1. Health Care System: Structure Chapter 13

2. Introduction Health care delivery in U.S. is different than all other developed countries Other developed countries have national health care programs run or organized by government Health care in U.S. delivered by an array of providers (health care facilities & professionals that provide care)

3. First question… Does the U.S. really have a health care system? Providers Consumers (patients) = + System?

4. Brief History of Health Care Delivery in the U.S. - 1

5. Brief History of Health Care Delivery in the U.S. - 2 Pre-1870 Timeline Today

6. Brief History of Health Care Delivery in the U.S. - 3 Pre- 187 0 Far behind Great Britain & Europe in both health care & medical education Far behind Great Britain & Europe in both health care & medical education Not grounded in science Not grounded in science Medical education was provided through apprenticeships Medical education was provided through apprenticeships

7. Brief History of Health Care Delivery in the U.S. - 4 Pre- 187 0 Health care provided in patients’ homes Health care provided in patients’ homes Hospitals in large cities & seaports Hospitals in large cities & seaports Almshouses (poorhouse) to provide food, shelter & basic care for indigent Almshouses (poorhouse) to provide food, shelter & basic care for indigent

8. Brief History of Health Care Delivery in the U.S. - 5 Pre- 187 0 Health care moved from patients’ homes to physician’s office & hospitals Health care moved from patients’ homes to physician’s office & hospitals Health care based on more science Health care based on more science 1900

9. Brief History of Health Care Delivery in the U.S. - 6 Pre- 187 0 1911 1st health insurance 1900

10. Brief History of Health Care Delivery in the U.S. - 7 Pre- 187 0 1911 Flu epidemic 1900 1918-19

11. Brief History of Health Care Delivery in the U.S. - 8 Pre- 187 0 1911 Spending 3.9% of GDP on health 1900 1918 1929

12. Brief History of Health Care Delivery in the U.S. - 9 Pre- 187 0 1911 Diagnosis, treatment, fee WWII & medical advances Hill-Burton Act 1900 1918 1929 1930s & 1940s

13. Brief History of Health Care Delivery in the U.S. - 10 Pre- 187 0 1911 Right or privilege Overall shortage & maldistribution 3rd party system takes hold Medicaid & Medicare 1900 1918 1929 30s/40s 1950s & 60s

14. Brief History of Health Care Delivery in the U.S. - 11 Pre- 187 0 1911 Cost containment Health planning agencies HMO Act 1973 1900 1918 1929 30s/40s 50s/60s 1970s

15. Brief History of Health Care Delivery in the U.S. - 12 Pre- 187 0 1911 Deregulation New medical technologies 1900 1918 1929 30s/40s 50s/60s 70s 1980s

16. Brief History of Health Care Delivery in the U.S. - 13 Pre- 187 0 1911 American Health Security Act of 1993 Managed care Costs hit $1 trillion 1900 1918 1929 30s/40s 50s/60s 70s 80s 1990s

17. Brief History of Health Care Delivery in the U.S. - 14 Pre- 187 0 1911 Medicare Modernization Act of 2003 Health Savings Accounts No patients’ bill of rights GDP 16.2% 1900 1918 1929 30s/40s 50s/60s 70s 80s 90s 2000s

18. Spectrum of care refers to the type of health care practice Population-based Public Health Practice (health promotion & disease prevention) Medical Practice Primary Care: clinical preventive services; 1st contact; front-line Secondary Care: specialized attention (acute & subacute care); e.g., ERs Tertiary Care: Subspecialty referral Spectrum of Health Care Delivery - 1

19. Long-term practice Restorative care: intermediate follow-up Long-term care: care for chronic conditions; personal care End-of-life practice Care provided in last six months of life: hospice care Spectrum of Health Care Delivery - 2

20. Types of Health Care Providers - 1 In 2005, 14 million health care workers; 9.9% of workforce 42% work in hospitals as compared to 63% in 1970 Over 200 different careers in the health care industry Six categories: i ndependent providers, limited care providers, nurses, nonphysician practitioners, allied health care professionals, public health professionals

21. Types of Health Care Providers - 2 Independent providers: health care professionals with the education & legal authority to treat any health problem Allopathic providers: MDs; their remedies produce effects different from those of the disease Osteopathic providers: DOs; their remedies emphasize the interrelationships of the body’s systems in diagnosis, prevention, & treatment

22. Types of Health Care Providers - 3 Nonallopatic providers: independent providers who provide nontraditional forms of health care Examples: chiropractors (adjusts spinal column), acupuncturists, naturopaths, herbalists, homeopaths Five general categories of complementary & alternative medicine (CAM): Alternate medical systems, mind/body interventions, biologically-based therapy, manipulative methods, energy therapy

23. Types of Health Care Providers - 4 Limited care (restricted care) providers: those who provide care for a specific part of the body Examples: dentists, optometrists, podiatrists, & psychologists

24. Types of Health Care Providers - 5 Nurses –Licensed Practical (Vocational) Nurses (LPNs): 1-2 years of training & carry out nontechnical duties –Registered Nurses (RN): diploma or associate degree & state license –Professional nurses: Bachelor of Science in Nursing (BSN); prepared for additional activities involving independent judgment –Advanced Practice Nurses (APN): master’s or doctoral degrees; e.g., nurse practitioners, clinical nurse specialists, certified nurse midwife

25. Registered Nurses Prepared for Advance Practice, 2004 © Department of Health and Human Services

26. Types of Health Care Providers - 6 Nonphysician Practitioners (also known as nonphysician clinicians or midlevel providers or physician extenders Examples: nurse practitioners (NPs) & physician assistants (PAs)

27. Types of Health Care Providers - 7 Allied health care professionals –Provide services that assist, facilitate, & complement work of physicians & other health care specialists –Examples: dietitians, physical therapists, medical technologists, EMTs, speech therapists, & exercise physiologists

28. Types of Health Care Providers - 8 Public health professionals –A health care worker who works in a public health organization –Examples: environmental health workers, public health administrators, epidemiologists, health educators, & biostatisticians

29. Health Care Facilities & Their Accreditation - 1 Health care facilities: physical settings Practitioner offices: privately owned practices Clinics: no beds; tax-supported clinics for medically indigent called public health clinics or community health centers

30. Health Care Facilities & Their Accreditation - 2 Hospital types –Provide secondary & tertiary care –Private (proprietary or investor-owned); specialty (provide mainly one type of medicine) –Public (government run or funded) –Voluntary (not-for-profit) –Types of service: full-service; limited-service

31. Health Care Facilities & Their Accreditation - 3 Outpatient & ambulatory care facilities: those that provide a wide array of outpatient services; they can range from hospital-based facilities to independently owned freestanding facilities Include: primary care centers, urgent/emergent care centers, ambulatory surgery centers, diagnostic imaging centers Some found in nontraditional settings

32. Health Care Facilities & Their Accreditation - 4 Rehabilitation Centers –Used to restore lost functions –Ambulatory & inpatient facilities Long-term Care Options –Residential care (e.g., nursing home & assisted living) –Home health care –Hospice, and home care

33. Health Care Facilities & Their Accreditation - 5 Accreditation: process by which an agency or organization evaluates & recognizes an institution as meeting certain predetermined standards Agencies/Organizations –Joint Commission on Accreditation of Health Care Organizations (JCAHO): 15,000 facilities –Centers for Medicare & Medicaid Services (CMS): grants “deeming authority”

34. Health Care System: Structure Chapter 13 - The End