Government Influences on Health Care Chapter 2 Government Influences on Health Care Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Key Terms accreditation care plan Federal Register health maintenance organization (HMO) homeopathy informed consent managed-care organizations (MCOs) Medicare Medicaid Nursing Licensure Compact (NLC) nurse practice acts Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Key Terms (cont.) Occupational Health and Safety Act (OSHA) political action committees (PACs) preferred provider organization (PPO) scope of practice standards of practice Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

The Importance of Understanding the Role of Government in Health Care The government plays a key role in promoting the health and well-being of Americans This knowledge lets consumers and health-care workers to have an understanding of and an informed say in developing new legislation Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Health Care Legislation Three levels of government Federal State Local Laws concerning health care were developed based on the fundamental principles of health-care leaders Standards of practice were the foundations of laws related to consumer protection Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Hospitals and Nursing Schools Bellevue Hospital School of Nursing American Red Cross Mayo brothers in Minnesota American Medical Association Rockefeller Foundation Carnegie Foundation American Society of Superintendents of Nurse Training Schools Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Hospitals and Nursing Schools (cont.) National League for Nursing (NLN) American Nurses Association (ANA) Columbia University in New York Hill-Burton Hospital Construction Act of 1946 Army Cadet Nursing Corps Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

The Multidisciplinary Health-Care Team Among others, the multidisciplinary health-care team includes: Doctors Nurses Laboratory technicians X-ray technicians Social workers Plan of care Standards of care Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Nurse Practice Acts Define the scope of practice for nurses within each state Scope of practice is the identification of and legal limitations to the usual and customary skills practiced by a professional Nursing Licensure Compact Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Consumer Bill of Rights Stressed the importance of the relationship between the health-care provider and the patient Stipulated that the health-care system: Is fair and meets patients’ needs Gives patients a way to address problems Encourages patients to take active roles in health care Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Consumer Bill of Rights (cont.) Rights of the consumer to: Have choice of providers Have access to emergency services Take part in treatment decisions Receive respect and nondiscrimination Maintain confidentiality of health-care information Have resources for complaint and appeal Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Patient’s Bill of Rights Minnesota was the first state to establish a Bill of Rights for Patients as a state law in 1973 American Hospital Association (AHA): The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities in 2003 Informed consent is one of the most important rights of patients See Box 2-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Accreditation The process by which an institution is recognized as meeting specific predetermined standards of care A hospital that is not accredited may not be eligible to receive state or federal funding assistance Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

AHA Criteria for Hospitals in Pursuit of Excellence Care coordination Efficiency Health-care–acquired infections Health-care equity Health information technology Medication management Payment models Patient input Workforce and culture See Box 2-2. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

The Government’s Role in Health Care To provide for the general welfare of the people and provide spending power to do so The Children's Bureau Woman, Infants, and Children program (WIC) Sheppard-Towner Act of 1921 President Roosevelt's New Deal National Insurance Plan Social Security Act of 1935 Unemployment Compensation and Old Age Benefit laws Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

United States Department of Health and Human Services Established in 1939 as the Federal Security Agency Renamed in 1980 Healthy People Under the guidance of this department, local, state, and federal governments provide direct services, financing, information, and setting of policy Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Direct Services Include providing health care to: Native Americans Military personnel and their families Prisoners Managing screening clinics for diseases Managing immunization clinics for children Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Financing The government funds health education programs and finances health care through: Medicare Medicaid Social Security The government also provides grants for medical and nursing research and education See Box 2-3. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Information National Institutes of Health (NIH) Centers for Disease Control and Prevention (CDC) Health, United States Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Policy Setting USDHHS Public Health Service sector Bureau of Professions Division of Nursing Division of Dentistry Division of Medicine Federal legislation concerning health care is recorded and published in the Federal Register See Table 2-1. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Policy Setting (cont.) Federal law can mandate quarantine, and state laws can mandate specific health-related actions Occupational health is regulated by the federal Occupational Safety and Health Act (OSHA) Selective Service Social Security benefits Divorce, abortion, and custody laws Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

The Rising Costs of Health Care The cost of health care in the United States has steadily increased in recent history and continues to rise. Public health benefits (Medicare and Medicaid) were introduced, but increasing costs threaten their survival. Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Health Care Delivery Systems Managed care organizations (MCOs) Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Private Health Insurance Increasing health-care costs have led to higher premiums for membership in private health-care insurance plans Prevention and early intervention seem to be the keys to reducing health-care costs and are the core of Healthy People 2020 Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Health-Care Reform  Any effort to reform health care must involve: Managing costs Promoting access Identifying payers Two major worries include rationing care and limiting coverage for specific problems Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Resurgence of Self Care Focus on illness prevention, early detection, and early intervention Self care Midwives Lay practitioners Hydrotherapy Homeopathy Dorothy Orem Martha Rogers Jean Watson Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Resurgence of Self Care (cont.) Complementary and alternative medicine (CAM) Outreach programs Nursing education programs Culturally competent care of a diverse population Occupational health programs Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Global Health United Nations (UN) was formed in 1945 Common goals, including: Human rights Peace Economic and social advancement of all people Meets annually with the World Health Organization (WHO) Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.

Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc. Future of Health Care Federal legislation and funding Political action committees (PACs) Nurses Copyright © 2013, 2004 by Saunders, an imprint of Elsevier Inc.