PH 381 Chapter 13

How is healthcare delivery in the US unlike other developed countries?

• Delivered by an array of providers in a variety of settings

• Paid for in a variety of ways

T or F. From colonial times through the late 1800s, anyone trained or untrained could practice medicine.

True

T or F. Early medical education was not grounded in science and was only experience-based prior to 1870.

True

History of healthcare delivery in the US

• Self-care has been a category of health care throughout history and today

• Past medical education was not as rigorous as today

• Most care was provided in patients' homes

• Hospitals were only in large cities and seaports

• Almshouses

• Pesthouses

Characteristics of hospitals that were only in large cities and seaports:

• Functioned more in a social welfare manner

• Not clean

• Unhygienic practices

Almshouse definition

A house built for the poor

Pesthouse definition

Hospitals for individuals with infectious diseases such as the plague

Healthcare delivery in the late 1800s to early 1900s

• Care moved from patient's home to physician's office and hospital

• Science had a bigger role in medical education

• Mortality decline due to improved public health measures

• More specialized training

• New procedures began to be used

• Two-party system created

Advantages of care being moved from patient's homes to physician's office and hospitals in the late 1800s to early 1900s:

• Building and staffing better

• Designed for patient care

• Trained people

• Medical supplies

• Reduced travel time

Healthcare delivery in the early 1920s:

Chronic diseases passed communicable diseases as leading causes of death

New procedures during the late 1800s and early 1900s were:

• X-ray

• Specialized surgery

• Chemotherapy

• Electrocardiogram (ECG)

What is the two-party system?

• System between patients and physicians

• Physicians collected own bills, set prices, and adjusted prices based on the patient's ability to pay

Healthcare Delivery in the 1940s and 1950s:

• WWII impact

• Hill-Burton Act

• Improved procedures, equipment, and facilities resulted in a rise in cost of health care

• Concept of health care as a basic right VS as a privilege

T or F. In the late 1950s, there was an overall shortage of quality care and maldistribution of healthcare services.

True

How did WWII impact healthcare delivery in the 1940s and 1950s?

• Employers used health insurance to lure workers due to wage restrictions

• Huge technical strides

What was the purpose of the Hill-Burton Act of 1946?

To give hospitals, nursing homes, and other health facilities grants and loans for construction and modernization

Healthcare delivery in the 1960s:

• Increased interest in health insurance

• Third-party payment system became standard method of payment

• Cost of health care rose

• Creation of Medicare (65+) and Medicaid (low-income)

Healthcare delivery in the 1970s:

• Health Maintenance Organization Act of 1973

• National Health Planning and Resources Development Act of 1974

What was the National Health Planning and Resources Development Act of 1974?

Health systems agencies put in place to cut costs and prevent building unnecessary facilities and purchasing unnecessary equipment

Healthcare delivery in the 1980s:

• Deregulation of healthcare delivery

• Proliferation of new medical technology

• Elaborate health insurance programs

What is meant by the deregulation of healthcare delivery?

• Role of competition

• Competitive market approach of questionable value in lowering healthcare costs

Healthcare delivery in the 1990s:

• American Health Security Act of 1993

• Managed care

• Children's Health Insurance Program (CHIP)

T or F. In the mid-190s, the percentage of GDP and dollars spent on health care continued to increase.

True

What constitutes managed care during the 1990s?

• Achieve efficiency

• Control utilization

• Determine prices and payment

Healthcare delivery in the 21st century:

• Medicare Prescription Drug, Improvement, and Modernization Act of 2003

• CHIP Reauthorization Act of 2009

• Affordable Care Act of 2010

Spectrum of healthcare delivery

• Population-based public health practice

• Medical practice

• Long-term practice

• End-of-life practice

Population-based public health practice definition

Implements intervention to prevent disease and promote health

What are public health practice interventions aimed at?

• Disease prevention

• Health promotion

• Specific protection

• Case findings

What is the goal of health education?

Empowerment and motivation

T or F. Many public health practices take place in governmental health agencies.

True

Primary medical care

• Clinical preventive services

• First-contact treatment

• Ongoing care for common conditions

Secondary medical care

• Specialized attention

• Ongoing management

Tertiary medical care

• Highly specialized and technologically sophisticated medical and surgical care

• For unusual and complex conditions

Type of long-term practices:

• Restorative care

• Long-term care

What is restorative care?

Provided after surgery or other treatment

Examples of restorative care:

• Rehab care

• Therapy

• Home care

• Inpatient and outpatient units

• Nursing homes

Characteristics of long-term care:

• Help with chronic illnesses and disabilities

• Time-intensive skilled care to basic daily tasks

Example of long-term care:

• Nursing homes

• Group homes

• Transitional care

• Day care

• Home health care

What is causing home health care to grow?

• Restructuring of healthcare system

• Technological advances

• Cost containment

What constitutes end-of-life practices?

- Services provided shortly before death

Example of an end-of-life practice:

Hospice care (terminal diagnosis)

Types of careers in the healthcare industry:

• Independent providers

• Limited care providers

• Nurses

• Physician assistants

• Allied healthcare professionals

• Public health professionals

T or F. There are over 200 types of careers in the healthcare industry.

True

What does it mean to be an independent provider?

Obtain specialized education and have the legal authority to treat any health problem or disease

Examples of independent providers:

• Allopathic providers

• Osteopathic providers

• Nonallopathic providers

Allopathic provider definition

• Produce effects different from those of diseases

• Doctors of Medicine (MDs)

Osteopathic provider definition

• Relationship between body structure and function

• Doctors of Osteopathic Medicine (DOs)

T or F. Allopathic and Osteopathic providers receive a similar education and training.

True

T or F. Most DOs work in primary care.

True

What kind of provider is a Doctor of Medicine (MD)?

Allopathic

What kind of provider is a Doctor of Osteopathic Medicine (DO)?

Osteopathic

Nonallopathic providers

• Nontraditional means of health care

• Complementary and Alternative Medicine (CAM)

Types of Complementary and Alternative Medicine (CAM):

• Natural products

• Mind-body medicine

• Manipulation

Examples of Complementary and Alternative Medicine (CAM):

• Chiropractors

• Acupuncturists

• Naturopaths

When is therapy considered complementary?

When used together with conventional medicine

When is therapy considered alternative?

When used in place of conventional medicine

Limited (or restricted) care providers

• Advanced training in a healthcare specialty

• Provide care for a specific part of the body

Examples of limited care providers:

• Dentists

• Optometrists

• Podiatrists

• Audiologists

• Psychologists

T or F. There are over 4 million people working in the nursing profession.

True

Three types of nurses:

1. Licensed practical nurses (LPNs)

2. Registered nurses (RNs)

3. Advanced practice registered nurses (APRN)

T or F. APRNs have either a master's degree or doctoral degree.

True

Physicians assistants

• Practice in many areas similar to physicians, but do not have MD or DO degrees

• Mid-level providers

• Training beyond RN, but less than physician

Allied healthcare professionals definition

• Assist, facilitate, and complement work of physicians and other healthcare specialists

• Education and training vary

Categories of allied healthcare professionals:

• Laboratory technologist/technicians

• Therapeutic science practitioners

• Behavioral scientists

• Support services

Characteristics of public health professionals:

• Work in public health organizations

• Usually financed by tax dollars

• Available to everyone

• Primarily serve the economically disadvantaged

Examples of public health professionals:

• Public health physicians

• Environmental health workers

• Epidemiologists

• Health educators

• Public health nurses

• Research scientists

• Clinic workers

• Biostatisticians

Examples of inpatient care facilities

• Hospitals

• Nursing homes

• Assisted living

Characteristics of inpatient care facilities

• Hospitals often categorized by ownership

• Teaching and nonteaching hospitals

• Full-service or limited-service hospitals

Private ownership hospital

• Profit making

• Specialty hospitals

Public ownership hospital

Supported and managed by government jurisdictions

Voluntary ownership hospital

• Not-for-profit

• About half of US hospitals

Outpatient care facilities

• One where a patient receives ambulatory care

• Group practices VS solo practices

• Clinics

Examples of outpatient care settings:

• Healthcare practitioners' offices

• Clinics

• Primary care centers

• Retail clinics at pharmacies

• Urgent/emergent care centers

• Ambulatory surgery centers

• Freestanding service facilities

Characteristics of clinics:

• Two or more physicians practicing as a group

• Do not have inpatient beds

• For-profit and not-for-profit

Characteristics of rehabilitation centers

• Work to restore function

• May be part of a clinic, hospital, or freestanding facility

• May be inpatient or outpatient

What does it mean for a healthcare facility to be accredited?

- Process by which an agency or organization evaluates and recognizes an institution as meeting certain predetermined standards

What is the Joint Commission?

A predominant accrediting organization

T or F. The accreditation of healthcare facilities assist in determining the quality of healthcare facilities.

True

T or F. The US healthcare "system" is unique compared to other countries.

True

Affordable Care Act of 2010

• Expanded coverage

• Curbed health insurance abuses

• Initiated improvements in quality of care

Characteristics of the structure of the US healthcare system:

• Complex

• Expensive

• Many stakeholders

• Intertwined policies

• Politics

Major issues with the healthcare system in the US also known as the triangle or health care:

• Cost containment

• Access

• Quality

T or F. All parts of the triangle of health care are equally important; the expansion of one compromises the other two.

True

What are major determinants to access of health care?

• Insurance coverage

• Generosity of coverage

T or F. The likelihood of being uninsured is greater for minority adults in low-income working families.

True

What is a major component of the Affordable Care Act of 2010?

Increasing the number of Americans with health insurance

Health insurance marketplaces definition

Organizations established to create more organized and competitive markets for purchasing health insurance

Factors that limit access to health care:

• Lack of health insurance

• Inadequate insurance

• Poverty

What characteristics should quality health care include?

• Effective

• Safe

• Timely

• Patient-centered

• Equitable

• Efficient

Groups that measure quality:

• Agency for Healthcare Research and Quality (AHRQ)

• National Committee for Quality Assurance (NCQA)

• National Quality Strategy (NQS)

• Accountable Care Organizations

• Patient-Centered Medical Homes

Three aims of the National Quality Strategy (NQS):

1. Better care

2. Healthy people/healthy communities

3. Affordable care

What is the National Quality Strategy (NQS) mandated by?

The Affordable Care Act of 2010 (ACA)

Payments come from four sources:

1. Direct or out-of-pocket payments

2. Third-party payments from private insurance

3. Governmental insurance programs

4. Other third-party payers

T or F. US is the biggest spender on health care in the world by total spent.

True

Packaged Pricing definition

Several services included in one price

Capitation definition

Paying for services on a per person premium for a period of time before service is received

Prospective Reimbursement definition

Using pre-established criteria to determine reimbursement amount in advance

Pay-for-Performance definition

Payment system that offer reward to providers/facilities for meeting/exceeding established standards

Characteristics of health insurance

• Cost is shared by all in the group

• Generally equitable

• Increased risk may lead to increased costs

Premium definition

Regular, periodic payment of insurance policy