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