5- the health care delivery system

8/7/2019 5- The Health Care Delivery System

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Basic Nursing: Foundations of Skills & Concepts

Chapter 5

THE HEALTH CAREDELIVERY SYSTEM


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What is the Health Care Delivery

System?

A mechanism for providing services that meet thehealth-related needs of individuals.


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Three levels of Health Care

Primary

Secondary

Tertiary


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Primary Care

Goal:To decrease the risk to a client (individualor community) of disease or dysfunction.

Approach:General health promotion. Protectionagainst specific illnesses.


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Secondary Care

Goal:To alleviate disease and prevent further disability.

Approach:Early detection and intervention.


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Tertiary Care

Goal:To minimize disability associated withchronic or irreversible conditions.

Approach:Restorative and rehabilitativeactivities to attain optimal level of functioning.


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The U.S. System

Health care services are delivered and financed bythree sectors:The public (official, voluntary, and nonprofit agencies)Public/privatePrivate (hospitals, extended-care facilities, hospices,schools, etc.)


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Health Care Settings

HospitalExtended-care facilitiesHome health careagencies

HospicesOut-patient settings

Schools

Industrial ClinicsManaged careorganizationsCommunity nursingcentersRural primary carehospitals


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Health Care Team Members

Health care is delivered by a multidisciplinaryteam, all working together. Examples include:Physician (MD)

Nurse (RN, LP/VN)Nurse Assistant (CAN)Registered Dietician (RD)


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Private Insurance Model

Basis of U.S. system

Individual pays monthly premiums for coverage

and receives access on an as needed basis


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Managed Care Model

Developed to provide coordinated care with anemphasis on prevention

A system of providing and monitoring carewherein access, cost, and quality are controlledbefore or during delivery of service


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HMOs, PPOs and EPOs

Health Maintenance Organizations (HMOs) have a single pointof entry. Entry into the health plan through a point designated bythe plan.Preferred Provider Organizations (PPOs) allow individuals toaccess health care from within a pool of providers.

Exclusive Provider Organizations (EPOs) are similar to PPOsexcept that care is intended to be delivered exclusively fromwithin the selected pool of providers.


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Federal Insurance Plans

Medicare: Provides health care coverage for elderly persons and disabled persons.

Medicaid: Federal and Local administeredprogram that provides health care services for the poor.


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Factors Influencing Health Care

Cost

Access

Quality


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Access Issues

Many factors influence an individuals ability toaccess the health care system:Inadequate or cost of insuranceCultural barriersLimited access to ancillary services (e.g. child care,transportation)Certain preexisting conditions making it difficult to obtaininsuranceShortage of providers in rural or inner city areas


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Quality Issues

Many factors influence the quality of careindividuals receive:The litigious environment and response toward defensivepractice (e.g. ordering all possible tests).The widely held American belief that more is better.Lack of access to and continuity of services result in subsequentmisuse of acute services.


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Challenges

The U.S. Healthcare system faces some seriouschallenges:Publics disillusionment with providersPublics loss of control over health care decisions

Changes in practice settingsDecreased use of hospitals and related impact on quality of careEthical issuesHealth care needs of vulnerable populations


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5- the health care delivery system

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