IMPACT OF TECHNOLOGY ON HEALTH CARE ACCESS QUALITY Geographic access can be improved with: Quality of Care New procedures can provide: Better diagnoses Quicker and more complete cures Risk reduction in a cost-effective manner New remedies Improved remedies (More effective, less invasive) Increased longevity Mobile equipment Remote access to equipment and personnel Access may NOT be reduced for the uninsured COST Decreased morbidity Shorter post-surgical recovery Most important factor in medical cost inflation Increase in labor costs Increase in capital costs Increase in facility costs Quality of Life Patients can overcome limitations with: Speech Hearing Vision Movement Ability to treat terminal conditions Increase in life expectancy Increase in physical activity Improved pain relief Rise in the cost of prescription drugs due to: Price inflation Increase in utilization Product shift Indirect cost reduction Lowered length of inpatient hospital stays Labor cost savings Decrease in error rates Increase in life expectancy validates money spent on technology

AGGREGATE OF PRINCIPLES WHAT IS HEALTH POLICY? The aggregate of principles, stated or unstated, that characterize the distribution of resources, services, and political influences that impact the health of the population. AGGREGATE OF PRINCIPLES Political Influences Resources Services DISTRIBUTION Impact on the health of the population

PRINCIPAL FEATURES OF HEALTH POLICY Healthcare is not seen as a right of citizenship Private sector plays a dominant role Government spending only fills the gaps in the private sector Government as subsidiary to private sector Federal, state, and local governments do not coordinate their policies Incremental and piecemeal policies result from competing interests Institutional fragmentation in legislation process Fragmented, incremental, and piecemeal reform Powerful interest groups resist change Business and consumer interests are not uniform Pluralistic and interest group politics State control makes it difficult to develop a national strategy Disparities among states may lead to inequalities in access to healthcare Decentralized role of the states Americans look to presidential leadership for sources of major change in health policies Presidential leadership

THE FUTURE OF LONG TERM CARE (LTC) CHALLENGES Financing Resources Most middle-class families are unprepared to meet LTC expenses Costs can be reduced with community-based care instead of nursing homes Regulation Workforce Fundamental contradictions between regulatory mechanisms and regulations exist An additional 1.9 million workers will be needed when baby boomers retire Long-Term Care Financing: Most middle-class families are unprepared to meet long-term care expenses Resources: Costs can be reduced if people can have their needs met using community-based care as opposed to a nursing home Infrastructure: New architectural designs, living arrangements, and worker and patient empowerment are improving the quality of life in nursing homes Workforce: When baby boomers are about to reach retirement age, an additional 1.9 million direct care workers will be needed in long-term care settings Regulation: Experts see fundamental contradictions between existing regulatory mechanisms that address quality issues in nursing homes through periodic inspections and sanctioning, and regulations that require the same facilities to implement quality improvement programs Information Technology: Interoperable IT systems will enable providers to track patients’ care across hospitals, nursing homes, home health agencies, and physicians’ offices IMPROVEMENTS Infrastructure Information Technology New architectural designs and living arrangements are empowering patients Use of technology to track patients’ care across any facility

RECOMMENDATIONS FOR FUTURE HEALTH CARE Address issues of practice variations. Incorporate evidence-based medicine (EBM) into computer-based models. Ongoing clinical trials should be the backbone of EBM. Guidelines and protocols must be revised and kept up-to-date. Incorporate economic analysis into practice guidelines. Restructure financial incentives (including provider payments and patient cost sharing). Address issues of practice variations. Computer-based models will have to incorporate evidence-based medicine (EBM). Ongoing clinical trials will be the backbone of EBM. Guidelines and protocols must be revised and kept up-to-date. Practice guidelines must incorporate economic analysis. Financial incentives (including provider payments and patient cost sharing) must be restructured.

The Future of the Health Care Workforce The need for physicans, nurses, and health care professionals with geriatric training is predicted to be far greater than the actual number As more women and minorities enter the health care workforce, changes will need to be made to accommodate differences and disparities As more women and minorities enter the health care workforce, changes will need to be made to accommodate differences and disparities Physicans Nurses Minorities The need for physicans, nurses, and health care professionals with geriatric training is predicted to be far greater than the actual number Females Geriatric Training Health Care Workers Supply and demand For physicians Supply Though the supply is predicted to grow, there may still be a shortage of physicians by 2020 Remarkable drop in student interest in primary care Feminization of the physician workforce will negatively impact rural areas because women have been less likely to choose rural practice Demand A greater proportion of elderly in the population The changing age-specific per capita physician utilization rates, with those age 45 and above using more services For nurses Long-term solution to shortage such as: Investments in training Expanding existing training capacity Opening new schools Adding fringe benefits focused on education Improvements of work environments Lengthening or redesigning of orientation programs for new nurses Increasing staffing levels Work redesign Future changes in economy, immigration, educational incentives, retirement trends, wages, delivery of health care, and societal values affect future nursing students Shortage from 1998 to 2006 Deficits in Geriatric Training Shortage of health care professionals schooled in geriatrics Elderly patients suffer from chronic conditions The elderly use the majority of home health care services and nursing home care, about half of hospital inpatient days, and approximately a quarter of all ambulatory care visits Workforce Diversity More women joining the medical workforce Awareness of gender pay disparities Need to address family issues (daycare, maternity leave, etc.) Health care workforce is becoming diverse both ethnically and racially Need for cultural competence Supply Demand