Instructor’s Name Semester, 200_

Chapter Objectives Define the term health care system. Trace the history of health care delivery in the United states from the mid-nineteenth century to the present. Discuss and explain the concept of the spectrum of health care delivery. List and describe the different levels of medical practice.

Chapter Objectives Distinguish between the different kinds of health care, including public health practice, medical practice, and long-term practice. List and characterize the various groups of health care providers. Explain the differences among allopathic, osteopathic, and nonallopathic providers. Define complementary and alternative medicine.

Chapter Objectives Explain why there is a need for health care providers. Prepare a list of the different types of facilities in which health care is delivered. Explain the differences among private, public, and voluntary hospitals. Explain the concept behind ambulatory care facilities.

Chapter Objectives Define home health care and explain the reason why this setting is being used more to deliver care. Explain what the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) does.

Health Care System: Structure American Delivery System Variety of Providers Variety of Settings Concerns Informal Cooperation of Providers Disease Treatment vs Health Care Conglomeration vs System

Brief History of U.S. Health Care

Brief History of U.S. Health Care Timeline 1850 1997

Brief History of U.S. Health Care Before 1850 - Medical Treatment occurred in Home 1850 1997

Brief History of U.S. Health Care Treatment moved to Physician’s Office & Hospital Home 1850 1900 1997

Brief History of U.S. Health Care 1st Insurance Hospitals Home 1850 1911 1997

Brief History of U.S. Health Care 3.9% of GDP spent on Health Care 1st Insurance Hospitals Home 1929 1850 1911 1997

Brief History of U.S. Health Care Age of Medicine NIH Established Hill-Burton Act 1st Insurance Hospitals Home 2.9% GDP 1850 1930 1950 1911 1997

Brief History of U.S. Health Care Medicare & Medicaid 1st Insurance Hospitals Age of Medicine Home 2.9% GDP 1965 1850 1911 1930 1950 1997

Brief History of U.S. Health Care Cost Containment - Health Systems Planning -Health Maintenance Organization Act 1st Insurance Hospitals Age of Medicine Home Medicare & Medicaid 2.9% GDP 1970s 1850 1911 1930 1950 1965 1997

Brief History of U.S. Health Care American Health Security Act of 1993 1st Insurance Cost Containment Hospitals Age of Medicine Home Medicare & Medicaid 2.9% GDP 1980s 1850 1911 1930 1950 1965 1970s 1997

Brief History of U.S. Health Care 14% GDP 1st Insurance Cost Containment Age of Medicine Increased Costs Home Medicare & Medicaid 2.9% GDP 1850 1911 1930 1950 1965 1970 1980 1992

Major Concerns in the U.S. 1. Medical Care Cost 2. Drug Abuse 3. Budget Deficit 4. Crime 5. Unemployment 6. AIDS

Health Care Spending (Select countries: 1960 & 1997)

Spectrum of Health Care Delivery Public Health Practice education is primary component Medical Practice primary secondary tertiary Long-term Practice restorative care long-term care

Public Health Practice Education provides information empowers motivates Settings Governmental health agencies Voluntary health agencies Social Services agencies Schools Business and industry

Spectrum of Health Care Delivery Public Health Practice education is primary component Medical Practice primary secondary tertiary Long-term Practice restorative care long-term care

Primary Medical Care Education Promotion of nutrition Safe water and sanitation Maternal and child health care Immunization Prevention and control of endemic disease Treatment Essential drugs

Secondary Medical Care Specialized care provided by physicians hospital or outpatient emergency care

Tertiary Medical Care Highly specialized For those with unusual or complex conditions Specialized hospitals Academic health centers

Spectrum of Health Care Delivery Public Health Practice education is primary component Medical Practice primary secondary tertiary Long-term Practice restorative care long-term care

Long-term Practice Restorative care Long-term care

Health Care Providers Independent Providers Allopathic specific remedies include drugs or medication Osteopathic recognition of reciprocal interrelationship between the structure & function of the body Nonallopathic chiropractors, acupuncturists, naturopaths, homeopaths

Health Care Providers Limited Care Examples have advance training in a health specialty and are licensed to practice it Examples dentists, optometrists, podiatrists, & psychologists

Nurses Licensed Practical Nurses (LPN) & Registered Nurses (RN) 1-2 yrs of training & carry out non-technical duties Registered Nurses (RN) associate or baccalaureate degree & state license Bachelor of Science in Nursing (BSN) prepared for additional activities involving independent judgment Advanced Practice Nurse (APNs)

Registered Nurses

Allied & Professional Health Care Providers Allied Health Care Professionals provide services that assist, facilitate, & complement work of physicians dietitians, physical therapists, medical technologists, EMTs, & speech therapists Public Health Professionals work in public health clinics & voluntary agencies environmental health workers, administrators, epidemiologists, health educators, & biostatisticians

Health Care Facilities Practitioner Offices Privately owned practices Clinics Hospitals Private Public Voluntary Ambulatory Care

Health Care Facilities Rehabilitation Centers Long-term care options Home health care Continuing Care chronic, respite, hospice, & home care Accreditation

Chapter 13 Health Care System: Structure