HCA 701: Survey of the U.S. Healthcare System

1. HCA 701: Survey of the U.S. Healthcare System Introduction to Healthcare Services in the United States

2. RESOURCES NEEDED TO MAINTAIN A HEALTH CARE DELIVERY SYSTEM Financing Health Care Delivery System Technology & Supplies Healthcare Professionals Facilities Source: Williams and Torrens, Introduction to Health Services, 2002

3. BASIC SERVICE COMPONENTS OF A HEALTH CARE SYSTEM • Public Health (Including Health Promotion and Disease Prevention) • Emergency medical services (including transportation) • Ambulatory care for simple/limited conditions • Acute and community hospitals and medical centers • Long-term care (either in-home or institutional care) • Mental Health Services (both inpatient and ambulatory) • Rehabilitation services (both inpatient and ambulatory) • Dental services • Pharmaceuticals/supplies/medical devices and equipment

4. Brief History of the Development of the U.S. Health Care System 1850 – World War II

5. Brief History of the Development of the U.S. Health Care System WWII - Present

6. Life Expectancy at Birth

7. Life Expectancy at Birth and at age 65 years 1900, 1950, and 2000

8. Classification for Health Status Today • Disease – a state of dysfunction of the normal physiological processes manifested as signs, symptoms, and abnormal physical or social function (includes injury). • Functional Ability – a process used to represent how independently an individual can perform or fulfill expected social roles (physical and mental). • Quality of Life – multidimensional concepts of measures covering symptoms/problem complexes, mobility, physical activity, emotional well-being and social functioning.

9. Blum’s Model of Factors Affecting Health Health • Environment • Fetal • Physical • Socio/Cultural • Lifestyle • Attitudes • Behavior Biology • Medical Care • Prevention • Cure • Care • Rehabilitative

10. Primary Cause of Death 1997Source: Healthy People 2010

11. Healthcare Professionals • Healthcare is a major employer • It has a rapidly growing labor sector • Professionals • Non-professionals and technicians • Non-institutional workers • Rapid growth due to: • Technology growth and specialization • Health insurance coverage • Aging population • Emergence of hospitals

12. Types of Healthcare Worker Certification • Licensure – state or legal designation • Certification and registration • Independent and dependent professions • Independents practice without physician supervision (e.g., doctors, dentists) • Dependents need physician supervision (most nurses, CNAs)

13. Physicians • Comprised of two types by practice • Primary care physicians – short supply in U.S. • Family Practice, Internal medicine, OB/GYN, Pediatricians • Specialists – Surplus in U.S. • Specialize in specific areas

14. Physician Surplus or Shortage? • Rapid growth of physicians, esp. specialists, during 1980-95 due to: • Massive federal outlays • Influx of International Medical Graduates (IMGs) • Maldistribution of physicians can give appearance of shortage • Not enough primary care providers • Medical underserved areas in rural communities and inner cities • Malpractice and the impact on physicians

15. Changing Role of the Physician • More employed physicians • By managed care organizations and hospitals (the emergence of the “Hospitalist”) • Large group practices emerged with the growth of managed care • Emphasis away from specialty areas to managed care • More female physicians

16. Distribution of Physicians by Specialty: 1980, 1986, 1995, 2000 (In thousands 1980 1986 1995 2000 Pct. Change Specialty No./% No./% No./% No./% 1986-2000 All specialties 414/100 521/100 630/100 684/100 31.4 Primary Care 159/38.5 179/34.4 205/32.5 219/32.0 22.2 Other Medical Specialties 25/6.2 62/12.0 83/13.2 94/13.7 50.2 Surgical Specialties 110/26.7 134/25.7 158/25.2 170/24.9 27.0 All other specialties 118/28.5 144/27.8 183/29.1 201/29.4 38.9

17. Will doctors meet demand in a bio-terror event

18. Nurses • Typifies the concern of healthcare: “nursing is concerned with human response to health problems” • Historic factors that shaped nursing as a career: • Occupation to support physicians • Emergence of hospitals as community institutions • Acceptable female occupations, primarily white females • Linked to religious orders

19. Understanding the Nursing Shortage • Changes in occupational opportunities for women since 1970s • Majority of RNs are 50+ years of age or married with children at home • Low salaries – pay compression • Burnout • Lack of clinical career ladder • Active vs. Inactive – about 1/3 of nurses not working fulltime

20. Ambulatory Care • Personal health care given to the patient in an non-hospital or institutional setting • Types of settings: • Physician owned private practice • Managed care clinic settings • Community health care settings • “Urgent care” facilities • Shift to ambulatory care due to several factors: • Medicare PPS • Managed care • Improved technology

21. Patient Visits per 100 persons by Ambulatory Service Type, 1993-94 and 1999-2000

22. Hospitals • The growth of Hospitals in the U.S. is a fairly recent history: • Hill-Burton • Hospital Insurance • Advances in medical science • Professional nursing • Improved medical school training for physicians • Cost containment practices have lowered hospital utilization • Decreased inpatient utilization through DRGs and managed care • Shift to outpatient services • System and specialty hospital growth

23. Hospital Classification • For-profits – fastest growing type of hospitals • For-profit and non-profit systems (e.g., Kaiser Permanente, Catholic Hospitals West) • Public Hospitals • Numbers are in decline • Serve disproportionate number of Medicaid and uninsured • Account for nearly 25% of uncompensated care • Includes federally funded facilities such as VA and Armed Services facilities (McCallahan Federal Hospital)

24. Hospitals (types cont.) • Academic teaching hospitals • Tripartite mission • Face shaky future • Rural Hospitals • Small, non-profit • Many with nursing home swing beds • Endangered • Quality of care in question • Types of services available being lost to cities

25. Number of Public Community Hospitals, U.S.

26. Constraining Governmental and third party purchaser pressure for cost containment Competition from multi-hospital systems and local physicians Conservatism of some traditionally oriented practicing physicians Cost of continuing technological advances Slower growth of the economy Changing governmental philosophy toward health care Propelling New health markets other than inpatient care Weakening power of physicians in the hospital New organizational structures Increasing power of a more business-oriented management team Aging of the population Changing customer expectations for service Constraining and Propelling Forces Affecting Hospital

27. Hospital Beds per 1,000 population by Ownership, 2002

28. Background: Las Vegas Hospitals September, 2001

29. Decontamination Capabilities and Personal Protection Equipment, 2001

30. Hospitals and Emergency Preparedness: Observation Areas and Data Collection

31. Mental Health Services Definition: Painful emotional symptoms…inability to think, remember or concentrate…increased potential of medical illness, pain, disability or even death • Affects 30% of all adults • Most mental illness is untreated • 20-40% of homeless population is suffers from mental illness • Mental illness is a crisis situation for Nevada hospitals

32. Percent Distribution of Mental Health 24-hour hospital and residential treatment beds

33. Who Gets Treatment for Mental Illness?