Chapter 2

1. Chapter 2 The Health Care Delivery System

2. 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

3. Types of Health Care Services • Primary: Health promotion and illness prevention • Secondary: Diagnosis and treatment • Tertiary: Rehabilitation Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

4. Three Levels of Prevention Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

5. Health Care SettingsPublic Sector • Federal Level • U.S. Department of Health and Human Services (DHHS) • State Level • Department of Health Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

6. Health Care SettingsPublic Sector • Local Level Health Units • Communicable disease control • Health records maintenance • Individual health services • Environmental health and safety • Public health education Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

7. Public Health Sector of Health Care Delivery Federal Level U.S. Department of Health and Human Services (DHHS) State Level Department of Health Local Level Health Units Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

8. Health Care SettingsPrivate Sector • Hospitals • Extended care facilities • Home health agencies • Hospices • Outpatient settings Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

9. Health Care SettingsPrivate Sector • Schools • Industrial clinics • Managed care organizations • Community nursing centers • Rural primary care hospitals Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

10. Health Care Team • Nurse (RN) • Physician (MD) • Physician Assistant (PA) • Pharmacist (RPh) • Dentist (DDS) • Dietitian (RD) • Social Worker (SW) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

11. Health Care Team • Respiratory Therapist (RT) • Physical therapist (PT) • Occupational Therapist (OT) • Chaplain • Unlicensed Assistive Personnel (UAP) • Dental Hygienist Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

12. Advanced Practice Registered Nurse • Diagnoses and manages common health problems. • Performs medical procedures (e.g., suturing, casting). Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

13. Nursing Roles • Caregiver • Teacher • Advocate • Manager • Expert • Case Manager • Team Member Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

14. Roles of the Nurse • Caregiver • Teacher • Advocate • Manager • Expert • Case Manager • Team Member Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

15. Economics of Health Care • Private Insurance • Managed Care • Primary care providers • Health Maintenance Organizations (HMOs) • Preferred Provider Organizations (PPOs) • Exclusive Provider Organizations (EPOs) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

16. Economics of Health Care • Federal Government Insurance Plans • Social Security Act 1965 • Medicare and Medicaid • Regulated by Centers for Medicare & Medicaid Services (CMS) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

17. Federal Government Insurance Plans • Medicare • Individuals over age 65 • Public funding • Permanently disabled individuals • Individuals with end-stage renal disease Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

19. Economics of Health Care • Canadian Health Insurance • National health insurance • Single-payer model • Short and long-term care • Financed with tax dollars Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

20. Factors Influencing the Delivery of Health Care • Cost • Access • Quality Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

25. Challenges Within the Health Care System • Nursing shortage • Loss of control over health care decisions • Decreased use of hospitals • Changing practice settings • Ethical issues • Vulnerable populations Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

26. Challenges Within the 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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

27. Challenges Within the 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

28. Challenges Within the 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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

29. Challenges Within the 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

31. Challenges Within the 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

32. Challenges Within the Health Care System • Nurses continue to advocate for ethical distribution of resources as health care reform progresses. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

33. Challenges Within the Health Care System • Vulnerable Populations • Children • The elderly • People with AIDS • The homeless • Others living in poverty Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

35. Vulnerable Populations • 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

36. Vulnerable Populations • 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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

38. Leadership and planning Delivery systems Legislation/regulationpolicy Professional/nursing culture Recruitment/ retention Economic value Work environment Public relations/ communication Education Diversity Ten Focus Areas of Nursing’s Agenda for the Future Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

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 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.