Current Health Care Systems and Trends Chapter 2 Current Health Care Systems and Trends

Today’s Health Care Industry Largest service employer in U.S. Americans spent $2.9 trillion on health care in 2013 Projected to grow 5.7% annually between 2013 and 2023

Technological Advancements Health care changed very gradually until beginning of 20th century Progress now increases rapidly Infectious diseases previously major causes of death Now largely under control

Question True or False: Penicillin and antibiotics were discovered in the mid-1800s.

Answer False Penicillin and antibiotics not discovered until 20th century

Technological Advancements Recent advancements: Organ transplants Microscopic and robotic surgery Gene therapy Targeted drug therapy

Question The purpose of targeted drug therapy is to _____ . Prevent drug abuse Destroy cancer cells Create personalized pharmaceutical products

Answer B. Destroy cancer cells Targeted drug therapy aims to destroy cancer cells or prevent them from dividing

Highlights of Health Care History Ancient and medieval times Early beliefs in supernatural causes Hippocrates Physician in ancient Greece Considered father of medicine Plagues during Middle Ages killed majority of population

Question Chronic illnesses were rare in ancient times because _____ . The average person did not live longer than 35 years The environment did not contain synthetic chemicals as it does today Physicians were unable to diagnose most diseases

Answer Chronic illnesses are most common in older adults A. The average person did not live longer than 35 years Chronic illnesses are most common in older adults

Highlights of Health Care History Renaissance Brought interest in science Experiments and observation

Highlights of Health Care History Surgery became respected form of treatment Body functions still poorly understood Technique of vaccination discovered by Jenner

Highlights of Health Care History Building of large hospitals Dentists introduced anesthesia Pasteur proved that bacteria caused certain diseases Advancements in public health and preventive medicine

Question Elizabeth Blackwell, the first female physician in the U.S., opened the first _____ . Hospital Nursing school Treatment center for mental illness

Answer B. Nursing school Blackwell opened first school of nursing in 1860 Enabled nursing to become established profession

Highlights of Health Care History Many discoveries E.g., blood groups, vitamins, penicillin and antibiotics, synthetic drugs to treat specific problems Health care specialties developed E.g., physical and occupational therapy Great advances in surgical techniques Emphasis on scientific approach to medicine

Hopes for the 21st Century Vaccine to prevent human immunodeficiency virus (HIV) Cure for acquired immune deficiency syndrome (AIDS) Cure for obesity Organ cloning

Hopes for the 21st Century Cures for cancer and heart disease More effective treatment for mental illness Less invasive treatments Drugs with fewer side effects

Specialization Effects on health care: Improved diagnosis and treatment More technical and fragmented medical practice Increased health care costs Breakdown of patient-provider relationships Increased job opportunities for health care professionals

Aging Population Life expectancy increase 1900 47 years Today 79 to 81 years Large number of “baby boomers” becoming older adults

Aging Population Older adults Needs of older adults: Heaviest users of health care services Needs of older adults: Long-term care facilities Home care services Treatment for chronic conditions

Question True or False: “Chronic” describes a health condition experienced as a result of aging.

Answer False Chronic Conditions and illnesses that cannot be cured quickly Persist over period of time

Increasing Costs of Health Care Costs increasing dramatically Technological advances Increased use of services due to aging population Rising costs of pharmaceutical products Increased use of expensive diagnostic tests Lack of competition in some areas

Increasing Costs of Health Care Costs increasing dramatically Rising expectations of patients More effective treatments Therefore, more patients seeking care Poor geographic distribution of health care providers

Costs of Health Care Sources of health care dollars, 2004

Costs of Health Care Uses of health care dollars, 2004

Health Care Facilities and Services Wide variety of health care facilities Many patient services for different needs Range in size from private individual offices to national organizations Many employment options available for today’s health care professionals

Hospitals Traditional health care setting Now high-tech facility limited to patients who need sophisticated treatment and 24-hour care Costs have increased dramatically Major challenge: Controlling expenses

Hospitals Various levels of care provided Trauma center Emergency department (ER) Intensive care unit (ICU) Cardiac care unit (CCU) General unit Transitional care unit (TCU) Rehabilitation unit

Question A patient who is hospitalized following a myocardial infarction (heart attack) would most likely be cared for in the _____ . CCU ICU Trauma center

Answer A. CCU Cardiac care unit (CCU)

ER VISITS Emergency departments used by some for routine care Extremely expensive Patient Protection and Affordable Care Act may alleviate the overuse of ERs Patient education necessary on use of insurance

Accreditation of Health Care Facilities The Joint Commission Private, non-profit organization Encourages high standards Provides guidelines Performs on-site inspections Accreditation voluntary But may be required to qualify for Medicare reimbursement

Ambulatory/Outpatient Services Patients do not require hospitalization Most surgeries today are outpatient Majority of ambulatory services performed in physicians’ offices

Ambulatory/Outpatient Services Facilities that offer outpatient services: Adult day care Dental offices Diagnostic centers Emergency and urgent care centers Health care services in companies, schools, and prisons

Ambulatory/Outpatient Services Facilities that offer outpatient services: Medical offices Rehabilitation centers Specialty clinics and offices Surgical centers Wellness centers

Long-Term Care Facilities Individuals do not need hospital But unable to live at home Fastest growing area of health care services

Long-Term Care Facilities Nursing home Skilled nursing facility Intermediate nursing facility Adult foster home Assisted living residence Continuing care community

Home Health Care Services Provide care to patients in their homes Tremendous growth in need for services Factors contributing to its growth: Shorter hospital stays Increase in older population Medical equipment that can be used at home Desire of individuals to stay at home

Home Health Care Providers Examples of professionals who provide care at home: Nurses Physical therapists and assistants Occupational therapists and assistants

Home Health Care Providers Examples of professionals who provide care at home: Speech therapists Medical social workers Nursing assistants and home health aides

Hospice Palliative care and support for dying patients and their families Team of professionals and volunteers Medical, emotional, and spiritual support Make patient’s last days as pain-free and meaningful as possible

Question True or False: Palliative care provides comfort and pain relief, but does not offer a cure.

Answer True Palliative care relieves But does not cure

Consolidation of Health Care Services Combines facilities under one ownership to control costs Buy supplies in large quantities Share expensive equipment Avoid duplication of lab and diagnostic services Share knowledge and management expertise Consolidate services

Consolidation of Health Care Services Provides more consistent and coordinated care for patients But reduces competition Thus, patients have fewer choices Can result in higher prices and lower quality

New Types of Facilities Expanded functions for pharmacies Immunizations, mini-clinics Medical malls Cluster of services in vacated retail malls

Government Health Services Supported by taxpayers Conduct research, regulatory, and educational activities

Government Health Services Examples of federal agencies: National Institutes of Health (NIH) Centers for Disease Control and Prevention (CDC) Occupational Safety and Health Administration (OSHA)

Question Which of the following service is provided by the National Institutes of Health? Make health care available for the uninsured Control the spread of diseases Conduct medical research

Answer C. Conduct medical research Role of National Institutes of Health: Conduct medical research

Government Health Services Examples of state services: License personnel and facilities Provide laboratory services Establish health data systems Conduct public health planning

Government Health Services Examples of local government services: Collect vital statistics Conduct sanitary inspections Screen for diseases Provide immunizations

Trends in Health Care New approaches: Search for alternatives to surgery and drugs Desire to use natural products Belief in mind-body connection Focus on prevention rather than cure More personal responsibility for health Patient access to information Desire for humanization of medicine

Wellness Promotion of health through preventive measures and practice of good habits Leading causes of death influenced by lifestyle habits

Wellness Wellness centers Routine physicals Immunizations Exercise and nutrition classes

Expanding Consciousness Theory developed by Margaret Newman Wellness is more than the absence of disease or disability

Question True or False Wellness means not having an illness or injury.

Answer False Wellness means more than the absence of disease or injury. It includes the practice of good lifestyle habits and promoting good health through preventive measures.

Complementary and Alternative Medicine Complementary medicine Used together with conventional medicine Alternative medicine Used instead of conventional medicine

Complementary and Alternative Medicine Integrative medicine Conventional used with nonconventional practices for which there is scientific evidence of effectiveness

Complementary and Alternative Medicine Whole medical systems Homeopathic Naturopathic Traditional Chinese Including acupuncture Ayurveda

Complementary and Alternative Medicine Mind-body medicine Patient support groups Meditation Prayer Guided imagery Creative activities Yoga

Complementary and Alternative Medicine Biologically based practices Aromatherapy Herbs Dietary supplements Natural products E.g., shark cartilage

Complementary and Alternative Medicine Manipulative and body-based practices Chiropractic Osteopathic Massage therapy Reflexology Relaxation exercises

Question Which of the following health care practices involves manipulating the spine to relieve pain or correct dysfunction? Naturopathy Acupuncture Chiropractic

Answer C. Chiropractic Chiropractic care Based on belief that pressure on nerves leaving spinal column causes pain and dysfunction

Complementary and Alternative Medicine Energy therapies Biofield Qi gong Reiki Therapeutic touch Bioelectromagnetic

Complementary and Alternative Medicine Susceptible to fraud Signs of fraudulent products: Claims to cure variety of problems Claims to be miraculous and/or secret Uses terms for which no definitions exist Provides undocumented case histories Requires payment in advance

Holistic Medicine Expanded view of traditional medicine Emphasizes prevention of disease and personal responsibility for health Reduce stress Proper nutrition Physical activity Positive attitude

Holistic Medicine All aspects contribute to health Physical Mental Emotional Spiritual

Challenges in Health Care Today Providing affordable care Patient Protection and Affordable Care Act of 2010 Subsidies for lower-income individuals Problem of high cost remains Some Medicare recipients cannot afford supplemental insurance

Challenges in Health Care Today Providing long-term care Increased need Costs increasing Medicare covers only certain short-term stays Funding may be inadequate

Challenges in Health Care Today Social conditions Poverty Homelessness Violence Substance abuse Spousal, child, and elder abuse Malnutrition

Challenges in Health Care Today Maintaining quality of care High costs encourage cutting expenses Amount of care may be decreased Decisions made by insurance companies rather than health care providers Preauthorization

Question There is concern about the quality of care in the U.S. because of the A. poor training of physicians B. high cost of providing health care C. lack of government support for health care research

Answer B. The high cost of health care sometimes influences the quality of care provided.

Treating Alzheimer’s Disease Progressive disease marked by dementia 6th leading cause of death in U.S. Cost of care Estimated to be $1.2 trillion by 2050

Challenges in Health Care Today Public health concerns Pandemics Influenza Ebola

Challenges in Health Care Today Medication adherence Failure to take medication results in expensive preventable health conditions May be due to high cost of drugs and/or side effects Providers must explain importance of medications

Challenges in Health Care Today Prescription drug overuse Painkiller prescriptions quadrupled since 1999 Almost 2 millions Americans abusing Deaths from overdose tripled since 1999

Challenges in Health Care Today Preventing prescription drug overuse Create prescribing guidelines Regulate pain clinics Identify fraudulent prescriptions Teach other pain control methods Educate patients about risk Improve access to antidotes

Challenges in Health Care Today Preventing antibiotic resistance Only effective against bacteria Bacteria can adapt so drugs are ineffective Can result from over and inappropriate use Considered a serious public health threat

Question Patients who request prescriptions for antibiotics when they have a cold are A. contributing to the problem of antibiotic resistance B. practicing good health habits C. likely to get well quickly

Answer A. Colds are caused by viruses and antibiotics are not effective against viruses. Taking unnecessary antibiotics leads to their being ineffective when needed.

Challenges in Health Care Today Personal responsibility for health Lifestyle choices influence incidence of heart disease, cancer, and stroke Healthy habits should be encouraged

Implications for Health Care Professionals Stay informed about important issues Contribute to delivery of high-quality care Model good health habits Provide effective patient education