Trends, Technology, and Emerging Issues:

Healthcare Trends

Trends:

  • Technology

  • Epidemiology

  • Geriatric Care

  • Wellness

  • Cost Containment

Technology:

  • Computers and audiovisual devices

  • Telemedicine

  • Long distance surgery

Epidemiology:

  • The study of diseases

  • Many researchers are focusin on diseases that are influenced by lifestyle factors

  • Taking responsibility for one’s own health is a growing trend in today’s world.

Geriatric Care:

  • Because people are living longer, geriatric care is in high demand

  • Geriatric facilities have developed quickly in recent year: Adult day care centers, Independent living facilities, Retierment Communities, and Nursing homes

Wellness:

  • Change in focus from sick care to health care

  • Wellness canters includer: Weight control facilities, Health food stroes, nutritional services, Stress reduction counseling

Public Health:

  • Public health serves to procet the health of individual people and communities through: Preventiohn, education, treatment, research, safety standards and programs, tracking outbreaks, laws that help protect public health

Cost Conatinment:

  • Outpaitent: Reduce the legnth of hospital stays to reduce cost

  • Preventeative Care: Get regular check ups and vaccinations to prevent illness

  • Energy Conservation: Use energy efficent lighting, solar power, and automatic faucets

Consumer Responisbilities:

The same team:

  • Healthcare provides are patients are on the same team working towards teh same goal health people

  • healthcare providers are encouraged practice patient centered care

Patient centered care:

  • Partnership between the healthcare providers and the patient

  • empower patients

  • communicate with patients

  • Adovcate for patients

Patient Responsisbilities:

  • Patients should communicate with healthcare providers

  • Patients shoudl advocate for themselves

  • Patients should comply with their plan

Self-Advocacy:

  • Heere are some ways to practice self- advocacy:

  • request copies of your medical records

  • Review you medical records and use patient portals

  • ask questions

  • research treatment options

  • learn the pros and cons of options including costs

Patient Compliance:

  • Patient compliance is cooperation or obedience to a prescribed treatment plan

Patients bill or rights:

  • The patients bill of rights includes eight key points:

  • right to emergency treatment

  • right to respect

  • right to informed consent

  • Right to refuse treatment

  • Right to choose providers

  • Right to privacy

  • right to appeal

  • Patient responsibilites

Technology and Emerging Issues:

Impact of emerging issues:

  • Emerging issues and technologies results in changes in healthcare delivery systems

  • healthcare providers must be adaptable and learn new things quickly

Advencements in technology:

  • Mobile stock unit(MSU)

  • Wireless wearable sensors

  • miniature wireless pacemakers

  • spectral Ct

Bioethics:

  • Bioethics is the application of ehtics to healthcare. New discoveries must be considered throught these principles:

  • Autonomy

  • Justicfe

  • beneficence

  • Non- Malefincence

Addiction:

  • Addiction now viewed as a disease called substance abuse disorder

  • Treatments are broader and more accessible

  • Treated by a team of healthcare providers

Essential Lifelong Learning:

  • Emerging issues and new discoveries and technologies related to healthcare require that healthcare providers and patients be flexible and always willing to learn new things.

Healthcare Econimics:

Health Insurance:

  • rising cost of healthcare is good for the economy but the expesnes are a burden for most individual familes

  • in the 1920s the USA developed a system of health insurancfe to help cover the cost of medical expenses

  • The Patient Protection and Affordable Care Act (ACA) of 2010 was passed to reduce the number of uninsured in the USA

Health Insurance Terms:

Premium: the amount paid to an insuracne agency for a health insurance policy

  • Deductible: The amoun that must be paid by the patient before the insurance agency will begin to make payments

  • Co-Payment: an amount piad by the patient for a certainh servuce

  • Co-INsurance: The co-insurance is the percentage of costs of a healthcare service htat is paid by the patient after they have paid the deductible

  • Out of pocket payments: a medical bill that must be paid by the patient. many health insurance policies have a limit to the amount of out of pocket expenses to be paid by the patient during a year

  • Cost sharing reduction (CSR): This discount applies to deductibles, copament, copayment, and co insurance for qualified health palns. It lowers out of pocket expenses

  • Premium Tax Credit: Based on your annual income and household information this credit lowers your monthly insurance proemium payment on qualified health plans

  • Heath Insurance Portability and Accountability Act (HIPAA): law that protects patients health informatio and confidentiality. signed in 1996, HPAA makes it illegal to gian access to a patients health information without their permission. It also placed strict permissions on the transfer of personal health information (PHI) between organizations.

Healthcare Fraud:

  • a crime

  • using someones health info as if it were your own

  • billing for medical servies that were not provided

  • delivery of unnecessary medical serviecs

  • misrepresentation of medical serviecs provided for higher reimnursement

  • providng or recieveing money for partcipation in any of the above fraud schemes

Health Insurance then vs now:

  • First broad coverage was workers compensation in 1914 and provided cash payments to injured workers with job related injuries

  • Today the Affordable care act requires health insurance companies ot cover 10 essential Health benefits

10 Essesntial Health Benefits:

  1. Outpatient care

  2. emergnecy services

  3. hospitilization

  4. pregnacy, maternitity and new born care

  5. mental health and substance abuse treatment

  6. presription drugs

  7. rehab and habilitatitve services and devices

  8. laboratory services

  9. preventative health services

  10. pediatrics services

Individual Insurancfe: when a person purchases a policy and agress to pay the entire premium for health coverage

Group Insurance: Generally purchases througha an employer. The premium is split between the employer and the person being insured.

Indemnity Insurance:

  • patients must pay for all healthcare explenses out of their own pockets. afterwrds the insurance agency will reimburse the patient for a percentageof the expenses

  • doesnt work for everyone many people cant afford to pay for out of pocket payments

Managed Care:

  • two primary concepts are to promote good health and to practice preventive medicine

  • managaed care plans offer medical servies through a system though a system of healthcare provideers the sysetm of providers offers services at reduced rates.

differences between managed care and indemnity:

  • payment for medical servies

  • choosing a healthcare provider

Reimbursement:

  • health insurance agencies do not always reimburse the full amount charged for services

  • physicians will either absorb or loss or they will charge the patient for the amount that was not paid by the insurance agency

Types of Insurance Plans:

Managed Care

  • Health maintenancef organization

  • preffered provider organizations

  • point of service

Health Maintenance organizations:

  • Clients must pay a premium deductible and co payments

  • clients myst visit in network doctors and select a primary care physician

  • HMOs urge cliente to practice healthy livibng and to recieve preventive treatments

Preferred provider organization:

  • Clients must pay a premium deductible and co payments

  • clients do not have to choose a primary care physician

  • clients may visit non network physicians by coverage is greater with in network pysicians

  • PPOs oftern have other fees and co payements

Exclusive Provider Organizations:

  • Coverage for healthacare services is limited to care from providers or hospitals in the plan’s network, exept for emergencies

  • referral is not required to see a sepcialaist

  • no voerage for care from out of network providers

Point of Service:

  • Client must pay a premium

  • clients must choose a primary care physican

  • For in network physciacns there is usually no deductible and co payments are low

  • specialist may be non network physicians but coverage may be limited

Managed Care Comparisons:

  • Hmos, ppos, epos, and pos plans have similarites and differences it is important to know how these types of managed care compare with each other

Making Informed Descisions:

  • The most cost effective plan dependes on an individuals healthacer need and the coverage included in the plan

  • anyone who buys health insurance should research and compare the types of plans that are available

  • People who know in advance that they will need extensive healthcare shoudl research prices for the expected care

Government Programs:

Public health inurance programs:

  • With public health insurance programs the federal gov finacnes healthcare services recieved by elgible groups of the population

  • medicare

  • medicaid

  • military health system

  • tricare

  • veterans health administraion

Government programs:

  • Public Medical assistance: medicaid and medicare

  • Affordable Care act (ACA): expanded eligibility criteria for medicaid and provided financial assistance for those who do not qualify for medicaid or lack insurance from employer

Medicaid:

  • Needs based program

  • Designes by the federal gov administered by stay gov

  • Provides medical assistance to individuals and families who the state determines to be medically needy

Medicaid Services:

  • Hospital services

  • prenatal care

  • child vaccines

  • pediatric services

  • physician services

  • diagnostic testing and x-rays

  • rehab and physical therpay

  • prescription drugs

  • home healthcare

Medicaid expansion:

  • The ACA provided the foundatiohn for medicaid expansion. Since it is a volunatary program and states may decide whether or not to participate, states also decide whether or not to expand meidcaid for their residents

  • as of may 2019, 37 states including washington DC have elected to expand mediciad

Medicare:

  • Entitlement program for any citizaen age 65 or older

  • administered be the federal gov

  • after deductible medicare will cover 80% of all medical expenses

medical services:

  • Hospital care: hospilization, skilled nursing facilites, home healthcare, hospise care, long term care facilites

  • Out patient services: medical, expenses, including therpay, medical equipmetn and testing, preventive care

Healthcare for the Military:

  • The US department of defense operates the military services to active duty and retires military members of the armed forces and their families

  • TRICARE is the health insurance program of the military health system

  • The veterans health administration(VHA) is the largest integrated health servies system in the United States