Health Care Systems and Health Care Sub-culture

1. Health Care Systems and Health Care Sub-culture By Kathleen Giuntoli, RN, MSN

2. HEALTH CARE DELIVERY SYSTEM“A NETWORK OF SERVICES” AVAILABLE TO INDIVIDUALS SEEKING TREATMENT OR PROMOTING OR MAINTAINING HEALTHHEALTH CARE SERVICESHEALTH CARE SETTINGS

3. ORGANIZATION OF HEALTH CARE DELIVERY SYSTEM • PRIVATE SECTOR • Provider’s office -FEE FOR SERVICE • PPO • MANAGED CARE • PUBLIC SECTOR • Local • State • Federal • International • VOLUNTARY AGENGIES • Non-governmental • Not for profit • Foundations

4. 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. Private Sector

5. 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

6. 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

7. 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. Public sector continued..

8. 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.

9. 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. Purpose:to 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) Voluntary Sector

10. Death rate Lower birth rate Greater longevity Elderly: by 2010, 40 million Americans or 14% of population will be >65 y/o, with 4.3 million over age 85. (People over age 85 are fastest growing group in US) 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 What Effects Health Care Costs?

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

12. 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 Primary Preventative Care

13. Secondary Preventative Care • 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. • 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.

14. 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. Tertiary Preventative Care

15. 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.

16. 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

17. Physician offices Ambulatory care centers Rural primary care hospitals Emergency and rescue systems Adult day care Respite care Case management programs School health clinics Industrial health services Home health Neighborhood community centers Free clinics Community Settings Outpatient settings

18. 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 Health Care Trends

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

20. 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. Summary