Health Care Delivery Mary Beth Vogel, BSN RN-C

1. Health Care DeliveryMary Beth Vogel, BSN RN-C B

2. A Little History… • Hippocrates: Father of Medicine • Michelangelo and DaVinci: dissection for accurate drawings

3. Anthony Leeuwenhoek: Father of Microscopy • 1714: Fahrenheit: thermometer • 1796: Jenner: smallpox vaccine • Ben Franklin: bifocals, catheters • Florence Nightingale: Founder of nursing

4. Joseph Lister: disinfectant/antiseptics • Louis Pasteur: germ theory/pasteurization • Elizabeth Blackwell: first woman to graduate from med school in 1849 • Clara Barton: Founder of Red Cross

5. 20th Century • Flemming: penicillin (1928) • Jonas Salk: polio vaccine (1952) • Crick and Watson: identified DNA (1953); Nobel Prize awarded in 1962 • 1975: amniocentesis dev and ability to remove life support (Karen Quinlan case) • Louise Brown: 1st in-vitro baby (1978) • AIDS identified (1984)

6. Bureau of Labor Statistics: • Largest industry in US: 13.5 million jobs • 8 out of 20 occup projected to grow the fastest are in hc • More new jobs (about 19 percent, or 3.6 million created between 2004 and 2014) will be in health care than in any other industry • About 545,000 establishments make up the hc industry • Hospitals constitute only 2% of all hc establishments; they employ 40% of all HCW

7. HCW also are more likely to remain employed in the same occup. Why? • High level of educ, training, $ required for many health careers • Job opportunities will remain excellent in all hc settings because job turnover d/t retiring baby boomers

8. Current Trends

9. 1. Cost Containment • Focus: max benefit for every $ • Causes of current high costs in US? • Technology • Aging population • Litigation • Poor health habits • # uninsured

10. Methods to Contain Costs: • 1. DRGs (diagnostic related groups) • 2. Combining services/eliminate dupl • 3. Outpatient, home care • 4. Preventative care • 5. Bulk purchasing/procurement • 6. Conservation of supplies, energy

11. 2. Home Health Care • A trend and a method to contain costs • Increasing number of disciplines can deliver care at home • House calls making a comeback?

12. 3. Geriatric Care • Rising elderly population will challenge US hc delivery • Assisted living and adult day care • SNF

13. 4. Developing technology • Marks US hc as best in the world? • Comes with an expensive pricetag

14. 5. Emphasis on prevention • Helps contain cost but is also a trend • Cheaper to prevent illness than tx it

15. 6. Alternative/Complimentary Tx • Alternative Tx: in place of traditional • Complimentary Tx: in addition to trad • Holistic care or Integrative Medicine may incorporate both • NIH: Office of Alt Med (OAM) to research new therapies and est standards • Why is it important to be aware of alt/comp tx?

16. Health Care Delivery in the US

17. 1. Hospitals • Acute care • Categorized by pop tx, affiliations, and/or funding • Types: • General • Specialty • Government • University • Religious

18. Funding: • Private/proprietary • Non-profit

19. 2. Outpatient Services • Wide range of careers/svcs • Clinics, physician offices, surgical svcs • Private, local, university, county/state

20. 3. LTC • SNF, assisted living, rehab • Tx: chronic illness, disabled, elderly • Long-term care, rather than acute care

21. 4. EMS • Paramedics / EMT • Ambulance/transport services, urgent care, ED, flight services

22. 5. Diagnostic Svcs • Techs, equip operators • Labs, radiology • Free standing, hosp assoc

23. 6. Home Health Svcs • HHA / CNA, LPN / RN, specialty services • Private agencies, hosp assoc • Nursing care • Personal care • Therapy ( PT, OT, Speech, RT) • Homemaking

24. 7. Hospice Care • Focus moves from curative to comfort care • Palliative/hospice • Home, hospital or specialized facility • Goal of Hospice Care: allow a person to die with dignity and in comfort. • Psychological, social, spiritual, physical

25. 8. Mental Health Services • Psychiatrist / psychologist • Specialized hosp or designated units in general hosp, psych clinics, tx ctrs for specific disorders

26. 9. Rehabilitation Services • Hospital or free standing • Services inc PT, OT, SLP

27. 10. Occupational Health • Industrial health • Company or assoc w/ hosp/med office • Wrkrs comp ins • Safety/prevention • MA

28. 11. Optical Services • Opticians, optometrists, ophthalmologists • Wide range of vision services from glasses to surgery

29. 12. School Health Services • Emergency care, education, counseling, screenings

30. Health Insurance • Protection against med costs • Contract btwn insurer and individ/grp • In US, often is a benefit of employment

31. Managed Care • Integrates cost and delivery of healthcare • Goal: elim wasteful spending • All health care must have a purpose • Involves 2nd opinions, networks, pre-certification, case management

32. Insurance Terms • Premium: cost of the plan • Deductible: fixed dollar amt payed before insurance begins to pay • Coinsurance: insured pays fixed % • Co-payment: flat fee/fixed dollar amt • Pre-certification/preauthorization • Referral • Network • Exclusions • PCP • 2nd surgical opinion • Terms of policy often negotiated btwn emplyrs/ins carriers

33. Types of health insurance 1. HMO (health maintenance org) • Selected network • PCP, referrals, pre-certs • Least expensive (historically) • Advantages: low out of pocket costs, may not have a lifetime max, focus on wellness • Disadvantages: non network may be denied or high co-ins%, “gatekeeper”, referrals; pre-authoriz for most proced

34. 2. PPO • More flexibility • No PCP/referrals but incentives for in-network • Advantages: low out of pocket expense, lgr network, usually no gatekeeper or referrals; limited pre-authoriz • Disadvantages: limitations for out of network, may be somewhat more expensive

35. Variations of 1 and 2: • Point of Service: PCP in-netwk but care out of netwk is cov. May need referrals • Fee for Service: most freedom, no netwks, no PCP. Providers receive fee for each scv. Most expensive

36. 3. Medicare: elderly (65+), SS for >2 years • Part A: hospital • Part B: outpatient/physician • Part C (Medicare advantage): expanded benefits • Part D: prescription drug

37. 4. Medicaid: hosp/med expense coverage for low-income • Varies by state 5. CHIP: for uninsured children < 19 6. TRICARE: military & families; admin by priv contractors; VA 7. Civilian Health and Medical Program of the Uniformed Services (CHAMPUS): inactive military/families

38. Government Agencies • WHO – UN sponsored, stats/info, addresses serious health prob in world • USDHHS – health probs in US • NIH – part of USDHHS, disease research • CDC – part of USDHHS, causes/spread/control of diseases • OSHA – standards, prev job-rel injuries • FDA – regulates food & drug products

39. Non-Profits • Support from member fees, donations, fed/state grants • May focus on single disease or grp • Emphasis on research, educ, local services • Red Cross, AHA

40. Organizational Structure • Chain of command • Streamlines prob solv, improve overall comm • Most efficient operation

42. Health Care Reform • What is wrong with our current system? • US spends more on hc than any other nation • But… • US is 23nd in life expectancy • US is 26th in infant mortality • Yet we spend more on hc than any other nation (WHO) • 46 million are uninsured • Here’s how other countries take care of their citizens: (pbs.org) http://video.pbs.org/video/1050712790/