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SUSHCS
- 1. NRSE 6002 Fall2012
- 2. High technology Sophisticated institutions Leading edge research High level training for health professionals
- 3. • Lack of standardized payment system • Unequal access for citizens • No central coordinating agency • Wide array of service settings that are not inter-connected • Few universal quality standards • Greater proportion of total economic output • Poorer outcomes than many developed countries
- 5. • 10 million people employed in health care • 664,000 MDs • 37,000 Dos • 2 million nurses • 162,000 dentists • 200,000 pharmacists • 700,000 health care administrators • 500,000 rehab therapists
- 6. 6,200 hospitals 16,700 nursing homes 5,400 mental health facilities 13,500 home health agencies 1,200 FQHCs 3,400 RHCs
- 7. 142 MD and DO schools 54 dental schools 80 pharmacy schools 1,500 nursing schools (all levels)
- 8. 1,000 commercial health insurance companies 70 Blue Cross/Blue Shield plans 750 health maintenance organizations 1,050 preferred provider organizations Self-insured employers Federal government State governments
- 9.
- 10. Women cared for the sick Healers, herbalists, midwives Passed traditions and knowledge from generation to generation Care centered in the home Care given by family and community members
- 11. Physicians were rising in Europe, but not in America Until 1800s, training was by apprenticeship Basic science research was centered in Europe American physicians focused on applied medicine – “practical” techniques Medical Journal
- 12. In 1800, 4 medical schools in US In 1850, there were 42 AMA formed in 1847 Reform of medical education began in the 1870’s and turned radically in 1910
- 13. • Urbanization • Science and technology • Rise of hospitals • Cultural authority • Maintenance of independent (non-employee) status through organization and cohesiveness • Licensing • Educational reform
- 14. Nursing arose from healing and religious traditions Development of nursing entwined with status of women over the centuries Nightingale ushered in era of “modern” nurse in 1860 NC first state to license “registered nurses” in 1903 State practice acts formalized profession
- 15. Apprenticeship Hospital schools Goldmark Report (1923) found nursing education inadequate in hospital programs Shift to college and university education initiated in 1893 and continues today
- 16. Let’s discuss!
- 17. Earliest hospitals in US were almshouses or were to isolate people with infectious disease or mental illness General hospitals developed in response to ◦ Urbanization ◦ Technology ◦ Medical specialization By 1900, 4,000 hospitals were in operation
- 18. Originated to assure clean water, control epidemics Public health nursing gained strength Gradually took over immunizations, communicable disease, sanitation Public health remained separate from physician practice
- 19. 1916 to 1920 Attempts by social reformers in 16 states to pass a bill requiring compulsory “health insurance” for workers Organized labor against it AMA “studied” it No surprise – no success
- 20. Effects of Great Depression on hospitals and physicians Hospitals started a pre-payment plan Physician groups started a pre-payment plan for physician services in the hospital, mainly surgery Private companies saw their success and joined in – and a new industry was born
- 21. 1935 – Social Security Act 1946 – Hill-Burton Act 1952 – failed health care reform under President Truman 1965 – Medicare and Medicaid passed in Lyndon Johnson’s vision for the Great Society ◦ Title VIII and Title XIX of the Social Security Amendment of 1965
- 22. Attempts to bring more system-ness through National Health Planning Act of 1974 Rise of HMOs ◦ HMO Act of 1973 Rising costs National Health Planning Act of 1974 HMO Act of 1973
- 23. Rise of for-profit health care providers and organizations Increasing corporate dominance Vertical and horizontal integration of health care organizations Especially in 80s, private sector assumed substantial control of health care delivery
- 24. Health Insurance and Portability and Affordability Act, 1996 Balanced Budget Act,1997 President Clinton’s health care reform attempt
- 25. “A medical care system that had begun to attract investors and in which business interests had started to re-shape the behaviors of doctors and health care facilities…” ◦ Arnold Relman, MD ◦ Editor-in-Chief, New England Journal of Medicine, 1980
- 26. http://money.cnn.com/magazines/fortune/fo rtune500/2010/performers/companies/profi ts/ Driven by profits Driven by technology
- 27. This is America,isn’t it?
- 28. Uninsured and underinsured do not have access to care (access) Costs continue to skyrocket (cost) Outcomes lag behind other developed countries (quality)
- 29. Uninsured 15% Employer- Medicaid/ Sponsored Other Public Insurance 13% 52% Medicare 14% Private Non- Group 5%
- 30. Uninsured 17% Medicaid/ Other Public Employer- 18% sponsored Insurance 60% Private Non- group 5%
- 31. 66% uninsured families have 1or more full time worker(s) 67% uninsured families below 200% poverty level Individuals between age 30 and 54 comprise the largest group of uninsured
- 32. Patient Protection and Affordable Care Act (March 23, 2010) ◦ Far reaching changes to all aspects of health care system ◦ http://www.kff.org/healthreform/upload/8061.pdf
- 33. Why are wearguing about the PPACA so hard?
- 34. Health care as Health care as economic model social resource Assumes free Requires market position government Market-based involvement demand for Assumes services government led Services provided position on ability to pay Ability to pay not Access is reward for necessary personal effort Access is a right
- 35. Individual Collective responsibility for responsibility for health health Benefits based on Basic benefits for individual everyone purchasing Strong obligation to Limited obligation collective good to collective good Public solutions Private solutions Planned rationing Rationing based on of health care ability to pay