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Current Trends in Health Care. Cost Containment. Trying to control the rising cost of health care and achieving the maximum benefit for every dollar spent. All aspects of health care are directed toward cost containment.
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Cost Containment • Trying to control the rising cost of health care and achieving the maximum benefit for every dollar spent. • All aspects of health care are directed toward cost containment. • Some reasons for high health care costs include technological advances, aging population, and health-related lawsuits.
Technological Advances • Highly technical procedures such as heart, lung, liver, or kidney transplants can cost hundreds of thousands of dollars. • Computers that can be used to examine internal body parts are valuable diagnostic tools but expensive.
Aging Population • Older individuals use more pharmaceutical products (medications), have more chronic diseases, and often need frequent health care services.
Health-related Lawsuits • Lawsuits force health care providers to obtain expensive malpractice insurance, order diagnostic tests even though they might not be necessary, and make every effort to avoid lawsuits by practicing defensive health care.
Methods of Cost Containment • Diagnostic related groups (DRGs) • Combination of services • Outpatient services • Mass or bulk purchasing • Early intervention and preventive services • Energy conservation
Diagnostic Related Groups (DRGs) • One way Congress is trying to control costs for government insurance plans such as Medicare and Medicaid • A limit is placed on patient’s cost of care and the agency providing care receives that set amount. • If the cost of care is less than the amount paid, the agency keeps the money; if it’s more, the agency must accept the loss.
Combination of Services • Done to eliminate duplication of services • Health care agencies join together or share specific services so care can be provided to a larger number of people at a decreased cost per person
Outpatient Services • Patients receive care without being admitted to hospitals or other care facilities • Reducing the length of hospital stays or decreasing the need for hospital admissions lowers the cost of health care
Mass or Bulk Purchasing • Buying equipment and supplies in larger quantities at reduced prices • Can be done by combining the purchases of different departments in a single agency or by combining the purchases of several different agencies • Computerized inventory can determine when supplies are needed and prevent overstocks and waste
Early Intervention and Preventive Services • Providing care before acute or chronic disease occurs • Methods include patient education, immunizations, regular physical examinations to detect problems early, incentives for individuals to participate in preventive activities, and easy access for all individuals to preventive health care services
Energy Conservation • Monitoring the use of energy to control costs and conserve resources • Recycling is also a form of energy conservation and most health care facilities recycle many different materials
Home Health Care • Diagnostic related groups and shorter hospital stays have created a need for providing care in the home • Another form of cost containment because it is usually less expensive • Multiple types of care can be provided in the home environment
Geriatric Care • Will continue to show rapid growth as “baby boomers” reach geriatric age • Examples: • Adult day care centers • Retirement communities • Assisted/independent living facilities • Long-term care facilities
Omnibus Budget Reconciliation Act (OBRA) • 1987 • Led to the development of many regulations regarding long-term care and home health care • Requires states to establish training and competency evaluation programs for nursing and geriatric assistants • Regulations serve to ensure certain standards of care
Telemedicine • Involves the use of video, audio, and computer systems to provide medical and/or health care services • New technology allows interactive services between health care providers even though they are in different locations
Wellness • State of being in optimum health with a balanced relationship between physical, mental, and social health • Examples: • Physical wellness • Emotional wellness • Social wellness • Mental and intellectual wellness • Spiritual wellness • Holistic Health
Physical Wellness • Promoted by a well-balanced diet, regular exercise, routine physical examinations and immunizations, regular dental and vision examinations, and avoidance of alcohol, tobacco, caffeine, drugs, environmental contaminants, and risky sexual behavior
Emotional Wellness • Promoted by understanding personal feeling and expressing them appropriately, accepting one’s limitations, adjusting to change, coping with stress, enjoying life, and maintaining and optimistic outlook
Social Wellness • Promoted by showing concern, fairness, affection, tolerance, and respect for others • Also by communicating and interacting well with others, sharing ideas and thought, and practicing honesty and loyalty
Mental and Intellectual Wellness • Promoted by being creative, logical, curious, and open-minded; using common sense; obtaining continual learning; questioning and evaluating information and situations; learning from life experiences; and using flexibility and creativity to solve problems
Spiritual Wellness • Promoted by using values, ethics, and morals to find meaning, direction, and purpose to life • Often includes believing in a higher authority and observing religious practices
Holistic Health • Care that promotes physical, emotional, social, intellectual, and spiritual well-being by treating the whole body, mind, and spirit • Based on the body’s natural healing powers
Complementary and Alternative Methods of Health Care (CAM) • Complementary therapies: methods of treatment that are used in conjunction with conventional medical therapies • Alternative therapies: methods of treatment that are used in place of biomedical therapies • Even though the terms are different, alternative is usually applied whether or not the therapy is used in place of or in conjunction with conventional medical therapies
Examples of CAM Practitioners • Ayurvedic • Chinese medicine • Chiropractors • Homeopaths • Hypnotists • Naturopaths
Ayurvedic Practitioners • Use an ancient philosophy, ayurveda, developed in India to determine a person’s predominant dosha (body type) and prescribe diet, herbal treatment, exercise, yoga, massage, minerals, and living practices to restore and maintain harmony in the body
Chinese Medicine • Use ancient holistic-based healing practice based on the belief that an life energy (Chi) flows through every living person in an invisible system of meridians (pathways) to link the organs together and connect them to the external environment or universe • Examples: acupuncture, acupressure, tai chi, and herbal remedies
Chiropractors • Believe that the brain sends vital energy to all parts of the body through nerves in the spinal cord • Use spinal manipulation, massage, and exercise to adjust the position of the vertebrae and restore the flow of energy
Homeopaths • Believe in the ability of the body to heal itself through the actions of the immune system • Use minute diluted doses of drugs made from plant, animal, and mineral substances to cause symptoms similar to the disease and activate the immune system
Hypnotists • Help an individual obtain a trance-like state with the belief that the person will be receptive to verbal suggestions and able to make a desired behavior change
Naturopaths • Use only natural therapies such as fasting, special diets, lifestyle changes, and supportive approaches to promote healing • Avoid the use of surgery or medicinal agents to treat disease
NCCAM • Because of the increased us of CAM therapies, the federal government established the National Center for Complementary and Alternative Medicine in 1992. • Purpose is to research the various therapies and determine standards of quality of care
AND…. • We are done with another one!