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Health Care System: Structure
Chapter 13
Introduction
• Health care delivery in U.S. is different than all other developed countries
• Other developed countries have national health care programs run or organized by government
• Health care in U.S. delivered by an array of providers (health care facilities & professionals that provide care)
First question…
Does the U.S. really have a health care system?
Providers Consumers(patients) =+ System?
Brief History of Health Care Delivery in the U.S. - 1
Brief History of Health Care Delivery in the U.S. - 2
Pre-1870Pre-1870
TimelineTimeline
TodayToday
Brief History of Health Care Delivery
in the U.S. - 3
Pre-Pre-18718700
• Far behind Great Britain & Europe in both health care & Far behind Great Britain & Europe in both health care & medical educationmedical education
• Not grounded in scienceNot grounded in science• Medical education was provided through apprenticeshipsMedical education was provided through apprenticeships
Brief History of Health Care Delivery
in the U.S. - 4
Pre-Pre-18718700
• Health care provided in patients’ homesHealth care provided in patients’ homes• Hospitals in large cities & seaportsHospitals in large cities & seaports• Almshouses (poorhouse) to provide food, shelter & basic Almshouses (poorhouse) to provide food, shelter & basic
care for indigent care for indigent
Brief History of Health Care Delivery in the U.S. - 5
Pre-Pre-18718700
• Health care moved from patients’ homes to physician’s Health care moved from patients’ homes to physician’s office & hospitalsoffice & hospitals
• Health care based on more scienceHealth care based on more science
19001900
Brief History of Health Care Delivery in the U.S. - 6
Pre-Pre-18718700
19111911
1st health insurance
19001900
Brief History of Health Care Delivery in the U.S. - 7
Pre-Pre-18718700
19111911
Flu epidemic
19001900 1918-191918-19
Brief History of Health Care Delivery in the U.S. - 8
Pre-Pre-18718700
19111911
Spending 3.9% of GDP on health
19001900 1918191819291929
Brief History of Health Care Delivery in the U.S. - 9
Pre-Pre-18718700
19111911
• Diagnosis, treatment, fee• WWII & medical advances• Hill-Burton Act
19001900 1918191819291929 1930s1930s
& 1940s& 1940s
Brief History of Health Care Delivery in the U.S. - 10
Pre-Pre-18718700
19111911
• Right or privilege• Overall shortage & maldistribution• 3rd party system takes hold•Medicaid & Medicare
19001900 1918191819291929 30s/40s30s/40s
1950s & 60s1950s & 60s
Brief History of Health Care Delivery in the U.S. - 11
Pre-Pre-18718700
19111911
• Cost containment• Health planning agencies• HMO Act 1973
19001900 1918191819291929 30s/40s30s/40s
50s/60s50s/60s
1970s1970s
Brief History of Health Care Delivery in the U.S. - 12
Pre-Pre-18718700
19111911
• Deregulation• New medical technologies
19001900 1918191819291929 30s/40s30s/40s
50s/60s50s/60s
70s70s1980s1980s
Brief History of Health Care Delivery in the U.S. - 13
Pre-Pre-18718700
19111911
• American Health Security Act of 1993
• Managed care• Costs hit $1 trillion
19001900 1918191819291929 30s/40s30s/40s
50s/60s50s/60s
70s70s80s80s
1990s1990s
Brief History of Health Care Delivery in the U.S. - 14
Pre-Pre-18718700
19111911
• Medicare Modernization Act of 2003• Health Savings Accounts• No patients’ bill of rights• GDP 16.2%
19001900 1918191819291929 30s/40s30s/40s
50s/60s50s/60s
70s70s80s80s
90s90s2000s2000s
• Spectrum of care refers to the type of health care practice
• Population-based Public Health Practice (health promotion & disease prevention)
• Medical Practice• Primary Care: clinical preventive services; 1st
contact; front-line• Secondary Care: specialized attention (acute &
subacute care); e.g., ERs• Tertiary Care: Subspecialty referral
Spectrum of Health Care Delivery - 1
• Long-term practice•Restorative care: intermediate follow-up•Long-term care: care for chronic
conditions; personal care
• End-of-life practice•Care provided in last six months of life:
hospice care
Spectrum of Health Care Delivery - 2
Types of Health Care Providers - 1
• In 2005, 14 million health care workers; 9.9% of workforce
• 42% work in hospitals as compared to 63% in 1970
• Over 200 different careers in the health care industry
• Six categories: independent providers, limited care providers, nurses, nonphysician practitioners, allied health care professionals, public health professionals
Types of Health Care Providers - 2
• Independent providers: health care professionals with the education & legal authority to treat any health problem
• Allopathic providers: MDs; their remedies produce effects different from those of the disease
• Osteopathic providers: DOs; their remedies emphasize the interrelationships of the body’s systems in diagnosis, prevention, & treatment
Types of Health Care Providers - 3
• Nonallopatic providers: independent providers who provide nontraditional forms of health care
• Examples: chiropractors (adjusts spinal column), acupuncturists, naturopaths, herbalists, homeopaths
• Five general categories of complementary & alternative medicine (CAM): Alternate medical systems, mind/body interventions, biologically-based therapy, manipulative methods, energy therapy
Types of Health Care Providers - 4
• Limited care (restricted care) providers: those who provide care for a specific part of the body
• Examples: dentists, optometrists, podiatrists, & psychologists
Types of Health Care Providers - 5
• Nurses– Licensed Practical (Vocational) Nurses (LPNs): 1-2
years of training & carry out nontechnical duties– Registered Nurses (RN): diploma or associate
degree & state license– Professional nurses: Bachelor of Science in Nursing
(BSN); prepared for additional activities involving independent judgment
– Advanced Practice Nurses (APN): master’s or doctoral degrees; e.g., nurse practitioners, clinical nurse specialists, certified nurse midwife
Registered Nurses Prepared for Advance Practice, 2004
© Department of Health and Human Services
Types of Health Care Providers - 6
• Nonphysician Practitioners (also known as nonphysician clinicians or midlevel providers or physician extenders
• Examples: nurse practitioners (NPs) & physician assistants (PAs)
Types of Health Care Providers - 7
• Allied health care professionals– Provide services that assist, facilitate, &
complement work of physicians & other health care specialists
– Examples: dietitians, physical therapists, medical technologists, EMTs, speech therapists, & exercise physiologists
Types of Health Care Providers - 8
• Public health professionals– A health care worker who works in a public health
organization
– Examples: environmental health workers, public health administrators, epidemiologists, health educators, & biostatisticians
Health Care Facilities & Their Accreditation - 1
• Health care facilities: physical settings
• Practitioner offices: privately owned practices
• Clinics: no beds; tax-supported clinics for medically indigent called public health clinics or community health centers
Health Care Facilities & Their Accreditation - 2
• Hospital types– Provide secondary & tertiary care– Private (proprietary or investor-owned); specialty
(provide mainly one type of medicine)– Public (government run or funded)– Voluntary (not-for-profit)– Types of service: full-service; limited-service
Health Care Facilities & Their Accreditation - 3
• Outpatient & ambulatory care facilities: those that provide a wide array of outpatient services; they can range from hospital-based facilities to independently owned freestanding facilities
• Include: primary care centers, urgent/emergent care centers, ambulatory surgery centers, diagnostic imaging centers
• Some found in nontraditional settings
Health Care Facilities & Their Accreditation - 4
• Rehabilitation Centers– Used to restore lost functions– Ambulatory & inpatient facilities
• Long-term Care Options– Residential care (e.g., nursing home & assisted
living)– Home health care– Hospice, and home care
Health Care Facilities & Their Accreditation - 5
• Accreditation: process by which an agency or organization evaluates & recognizes an institution as meeting certain predetermined standards
• Agencies/Organizations– Joint Commission on Accreditation of Health Care
Organizations (JCAHO): 15,000 facilities– Centers for Medicare & Medicaid Services (CMS):
grants “deeming authority”
Health Care System: Structure
Chapter 13 - The End
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