1. 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

2. 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

3. 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

4. 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

5. 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.

6. 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