1. Health Care systems and Health care Sub-culture
By Kathleen Giuntoli, RN, MSN

2. HEALTH CARE DELIVERY SYSTEM “A NETWORK OF SERVICES” AVAILABLE TO INDIVIDUALS SEEKING TREATMENT OR PROMOTING OR MAINTAINING HEALTH HEALTH CARE SERVICES HEALTH CARE SETTINGS

3. ORGANIZATION of Health Care DELIVERY SYSTEM
PRIVATE SECTOR
Provider’s office -FEE FOR SERVICE
PPO
MANAGED CARE
PUBLIC SECTOR
Local
State and
Federal
International level
VOLUNTARY AGENGIES
Non-govn’t
Not for profit
Foundations

4. Private Sector Independent Practice
Fee for service
Free choice of a provider
Disease oriented with limited illness prevention (PE’s, immunizations and screening).
Private care in hospital
Preferred Provider Organization (PPO)
Developed in 1980’s
Network of doctors and hospitals agree to give the sponsoring organizations discounts for their services.
PPO’s do not exercise tight management over medical care.
Criticism of PPO is inability to control cost.

5. MANAGED CARE Private Sector continued…
Health Maintenance Organizations (HMO)
Deliver comprehensive care and treatment services for a group of enrollees who pay pre-negotiated and fixed payments.
Example: Group Health or Kaiser-Permanente
Provides care to maintain health (Prevention programs “free and clear”)
Health care is obtained by hospitals, doctors and other providers who are participating with HMO.
HMO is responsible to set standards of care (i.e.: NCQA)
Goal is to : increase quality, increase access to health care and decrease costs
HEALTH PROMOTION, ILLNESS PREVENTION CONTROLS COST

6. PUBLIC SECTOR
Official and voluntary public agencies operating at local, state, federal and international level.
Local health departments of a town, city county district. There is a chief health officer
Responsibilities: vital statistics,communicable disease control, environmental health and safety, personal health services like Maternal child health (MCH) and public health education

7. Public sector continued..
State level
State health officer in charge of (DOH)
Responsibilities in policy, planning, and coordination of programs and services for local units under the jurisdiction.
Federal Level
US department of Health and Human Services (DHHS) est. in 1979, concerns with the health of the nation.
Major functions: assisting states and local with the dev. Of health resources and education and regulation.

8. Federal level continued…
Assisting with delivery of health services to Americans. Medicare and Medicaid.
Medicare (1965). -Social insurance program for people over age 65.
Medicaid- welfare program providing partial Health care services for low income people. Supported by Federal and State government. (Washington State: Health options and Basic health plan.)
Supporting and conducting research in health sciences and protecting the people against impure and unsafe foods, drugs, and cosmetics and potential hazards, and nationals leadership for communicable disease control.

9. Voluntary Sector
Not for profit health movement which began in 1882, stems from the good will and humanitarian concerns that are part of the non-government, free-enterprise heritage of people in the United States.
Purpose-to provide public and professional educational programs to improve services and quality of facilities and personnel.
Funding comes from citizens, business and industry
Examples: Am. Red Cross,(funded by Rockefeller and Ford foundations) National Prevention of Blindness, National Association for Mental Health.
Professional organizations: American Medical Association (AMA) or National league of nursing. or (NLN.)

10. What Effects Health Care Costs?
Other effects on health care costs
Family diversity- the shrinking family (only 26 % of Am. Households with children under 18yo include married couple.
Cultural diversity
Lifestyle (cause of death- heart disease, stroke, cancer and COPD.)
Economic factors
Affluence/Poverty
Technology
Death rate
Lower birth rate
Greater longevity
Elderly: by 2010, 40 million Americans or 14% of population will be >65 yo, with 4.3million over age 85. (People over age 85 are fastest growing group in US

11. HEALTH CARE SERVICES
Types of HEALTH CARE according to the needs of the client.
PRIMARY CARE
SECONDARY CARE
TERTIARY CARE

12. Primary Preventative Care
Initial contact with family practice provider in an office or clinic.
Primary care is directed toward health promotion and specific protections against illness. Ie:(stop smoking, car safety restraints, dietary control)
Teaching self breast exam
Immunizations
Accident prevention education (child safety locks, plugs etc.)
Family planning

13. Secondary Preventative Care
Focus on early detection of disease, prompt intervention and health maintenance for pts. experiencing health problems.
Includes referrals to facilities for additional testing, consultation, and diagnosis.
Examples of activities :
Providing wound care, giving medications, exercising arms and legs, assessing children for normal growth and dev. Encouraging regular medical and dental screenings.
Primary care doctor refers you to cardiologist for cardiac catheterization after receiving your cholesterol tests back, hearing of your chest pain and noting your SOB while ambulating up stairs.

14. Tertiary Preventative Care
Begins after an illness is diagnosed and treated and aimed at rehabilitating patient and restore them to maximum level of functioning.
Activities would include:
Caring for the cardiac surgery pt after surgery
Teaching pt. w/diabetes how to recognize and prevent further complications
Referring a women to a support group after breast removal (mastectomy)
Teaching a brain stem injured pt to walk.

15. HEALTH CARE SETTINGS WHERE DO WE GET OUR CARE?
INPATIENT SETTINGS:
HOSPITALS-function is to deliver patient services, diagnostic and therapeutic for particular general medical condition.
EMERGENCY DEPT/TRAUMA CENTER
-functions : triage care of acutely ill and injured clients, 24 hours/day as well as walk –in services for less acutely ill clients.

16. Where do we get care? In -patient Continued…
Psychiatric facilities- function psychiatric in patient facility is to provide diagnostic and treatment services for clients with psychiatric –related illnesses
Rehabilitation centers- long term service offered to clients who need additional therapy or treatment for recovery from an injury or illness.
Long term care (LTC) range services from skilled nursing, adult family homes and assisted living.
Hospice- special services that addresses needs of the dying patient

17. Community Settings Out patient settings Adult day care
Respite care
Case management programs
School health clinics
Industrial health services
Home health
Neighborhood community centers
Free clinics
Physician offices
Ambulatory care centers
Rural primary care hospitals
Emergency and rescue systems

18. Health Care Trends Computer use –emailing your doctor
Health care in shopping centers
Decentralizing services: birthing centers, outpt. Surgery centers, dialysis centers
Emergency centers/ “doc in the box”,walk in care

19. Health care team (1 out of 10 Americans work in health care)
Primary care
Nurses, physician's, physician assistants, ARNP.
Allied members-technologists, pharmacists,social workers,alternative practitioners, spiritual and religious personnel.
Dietitians
Respiratory therapists, PT, OT etc.

20. Summary Health care system Health care services Health care settings
Network of service available to individuals seeking treatment for a health problem or assistance with maintaining or promoting health
Health care services
Primary, Secondary or Tertiary care
Health care settings
In patient
Out patient
Community Settings
Health care trends- technology, “doc in the box,” service, decentralized services
Health care team: diverse professional group that works together to assist individuals with attaining, maintaining and regaining health.