1. Trends In Health Care Cost Containment Diagnostic Related Groups
Outpatient Services
Energy Conservation
Home health Care
Geriatric Care
Telemedicine
Wellness

2. History of Health Care Trends In Health Care
A. Cost Containment: controlling the rising cost of health care
- Reasons high costs:
Technological advances
Aging population (Rx)
Lawsuits (malpractice Ins.)

3. Trends In Health Care
B. Diagnostic Related Groups: DRG’s place a limit on the cost of health care Example: (?) Surgery $5,000 Limit If hospital costs are less than $5,000 then hospital makes $$, otherwise hospital loses $$

4. Trends In Health Care
B. Diagnostic Related Groups: 1) Combination of Services: health care facilities shop for services (laboratory, x-ray, etc.) to save $$.

5. Trends In Health Care
C. Outpatient Services: Patients receive care and are discharged home without being admitted to the hospital. Examples: Surgical Centers, Physical Therapy, etc.

6. Trends In Health Care
D. Energy Conservation: Energy is a large expense for health care facilities. - Energy Efficient Bulbs - Consolidating Work Areas - Recycling

7. Trends In Health Care
E. Summary: The quality of health care should not be lowered simply to control costs. - Provider responsibility: provide the best health care while being conscious of costs

8. Trends In Health Care
E. Summary: The quality of health care should not be lowered simply to control costs. - Personal responsibility: take preventative measures to avoid or limit injury, illness & disease

9. Trends In Health Care
Home Health Care

10. Trends In Health Care
A. Home Health Care: Created mainly as a result of DRG’s. History shows that this is not a new concept.

11. Trends In Health Care Home Health Care: Services include:
- Nursing care
- Physical/occupational therapies
- Respiratory therapy
- Social services
- Nutrition & food services

12. Trends In Health Care
Geriatric Care

13. Trends In Health Care
A. Geriatric Care: Care of the elderly. People are living longer.

14. Trends In Health Care
A. Geriatric Care: Omnibus Budget Reconciliation Act of (OBRA) Government Act which requires states to establish competency standards which nursing assistants must meet. (Exam)

15. Trends In Health Care
A. Geriatric Care: Omnibus Budget Reconciliation Act of (OBRA) Requires long-term health care workers to attend continuing education courses

16. Trends In Health Care
A. Geriatric Care: Omnibus Budget Reconciliation Act of (OBRA) Loss of license/certificate can occur if compliance is not maintained. Facility can also be fined and even shut down.

17. Trends In Health Care
A. Geriatric Care: Types of Facilities: - Adult day care centers - Retirement communities - Assisted living care centers - Long-term care centers

18. Trends In Health Care
Telemedicine

19. Trends In Health Care
A. Telemedicine: Involves using technology to provide care Methods: - Computerized (EKG’s) - Remote (robotics) - Video (surgery) - Phone/Fax (Reports)

20. Trends In Health Care
Wellness

21. Trends In Health Care
A. Wellness: A state of being in optimum health as it relates to physical, mental and social health. Preventative measures: diet, exercise, rest, stress reduction, habit cessation

22. American Healthcare

23. European Invention of microscope-van Leeuwenhoek (1670s)
Pasteur (1860s)
Semmelweis (1840s) – hand washing
Lister (1860s) –antiseptics
Koch (1870s) – microbe with disease
Fleming (1920s) – penicillin

24. AMERICAN - EARLY SETTLERS
No Formally trained physicans/nurses
Treatments word of mouth “old wives tales”
Used herbs and home made concoctions
Women cared for house, children and those that were ill

25. First Physicians in America
English system-physicians, apothecary and chirurgeon
Few university educated physicians came to the new world
“A few physicians among us are eminent for their skill. Quacks abound like locusts in Egypt, and too many have been recommended to full practice and profitable subsistence” Smith, 1758, History of New York

26. First Medical Training
1756 College of Philadelphia (Univ. of Penn)
1768 King’s College (Columbia)
Most trained in an apprenticeship process
Process unregulated and unstructured

27. American Medical Association
Founded in 1847
Goal to improve medical education
Common goal difficult; Not see need to change (note that Pasteur, Koch and Lister had not made impact)
Abraham Flexner headed a study of medical education (The Flexner Study)

28. Medical Practice
Medicine was not a field that provided wealth or prestige
Many had to have second jobs
Physicians had no need for hospitals
Patients treated at home and care for by families or hired help

29. Hospitals
Very few hospitals; physician had little need; more affluent stayed at home
Three kinds
Pest houses
Almshouses
Marine Hospital– Seamen’ Act
Seen as a place to go to die!
Changed in 1900’s with improved sanitation, decrease in hospital acquire infection and antiseptics introduction

30. Nurses Not a “suitable profession” is 18th and 19th century
Most healthcare provided by Catholic Nuns
Florence Nightingale 1850’s
Leave your shackles and become a nurse
Reformed the health care of soldiers during the Crimean War

31. Health Insurance No such thing as health insurance existed
Until----- “Birth of the Blues”
1929 Baylor Hospital
50 cents a month
21 days of hospital care at Baylor Hospital
Beginning of employer provided health insurance

32. Effect of World War II New technology New professions
Advanced Education
Suburbanization
Hill Burton Construction Act
Changes is social norms
Birth of “Baby Boomers”

33. Those without Health Care
President Lyndon Baines Johnson ( )
Great Society
1965/1966 Medicare and Medicaid – care paid for by the federal government

34. Is healthcare a basic right?
Yes – It is a basic right. (Explain)
No - Medical care is a commodity. (Explain)

35. Is universal healthcare a basic right?
Read both articles
Thinks to think about are
What is a basic right
Funding
Standard of care
Trends In Health Care (Slides)

36. Is healthcare a basic right?
Write a 3 paragraph explanation of your stance on the question “Is healthcare a basic right?”.
Include – 3 sources
Article I passed out and 2 new sources