Chapter 11 The Health Care System Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

U.S. Health Care System Figure 11-1 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

U.S. Health Care System (Cont.) Private health care subsystem Focus on the individual Nonprofit and for-profit agencies Models of services Solo practice Single specialty group practice Multispecialty group practice Integrated health maintenance model Community health center Voluntary or nonofficial agencies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

U.S. Health Care System (Cont.) Public health care system Mandated by the U.S. Constitution Focus on the population “promote the general welfare of its citizens.” Federal policies and practices influence local and state governments Coordination of services under Department of Health and Human Services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Public Health Public health refers to the efforts organized by society to protect, promote, and restore the people’s health. Concerned with a healthy population Concerned with a healthy environment Scope is broad Encompasses activities that promote good health Organized into multiple levels (federal, state, local) Provides services for those unable to obtain health care without assistance Establishes laws, rules, and regulations to protect the public Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Public Health System Federal level subsystem U.S. Department of Health and Human Services Surgeon General and numerous other agencies Targets general population, special populations, and international health IOM Report, HHS in the 21st Century: Charting a New Course for a Healthier America (2008), recommended transformation of system Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Current HHS Strategic Plan Transform health care Advance scientific knowledge and innovation Advance health, safety, and well-being of the American people Increase efficiency, transparency, and accountability of HHS Strengthen the nation’s health and human services infrastructure and workforce Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Public Health System (Cont.) State level subsystem State health departments Responsible for the health of their citizens Central authorities in the public health care system Dependent on federal level for guidance and resources Establish own state laws Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Public Health System (Cont.) Local health department subsystem Local health departments (LHD) Responsible for direct delivery of public health services and protection of the health of citizens Not all communities have LHDs Responsible for: Community health services Environmental health services Personal health services Mental health services Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Health Care Providers Provider organizations Health care professionals Any organization that provides health care to the community Health care professionals The interprofessional health care team Professionals and nonprofessionals Nontraditional health care providers Complementary and alternative therapies Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care To Err Is Human: Building a Safer Health System (IOM, 1999) focused on safety within the health care delivery system Crossing the Quality Chasm (IOM, 2001) focused on developing a new health care system for the twenty-first century, one that improves care Leadership by Example (IOM, 2003) was a report requested by Congress that examined the federal government’s quality enhancement processes Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) Who Will Keep the Public Healthy? (IOM, 2003) brought public health into the forefront by focusing on issues including globalization, rapid travel, scientific and technological advances, and demographic changes In-depth exploration of educational needs for improved public health Need for appropriately prepared public health professionals Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) Who Will Keep the Public Healthy? (Cont.) New content areas for public health professionals: Informatics, genomics, communication, cultural competence, community-based anticipatory research, global health, policy and law, and public health ethics Old content areas for public health professionals: Epidemiology, biostatistics, environmental health, health services administration, and social and behavioral science Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) Health Professions Education (IOM, 2003), the education of all health professionals is viewed as a bridge to quality care. Provide patient-centered care Work in interdisciplinary teams Employ evidence-based practice Apply quality improvement Utilize informatics Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) Priority Areas for National Action (IOM, 2003) identified priority areas that should be addressed to improve quality Patient and family engagement Population health Safety Care coordination Palliative care Overuse Access Health systems infrastructure capabilities Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) Keeping Patients Safe: Transforming the Work Environment (IOM, 2004) addressed critical quality and safety issues with a focus on nursing care and nurses Focused on nurses in acute care and the work environment for safer patient care Also looked at nursing shortage, health care errors, patient safety risk factors, nurse’s role in quality improvement, and work environment threats to patient safety Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) The Future of Nursing. Leading Change, Advancing Health (IOM, 2011) focuses on the nursing profession and how it might fit into the change process Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Quality Care (Cont.) The Future of Nursing. Leading Change, Advancing Health (Cont.) Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States. Effective workforce planning and policy making require better data collection and an improved information infrastructure. Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Accreditation Joint Commission National Committee for Quality Assurance (NCQA) Health Plan Effectiveness Data and Information Set (HEDIS) American Healthcare Commission Consumer Assessment of Healthcare Providers and Systems (CAHPS) Agency for Healthcare Research and Quality (AHRQ) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

… the ultimate test of the public health subsystem is whether it effectively serves the people by their measurements, not those of the public health profession. – Koop (1989) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Critical Issues in Health Care Delivery Managed care Information technology Telehealth Electronic medical records (EMRs) Social media Consumer advocacy and client rights Client/consumer-centered health care Coordination and access to care Disparity in health care delivery Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Critical Issues in Health Care Delivery (Cont.) Globalization and international health World has no real boundaries CDC active in responding to preparedness and international travel WHO fosters collaborative global initiatives ICN gives nursing perspective Health care reform The Clinton Health Reform Initiative Patient Protection and Affordable Care Act of 2010 Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Future of Public Health What services? Who has access? Who pays? How is it delivered? What is the role of government? Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

Impact on Community Health Nursing Principles of change that focus on quality, access, and cost… The need for patient-centered care The need for stronger primary care services The need to deliver more care in the community The need for seamless, coordinated care The need for reconceptualized roles for health professionals The need for interprofessional collaboration – The Future of Nursing. Leading Change, Advancing Health (IOM, 2011) Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.