1. Trends in Health Care
HTR objective 02.04

2. Cost Containment
Why does health care cost so much? And what can be done to bring the costs associated with health care down??

3. Cost Containment means trying to control the rising cost of health care and maximizing every dollar spent
Technological Advances are expensive (heart, lung, kidney, and liver transplants, artificial hearts, Computers to examine internal body parts, people are surviving illnesses that used to be fatal, and are then requiring expensive and life long care…)
Aging population (increased use of pharmaceutical agents, more chronic diseases, need frequent health care services)
Increases in health related lawsuits also increase cost!
Malpractice insurance is expensive!
Doctors order diagnostic tests even though they might not be necessary
Doctors make every effort to avoid lawsuits by practicing “defensive” medicine

4. Costs could rise to levels that prohibit providing services to all individuals….
even though everyone SHOULD have equal access to health care regardless of ability to pay.

5. Summarize In your own words, explain the concept of cost containment.
What are two reasons that the costs of health care are so high?

6. Methods used to control costs
DRG’s, combination of services, outpatient services, mass or bulk purchasing, early intervention and preventive services, energy conservation

7. DRG’s Diagnostic Related groups
Attempts by Congress to control costs for Medicare and Medicaid
Payment is based on diagnosis
Certain amount paid for each disease condition
Agencies providing care for less can KEEP the extra money
Agencies accept loss if care costs more than payment allowed.

8. Combination of services
Health care agencies share services
Care can be provided to a larger number of people at a decrease in cost per person
Example??
Lab Corp

9. Outpatient services
Patients receive care without being admitted to hospitals or other care facilities
Hospital care is EXPENSIVE
Reducing the length of stay or decreasing the need for hospital admission lowers the cost.
Example? Open heart surgery patients used to spend several weeks in the hospital and now stay on average 5-7 days
Less expensive home care or transfer to a skilled care facility is used for those who require additional assistance
Examples of outpatient services are surgery, x-rays, diagnostic tests

10. Mass or bulk purchasing
Buying equipment and supplies in larger quantities at reduced prices
Combine purchases of different departments in an agency
Combine purchases of several different agencies
Major health care system purchasing medical supplies for hundreds or thousands of health care agencies can obtain much lower prices than an individual agency
Computerized inventory can be used to determine when supplies are needed and to prevent overstock and waste.

11. Early intervention/preventive services
Providing care before acute or chronic illness occurs
Preventing illness is ALWAYS cheaper than treating illness
Methods to prevent illness include
Patient education
Immunizations
Regular physical examinations to detect problems early
Easy access for all individuals to preventive health care services
People with limited access to health services and restricted finances use expensive emergency rooms and acute care facilities much more frequently
Providing early intervention and care to these individuals is much more cost effective.

12. Energy conservation
Monitoring the use of energy to control costs and conserve resources
Major expenses for every health care industry/agency are electricity, water, and/or gas
Most large health care facilities perform energy audits to determine how resources are being used and to calculate ways to conserve energy
Methods used include designing and building new energy efficient facilities, constantly monitoring and maintaining heating/cooling systems, using insulation and thermopane windows to prevent hot/cool air loss, repairing plumbing fixtures immediately to stop water loss, replacing energy consuming light bulbs with fluorescent or energy efficient bulbs, installing infrared sensors to turn water faucets on and off, and using alternative forms of energy such as solar power.
Recycling is a form of energy conservation and most health care facilities recycle many different materials.

13. Summarize List three of the ways we try to control health care costs.
Give an example of each of the cost control measures you listed.

14. It is important to note:
The quality of health care should not be lowered simply to control costs.

15. AHCPR Agency for health care policy and research
Federal Agency established in 1990
Its purpose is to research the quality of health care delivery and identify the standards of treatment that should be provided.
Every health care worker must make every effort to provide quality care while doing everything possible to avoid waste and keep expenses down.
Health care consumers must be more responsible for their own care, learn about all options for health care services, and follow preventive measures to avoid or limit illness and disease.

16. Other trends Home Health Care Geriatric Care Telemedicine Wellness
Alternative and complementary methods of health care
National Health Care Plan

17. Home Health care Rapidly growing field
DRG’s result in shorter hospital stays so patients need care at home
Home Health Care is less expensive to provide
Can include:
Nursing care
Physical and occupational therapy
Respiratory therapy
Social services
Nutritional and food services
Homemaking services

18. Geriatric Care Care for the elderly Rapidly growing field….WHY??
Individuals are living longer
Baby boom generation are reaching geriatric status
Will lead to growth of different facilities
Adult day care centers
Retirement communities
Assisted/Independent Living Facilities
Long Term Care Facilities

19. OBRA Omnibus Budget Reconciliation Act of 1987
Federal law that created regulations regarding long term care and home health care
Requires states to establish training and competency evaluation programs for nursing/geriatric assistants
Nursing assistants in long term care must:
Complete mandatory state approved training program
Pass written and or competency examination
Obtain certificate of registration (certification)

20. Telemedicine
Uses video, audio, and computer systems to provide medical and or health care services
New technology allows interactive services between health care providers even though they are in different locations
EMT’s providing care to a heart attack victim use technology to transmit medical data such as an EKG to the emergency room physician who can monitor the data and direct the care of the patient.
Surgeons using a computer can guide a remote-controlled (robotic) arm to perform surgery on a patient miles away
A surgeon can direct the work of another surgeon by watching the procedure on video beamed by a satellite system.
As consumers become more computer literate, more health care services will be provided electronically.
Telemedicine machines, operating over telephone lines, are “user friendly”, compact, and less expensive than when they were developed.
People with chronic illnesses or disabilities can receive care in the comfort of their homes:
Decreases the need for trips to medical care facilities
Can test blood sugar levels, oxygen levels, blood pressure measurements, and other vital signs, transmitting results to nurse or physician.
Can use online courses to learn to manage illness
Can schedule an “appointment” and talk “face to face” with health care provider using video conferencing
Electronic reminders to take medicine or perform diagnostic tests
Receive answers to health related questions
Provides access to specialists thousands of miles away.

21. Summarize What is Home Health Care? What is geriatric care?
What is OBRA and what does it do?
Define telemedicine and give one example.

22. Wellness
Defined as the state of being in optimal health with balanced relationship between physical, mental, and social health.
People are more aware of the need to maintain health and prevent disease.
Improves quality of life
Saves MONEY
Recognize the importance of:
Exercise, good nutrition, weight control, and health living habits!
Development of wellness centers, weight loss centers, health food stores, nutrition services, stress reduction counseling, and habit cessation management

23. Ways to promote wellness
Physical Wellness: well balanced diet, regular exercise, routine physical examinations, immunizations, regular dental care and vision care, avoid alcohol, tobacco, caffeine, drugs, environmental contaminants, and risky sexual behavior.
Emotional Wellness: understanding personal feelings and expressing them appropriately, accepting one’s limitations, adjusting to change, coping with stress, enjoying life, and maintaining an optimistic outlook.
Social Wellness: showing concern, fairness, affection, tolerance, and respect for others, communicating and interacting well with others, sharing ideas and thoughts, and practicing honesty and loyalty.
Mental and Intellectual Wellness: being creative, logical, curious, and open-minded; using common sense; obtaining continual learning, questioning and evaluating information and situations; learning from life experiences; and using flexibility and creativity to solve problems
Spiritual Wellness: using values, ethics, and morals to find meaning, direction, and purpose

24. Holistic health care
The trend toward wellness has led to holistic health care
Treatment of the WHOLE person by promoting physical, emotional, social, intellectual, and spiritual wellness through treatment of the whole body, mind, and spirit.
Treatment is directed toward protection and restoration
Patient is responsible for choosing his or her own care
Health care workers must respect the patient’s choices and provide care that promotes the well being of the whole person.

25. Alternative and complementary methods of health care
Ayuveda
Chinese Medicine
Chiropractic Care
Homeopathy
Hypnotism
Naturopathy

26. Introduction
The most common method of health care in the US is the biomedical or WESTERN system of health care.
It is based on evaluating the physical signs and symptoms of a patient, determining the cause of disease, and treating the cause.
A major trend in health care is the use of alternative or complementary health care therapies.
Alternative therapies are methods of treatment used instead of biomedical therapies.
Complementary therapies are used along with conventional medical therapies.
Interest in holistic health care has increased the use of alternative/complementary therapies. We must consider the whole individual and recognize that the health of each part has an effect on the person’s total health status. Skilled practitioners, rituals, and specialized practices are a part of the therapy. Many therapies are based on cultural values or beliefs.

27. Ayurveda Ayurvedic practioners:
Use an ancient philosophy, Ayurveda, developed in INDIA to determine a person’s predominant body type (dosha).
Prescribe diet, herbal treatment, exercise, yoga, massage, minerals, and living practices to restore and maintain harmony in the body.

28. Chinese medicine Chinese medicine practioners:
Use an ancient holistic-based healing practice based on the belief that a life energy (CHI) flows through every living person in an invisible system of meridians (pathways) to link the organs together and connect them to the external environment or universe.
Use acupuncture, acupressure, tai chi, and herbal remedies to maintain the proper flow of energy and promote health.

29. Chiropractic care Chiropractors:
Believe that the brain sends vital energy to all body parts through nerves in the spinal cord.
Misalignment of the vertebrae (bones) places pressure on spinal nerves, which results in disease and pain.
Use spinal manipulation, massage, and exercise to adjust the position of the vertebrae and restore the flow of energy.

30. Homeopathy Homeopaths:
Believe in the ability of the body to heal itself through the actions of the immune system
Use minute diluted doses of drugs made from plant, animal, and mineral substances to cause symptoms similar to the disease and activate the immune system.

31. hypnotism Hypnotists:
Help an individual obtain a trancelike state with the belief that the person will be receptive to verbal suggestions and able to make a desired behavior change.

32. Naturopathy Naturopaths:
Use only natural therapies such as fasting, special diets, lifestyle changes, and supportive approaches to promote healing.
Avoid the use of surgery or medicinal agents to treat disease.

33. CAM: most therapies are noninvasive and holistic
Often less expensive than traditional western therapies
It is essential to learn the legal requirements of your state regarding the different types of CAM.
Patient’s have the right to choose their own type of care.
Caregiver’s should be
NON JUDGEMENTAL!
As more patient’s choose CAM, it is increasingly important for health care providers to become aware of and understand those types of treatment.

34. summarize Define alternative therapy. Define complementary therapy.
List and describe two types of alternative or complementary therapy.

35. National health care plan
The high cost of health care and a large number of uninsured individuals has created a demand for a national health care plan.
Many types of plans have been proposed. Four such plans are as follows:
One plan involves Nationalized medicine (government would pay for all health care services and levy taxes to pay for them)
The second plan involves the creation of health care cooperatives that allow the consumer to purchase health care at a lower cost.
The third plan is based on Managed care and would require employers to provide coverage with the federal government subsidizing insurance for the poor.
The fourth plan allows each state to establish it’s own health care plan paid for by employers, individuals, and/or government subsidies.
The main goal in health care reform is to ensure that all Americans can get health coverage.

36. Problems with a national health care plan
Cost of creating
Fact that those with insurance may pay more to cover uninsured individuals
Lack of free choice to consumers in choosing their own health care providers
Regulations will have to be created to establish a national health care system

37. Are we seeing the development of a national health care plan in the us now???
What is it called?
How will it affect us?
Is it a good thing or a bad thing?
Is it important to all of us to know what is happening with the development of our national health care plan?
What impact do you think it will have on health care in our nation?