Chapter 4 The Health Care Delivery System Fundamentals of Nursing: Standards & Practices, 2E

 Copyright by Delmar, a division of Thomson Learning 4-2 What is a Health Care Delivery System?  It is a mechanism for providing services that meet the health-related needs of individuals.  Nursing is a major component of the U.S. health care delivery system.

 Copyright by Delmar, a division of Thomson Learning 4-3 Types of Health Care Services  Primary: health promotion and illness prevention  Secondary: early detection and intervention  Tertiary: restorative and rehabilitative care

 Copyright by Delmar, a division of Thomson Learning 4-4 Health Care Settings - Public Sector  Federal Level U.S. Department of Health and Human Services  State Level Department of Health

 Copyright by Delmar, a division of Thomson Learning 4-5  Local Level Health Units Communicable disease control Health records maintenance Individual health services Environmental health and safety Public health education

 Copyright by Delmar, a division of Thomson Learning 4-6 Health Care Settings - Private Sector  Hospitals  Extended care facilities  Home health agencies  Hospices  Outpatient settings

 Copyright by Delmar, a division of Thomson Learning 4-7  Schools  Industrial clinics  Managed care organizations  Community nursing centers  Rural primary care hospitals

 Copyright by Delmar, a division of Thomson Learning 4-8 Health Care Team  Nurse (RN)  Physician (MD, DO)  Physician assistant (PA)  Pharmacist (RPh)  Dentist (DDS, DMD)  Dietitian (RD)  Social worker (SW)

 Copyright by Delmar, a division of Thomson Learning 4-9  Respiratory therapist (RT)  Physical therapist (PT)  Occupational therapist (OT)  Chaplain  Unlicensed assistive personnel (UAP)

 Copyright by Delmar, a division of Thomson Learning 4-10 Roles of the Nurse  Caregiver  Teacher  Advocate  Manager  Expert  Case manager  Team member

 Copyright by Delmar, a division of Thomson Learning 4-11 Economics of Health Care  Private insurance  Managed care primary care providers health maintenance organizations preferred provider organizations exclusive provider organizations

 Copyright by Delmar, a division of Thomson Learning 4-12  Federal government insurance plans Medicare Medicaid  Canadian health insurance

 Copyright by Delmar, a division of Thomson Learning 4-13 Factors Influencing the Delivery of Health Care  Cost  Access  Quality

 Copyright by Delmar, a division of Thomson Learning 4-14 Cost  Four major factors increase the cost of health care an oversupply of specialized providers a surplus of hospital beds the passive role assumed by most consumers inequitable financing of services

 Copyright by Delmar, a division of Thomson Learning 4-15 Access - Limiting Factors  Inability to obtain insurance  Cultural barriers  Shortages of health care providers  Limited access to ancillary services  Parents’ inability to take time from work to transport children to health care providers

 Copyright by Delmar, a division of Thomson Learning 4-16 Quality  Estimated that 30%-40% of diagnostic/medical procedures performed in U.S. are unnecessary  Inappropriate use of resources  A 1998 study revealed that 72% of nurses surveyed stated that the quality of care at their hospital had declined due to cost-containment measures.

 Copyright by Delmar, a division of Thomson Learning 4-17 Challenges Within the Health Care System  Disillusionment with professionals Americans believe major problems of the health care system are greed and waste. Americans are suspicious of professionals. Consumers are becoming increasingly tired of paying the high cost of care, and question medical practices and fees.

 Copyright by Delmar, a division of Thomson Learning 4-18  Positive Perception of Nurses Several studies verify the public’s trust in nurses. The public believes that if nurses were allowed to use their skills, they would significantly enhance quality of care and reduce costs.

 Copyright by Delmar, a division of Thomson Learning 4-19  Loss of Control Consumers have expressed a loss of personal control within the health care system. Some feel terrorized by the system. Many American workers state that their greatest concern is the possible loss of health care coverage.

 Copyright by Delmar, a division of Thomson Learning 4-20  Decreased Hospital Use shorter lengths of stay technologic advances greater availability of outpatient facilities more services available in outpatient settings expectations/demands of third-party payers

 Copyright by Delmar, a division of Thomson Learning 4-21  Changing Practice Settings Most nurses currently practice in hospitals and will continue to do so in the future. Nursing employment outside the hospital continues to increase rapidly. Larger numbers of nurses will be needed for primary care, public health, extended care facilities, and the home setting.

 Copyright by Delmar, a division of Thomson Learning 4-22  Ethical Issues The U.S. is struggling with a major ethical conflict of cost containment versus compassionate quality care.

 Copyright by Delmar, a division of Thomson Learning 4-23 Today, the U.S. health care delivery system is faced with the dilemma of citizens’ needs being greater than available resources. Nurses continue to advocate for ethical distribution of resources as health care reform progresses.

 Copyright by Delmar, a division of Thomson Learning 4-24  Vulnerable Populations Children The elderly People with AIDS The homeless Others living in poverty

 Copyright by Delmar, a division of Thomson Learning 4-25 Nursing’s Response to Health Care Challenges  Nursing’s Agenda for Health Care Reform  Standards of care  Advanced practice  Public versus private programs  Public health  Community health  Long-term care