✅ ch 3

Forces Driving Health Care Demand

• Demographic trends

  • ex: aging baby boomer generation, immigration, psych issues with kids & teenagers, change in cause-of-death rates since COVID

• Social and economic trends

  • ex: changing lifestyles, growing appreciation of quality of life, changing composition of families, revised definition of quality health care & increase in use of complementary and alternative therapies

• Health workforce trends

  • ex: nursing shortages, baby boomers who are very experienced have left the workforce

• Technological trends

  • ex: telehealth, AI

disparities in U.S. health care systems

• addressed by the Triple Aim: Cost, Access, Quality

  • Came out during the affordable care act

2010 Affordable Care Act

• Cost, Access, and Quality (“Triple Aim”) is the foundation

  • Customer Service is #4

• Attempts to improve health equity across diverse populations

• Economic changes

• Ability to purchase & shifting of costs

Current Health Care System in the US

• Triple Aim addresses causes of disparities

• 2010 Affordable Care Act

Triple Aim - Access to healthcare

• Social determinant of health defined by WHO

• Two class system: private & public

  • Superior vs lower quality care

• Employment provided health care related to economy

• Job-based health care depends on the economy

• Insurance status impacts access to healthcare

• the uninsured are less likely to receive preventive care services for major health conditions & chronic diseases

Triple Aim - Quality in healthcare

• Healthy People 2030 identifies public health priorities & objectives

• To Err Is Human: Building a Safer Health System (IOM, 2000)

• Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2003)

• Hospital Compare (2005)

• Institute for Healthcare Improvement (HIT)

• Development of accreditation process

To Err Is Human: Building a Safer Health System (IOM, 2000)

Preventable medical errors cost hospitals billions and many lives each year

Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2003)

• Nurses’ long hours threaten patient safety by causing fatigue, slower reactions, and reduced attention to detail

• Called for state regulators to pass laws barring nurses from working more than 12 hours a day and 60 hours a week, even if by choice

Hospital Compare (2005)

• database of hospital quality measures

• CMS offers a consumer website showing how hospitals perform in care for heart attack, heart failure, and pneumonia

• Public health accreditation is new, and its impact on quality and safety is still unclear

Institute for Healthcare Improvement (HIT)

4 principles to improve global health outcomes:

• Provide safe, high-quality care

• Partner communities with health systems

• Strengthen training and collaboration

• Use innovation to share and learn

Organization of the Health Care System

• Primary care system

• Public health system

• The federal system

• The state system

• The local system

Organization of the Health Care System - Primary Care System

• Accessed in US through insurance

• Managed care

  • Network of providers who follow certain rules to control costs and ensure proper care

  • A gatekeeper (usually the primary doctor) decides if you need to see a specialist

  • examples of managed care: Health maintenance organizations (HMOs) and preferred provider organizations (PPOs)

  • Medicare and Medicaid use managed care sometimes

Medicare

• Traditional plan:

  • Part A: hospital, inpatient, skilled nursing, hospice, home health

  • Part B: services provided by doctors, other HCP, home health, durable medical equipment (DME), preventive services

• Part D: prescription drugs/vaccines

• Part C (Medicare Advantage Plan): covers Part A, B, and D

• For seniors over 65 & ppl with disability

Organization of the Health Care System - Public Health System

• National, state, or local laws/mandates

• Multilevel: federal, state, and local systems

• Interdependent

  • Local health departments provide care that is mandated by state and federal regulations

    • ex: a law mandating immunizations for all children entering kindergarten OR a law requiring constant monitoring of the local water supply

Organization of the Health Care System - Federal System

U.S. Department of Health and Human Services (USDHHS): oversees all regulations dealing with healthcare

Organization of the Health Care System - State System

• Responsibilities:

  • primary response to a pandemic

  • health care financing for administration of programs (ex: Medicaid)

  • Mental health and professional education

  • Health codes and licensing

  • Insurance regulations

  • Direct assistance to local health departments

• Board of examiners of nurses

Organization of the Health Care System - Local System

• Direct responsibility to the citizens of its community or jurisdictions

• PHN’s provide population level or direct services, whether special or selected services

• Focus on emergency preparedness and response

Institute of Medicine (IOM) committee

• Created to study how primary care and public health work together

• The report called for a transformative vision placing public health at the center of U.S. health care

• Participating networks should be strengthened (local, primary care, public health & community)

• Provided recommendations

Potential Barriers to Integration of Public Health and the Primary Care Systems

• Different roles, functions, and foci

  • Primary care is person focused

  • Public health is community focused

• Different funding models

  • Primary care: individual client payments and health insurance

  • Public health: tax dollars, federal/state grants

Primary care is ________ focused

person

Public health is _________ focused

community

Primary care funding model

individual client payments and health insurance

Public health funding model

tax dollars, federal/state grants

Primary Health Care (PHC)

• the goal of the integration of public health and primary care

  • 1977: ___ movement began (30th WHO Health Assembly)

  • 1978: Declaration of Alma-Ata (“Health for All by the Year 2000”)

  • 1998: “Health for All in the 21st Century”

• highly political, and each United Nation interprets goals based on its own culture, resources, needs, and type of government

  • Most nations have not achieved goals