1. Trends in Health Care

2. Health care has seen many changes during the past several decades, and many additional changes will occur in the years to come. An awareness of such changes and trends is important for any health care worker.

3. Cost Containment
Trying to control the rising cost of health care and achieving the maximum benefit for every dollar spent
Reasons for high health care costs:
- Technological advances
- Aging population
- Health-related lawsuits
Because these expenses must be paid, a major concern is that health care costs could rise to levels that could prevent providing service to all people

4. Methods of Cost Containment
Diagnostic related groups (DRGs)
Combination of services
Outpatient services
Mass / Bulk purchasing
Early intervention & preventive services
Energy conservation

5. Diagnostic related groups (DRGs):
Predetermined payment of structure for health care services established by the federal government
Attempt to control costs for government insurance plans such as Medicaid & Medicare
Patients with certain diagnoses who are admitted to hospitals are classified in one payment group. A limit is placed on the cost of care, & the agency receives this set amount.
If cost of care is less, agency keeps extra $$$ /
If cost of care is more, agency accepts the loss
Encourages the agency to provide care within expense limit allowed

6. Combination of Services:
Health care agencies join together or share specific services so care can be provided to a larger number of people at a decreased cost per person
Examples:
- Clinics & Labs shared by different agencies
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)

7. Outpatient Services:
Patients receive care without being admitted to hospitals or other care facilities
Reducing the length of hospital stay or need for a hospital admission lowers the cost of health care
Surgery, radiographs, diagnostic testing, & many other procedures that once required admission to a hospital are now done on an outpatient basis
Less expensive home care or transfer to a skilled-care facility can be used for patients who require additional assistance

8. Mass or Bulk Purchasing:
Buying equipment & supplies in larger quantities at reduced prices
Can be done by:
Combining purchases of different departments within an agency
Combining purchases of several different agencies
Computerized inventory can be used to determine when supplies are needed to and to provide overstocks & waste

9. Early Intervention& Preventive Services:
Providing care before acute or chronic disease occurs
Preventing illness is always more cost effective than treating illness
Methods used:
- Patient education
- Immunizations
- Regular physical exams
- Incentives for participation
-Easy access to preventive care

10. Energy Conservation:
Monitoring the use of energy to control costs & conserve resources
Major expenses for health care facilities include electricity, water, & gas
Most perform energy audits to determine how resources are being used & calculate ways to save
Methods used for energy conservation:
- Energy efficient lightbulbs
- Sensors to turn lights & faucets on / off
- Thermopane windows
- Recycling

11. Cost Containment - Summary
The quality of health care should not be lowered simply to control costs
Agency for Health Care Policy (AHCPR) researches the quality of health care delivery & identifies standards of treatment that should be provided
Everyone must work together to help control cost:
- Healthcare workers must make every effort to
provide quality care while avoiding waste
- Health care consumers must assume responsibility by
being informed of options for health care & following
preventive measures to avoid or limit illness & disease

12. Home Health Care Rapidly growing field
DRGs & shorter hospital stays have created a need for providing care in the home
Current trends show a return to practices of the past when home care was the usual method of treatment
All aspects of health care can be involved
Another form of cost containment because it is usually less expensive to provide

13. Geriatric Care Care for the elderly Will continue to grow due to
- large number of individuals experiencing longer
life spans because of advances in health care
- “Baby boom” generation is now reaching
geriatric age
Many different facilities involved in providing care:
- Adult day care centers, retirement communities, assisted/independent living facilities, long-term care facilities

14. Omnibus Budget Reconciliation Act
OBRA
Established in 1987, requires states to establish training & competency evaluation programs for nursing & geriatric aides
All assistants working in a long-term care facility or home health care is now required under federal law to obtain certification/registration by completing a mandatory:
- state-approved training program
- pass a written exam
- pass a competency skills exam

15. Omnibus Budget Reconciliation Act
OBRA also requires:
- continuing education
- periodic evaluation of performance
- retraining and/or testing if a nursing assistant
doesn’t work in a health care facility for more
than 2 years
Each state maintains a registry of qualified individuals
Minimum skills required are specified in the Nurses Aide Competency Evaluation Program (NACEP) developed by the National Council of State Boards of Nursing

16. Telemedicine
Involves the use of video, audio, & computer systems to provide medical and/or health care services
Examples:
- EMTs at scene of accident/illness may transmit
data to ER physician
- Physician’s able to access lab results/medical
records from hospital or vice versa
- Robotic surgeries
- Info sent to physician or nurse via telephone from
home

17. Wellness
State of being in optimum health with a balanced relationship between physical, mental, & social health
People are more aware of need to maintain health & prevent disease to improve quality of life
More individuals recognizing the importance of exercise, good nutrition, weight control & healthy living habits
Led to establishment of wellness centers, weight control facilities, health food stores, nutrition services, stress reduction counseling, & habit cessation management

18. Wellness
Wellness is determined by the lifestyle choices made by an individual & involves many factors
Some of the factors & ways to promote wellness include:
- Physical wellness
- Emotional wellness
- Social wellness
- Mental & Intellectual wellness
- Spiritual wellness
(p 19)

19. Pandemics
An infectious disease that affects many people over a wide geographical area: a worldwide epidemic
Becoming an increasing concern due to society becoming more global – people can travel readily throughout the world & disease can spread more rapidly from individual to individual
The World Health Organization (WHO) has major concerns about influenza pandemics
Examples: H1N1 virus in 2009, HIV/AIDS in 1980
Many governments creating pandemic influenza plans to protect populations
- Education, Vaccine production, Antiviral drugs,
Development of protective public health measures,
& International cooperation

20. Drug-Resistant Bacteria
Of growing concern are the drug-resistant bacteria, or superbugs
Examples:
- Methicillin-resistant Staphylococcus aureus (MRSA)
- Vancomycin-resistant Enterococcus (VRE)
Believed to be caused by decades of unnecessary antibiotic use which caused genetic mutations of bacteria and resistance to commonly used antibiotics