health care and delivery system .ppt

The Health Care
Delivery System
Chapter 2

2-2
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Health Care Delivery System?
 Mechanism for providing services that
meet the health-related needs of
individuals.
 Nursing is a major component of the U.S.
health care delivery system.

2-3
Types of Health Care Services
 Primary: Health promotion and illness
prevention
 Secondary: Diagnosis and treatment
 Tertiary: Rehabilitation

2-4
Three Levels of Prevention

2-5
Health Care Settings
Public Sector
 Federal Level
• U.S. Department of Health and Human
Services (DHHS)
 State Level
• Department of Health

2-6
Public Sector
 Local Level Health Units
• Communicable disease control
• Health records maintenance
• Individual health services
• Environmental health and safety
• Public health education

2-7
Public Health Sector of Health
Care Delivery
Communicable
Disease Control
Health Records
Maintenance
(Vital Statistics)
Individual
Health Services
(e.g. Maternal-
Child Health
Programs)
Environmental
Health and
Safety
Public Health
Education
Federal Level
U.S. Department of Health and Human Services (DHHS)
State Level
Department of Health
Local Level
Health Units

2-8
Private Sector
 Hospitals
 Extended care facilities
 Home health agencies
 Hospices
 Outpatient settings

2-9
Private Sector
 Schools
 Industrial clinics
 Managed care organizations
 Community nursing centers
 Rural primary care hospitals

2-10
Health Care Team
 Nurse (RN)
 Physician (MD)
 Physician Assistant (PA)
 Pharmacist (RPh)
 Dentist (DDS)
 Dietitian (RD)
 Social Worker (SW)

2-11
Health Care Team
 Respiratory Therapist (RT)
 Physical therapist (PT)
 Occupational Therapist (OT)
 Chaplain
 Unlicensed Assistive Personnel (UAP)
 Dental Hygienist

2-12
Advanced Practice Registered
Nurse
 Diagnoses and manages common health
problems.
 Performs medical procedures (e.g.,
suturing, casting).

2-13
Nursing Roles
 Caregiver
 Teacher
 Advocate
 Manager
 Expert
 Case Manager
 Team Member

2-14
Roles of the Nurse
 Caregiver
 Teacher
 Advocate
 Manager
 Expert
 Case Manager
 Team Member

2-15
Economics of Health Care
 Private Insurance
 Managed Care
• Primary care providers
• Health Maintenance Organizations (HMOs)
• Preferred Provider Organizations (PPOs)
• Exclusive Provider Organizations (EPOs)

2-16
 Federal Government Insurance Plans
• Social Security Act 1965
• Medicare and Medicaid
• Regulated by Centers for Medicare &
Medicaid Services (CMS)

2-17
Federal Government Insurance
Plans
 Medicare
• Individuals over age 65
• Public funding
• Permanently disabled individuals
• Individuals with end-stage renal disease

2-18
Federal Government Insurance
Plans
 Medicaid
• Medically indigent
• Determined by federal and state
governments
• Inpatient and outpatient hospital services
• Physician services
• Laboratory services
• Rural health clinic services

2-19
 Canadian Health Insurance
• National health insurance
• Single-payer model
• Short and long-term care
• Financed with tax dollars

2-20
Factors Influencing the Delivery
of Health Care
 Cost
 Access
 Quality

2-21
Cost
 Four major factors increase the cost of
health care
• An over supply of specialized providers
• A surplus of hospital beds
• The passive role assumed by most
consumers
• Inequitable financing of services

2-22
Access Limiting Factors
 Prohibitive costs for employer to provide
 Inability to obtain individual insurance
 Cultural barriers
 Persons with preexisting conditions
 Shortages of health care providers
 Limited access to ancillary services

2-23
Quality
 Estimated that 30% to 40% of
diagnostic/medical procedures performed
in U.S. are unnecessary
 Inappropriate use of resources
 A 2002 study revealed that 73% of
nurses surveyed stated that the quality of
care at their hospital had declined due to
cost-containment measures.

2-24
Challenges Within the
Health Care System
 Positive Perception of Nurses
• Nurses are persistently seen as having the
highest standards of honesty and ethics.
• The public believes that if nurses were
allowed to use their skills, they would
significantly enhance quality and reduce
costs.

2-25
Health Care System
 Nursing shortage
 Loss of control over health care decisions
 Decreased use of hospitals
 Changing practice settings
 Ethical issues
 Vulnerable populations

2-26
Health Care System
 Nursing Shortage: By 2020 the workforce
is forecast to be 20% below
requirements.
• Fewer people entering the profession
• Aging of the nursing population
• Other career options offering greater
remuneration

2-27
Health Care System
 Loss of Control
• Consumers express a loss of personal
control within the health care system.
• Some feel terrorized by the system.
• Many American workers state that their
greatest concern is the possible loss of
health care coverage.

2-28
Health Care System
 Decreased use of hospitals
• Shorter lengths of stay
• Technologic advances
• Greater availability of outpatient facilities
• More services available in outpatient
settings
• Expectations/demands of third-party payers

2-29
Health Care System
 Changing Practice Settings
• Most nurses currently practice in hospitals
and will continue to do so in the future.
• There is an ever-increasing need for
expanded services and settings.
• Larger numbers of nurses will be needed for
primary care, public health, extended care
facilities, and the home setting.

2-30
Home Health Nursing
 The percentage of home health nurses is increasing in
numbers, as health care reform places more nurses
(as this home health nurse) outside the acute care
setting.

2-31
Health Care System
 Ethical Issues
• At present, citizens’ needs are greater than
available resources.
• The United States is struggling with major
ethical conflicts over allocation of scarce
resources versus compassionate quality
care.

2-32
Health Care System
 Nurses continue to advocate for ethical
distribution of resources as health care
reform progresses.

2-33
Health Care System
 Vulnerable Populations
• Children
• The elderly
• People with AIDS
• The homeless
• Others living in poverty

2-34
Vulnerable Populations
 Children
• Children are more likely to be insured than
adults.
• One in five children lives in a family with an
income below the poverty level.
• The State Children’s Health Insurance
Program was passed in 1997 to expand
health insurance coverage to uninsured low
income children.

2-35
 The Elderly
• A large number of elderly people live in rural
areas.
• Many elderly have no health insurance.
• Many hospitals in rural areas have been
closed due to economic pressures.

2-36
 People with AIDS
• Over 300,000 Americans have been
diagnosed with AIDS.
• Approximately 800,000 Americans are
infected with HIV.
• The most rapid spread of the disease is
occurring among women, children, and IV
drug users and their sexual partners.

2-37
Nursing’s Response to Health
Care Challenges
 Nursing’s Agenda for the Future is a plan
that focuses on strategies to improve
professional conditions for nurses and
quality of health care by 2010.

2-38
Ten Focus Areas of Nursing’s
Agenda for the Future
 Leadership and
planning
 Delivery systems
 Legislation/regulation
policy
 Professional/nursing
culture
 Recruitment/
retention
 Economic value
 Work environment
 Public relations/
communication
 Education
 Diversity

2-39
Nursing’s Response to Health
Care Challenges
 Standards of care
 Advanced practice
 Public versus private programs
 Public health
 Community health
 School nursing
 Long-term care

health care and delivery system .ppt

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health care and delivery system .ppt