Local
• State
• Federal
• International

• VOLUNTARY AGENGIES
• Non-governmental
• Not for profit
• Foundations

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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.

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MANAGED CAREPrivate 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

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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

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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.

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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.

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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,
  free-enterprise heritage of the people in the
  United States.
• Purposeto 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)

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What Effects Health Care Costs?

• Other effects on health care costs
• 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

• Death rate
• Lower birth rate
• Greater longevity
• Elderly by 2010, 40 million Americans or 14 of
  population will be gt65 y/o, with 4.3 million over
  age 85. (People over age 85 are fastest growing
  group in US)

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HEALTH CARE SERVICES

• Types of health care according to the needs
• of the client.
• PRIMARY CARE
• SECONDARY CARE
• TERTIARY CARE

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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

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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.

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Tertiary Preventative Care

• Begins after an illness is diagnosed and treated
  is aimed at rehabilitating patient and
  restoring them to maximum level of functioning.

• Activities would include
• Caring for the cardiac surgery pt. after surgery
• Teaching pt. w/diabetes how to recognize and
  prevent further complications
• Referring a women to a support group after breast
  removal (mastectomy)
• Teaching a brain stem injured pt. to walk.

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HEALTH CARE SETTINGSWHERE 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.

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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

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Outpatient settings
Community Settings

• Adult day care
• Respite care
• Case management programs
• School health clinics
• Industrial health services
• Home health
• Neighborhood community centers
• Free clinics

• Physician offices
• Ambulatory care centers
• Rural primary care hospitals
• Emergency and rescue systems

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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

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Health care team(1 out of 10 Americans work in
health care)

• Primary care
• Nurses, physicians, physician assistants, ARNPs.
• Allied members-technologists, pharmacists, social
  workers, alternative practitioners, spiritual and
  religious personnel.

• Dietitians
• Respiratory therapists, PT, OT, etc.

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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 trends- technology, 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.