© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 2 Current Health Care Systems and Trends

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Today’s Health Care Industry Largest service employer in U.S. Americans spent $2.5 trillion on health care in 2009 –May increase to $4.4 trillion by 2018

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technological Advancements Health care changed very gradually until beginning of 20 th century Progress now increases rapidly Infectious diseases previously major causes of death –Now largely under control

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Penicillin and antibiotics were discovered in the mid-1800s.

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False Penicillin and antibiotics not discovered until 20 th century

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technological Advancements Recent advancements: –Organ transplants –Microscopic and robotic surgery –Gene therapy –Targeted drug therapy

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question The purpose of targeted drug therapy is to _____. A.Prevent drug abuse B.Destroy cancer cells C.Create personalized pharmaceutical products

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer B. Destroy cancer cells Targeted drug therapy aims to destroy cancer cells or prevent them from dividing

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Highlights of Health Care History Ancient and medieval times –Early beliefs in supernatural causes –Hippocrates Physician in ancient Greece Considered father of medicine –Plagues during Middle Ages killed majority of population

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Chronic illnesses were rare in ancient times because _____. A.The average person did not live longer than 35 years B.The environment did not contain synthetic chemicals as it does today C.Physicians were unable to diagnose most diseases

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. The average person did not live longer than 35 years Chronic illnesses most common in older adults

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Highlights of Health Care History Renaissance –Brought interest in science –Experiments and observation

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Highlights of Health Care History 1700s –Surgery became respected form of treatment –Body functions still poorly understood –Technique of vaccination discovered by Jenner

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Highlights of Health Care History 1880s –Building of large hospitals –Dentists introduced anesthesia –Pasteur proved that bacteria caused certain diseases –Advancements in public health and preventive medicine

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Elizabeth Blackwell, the first female physician in the U.S., opened the first _____. A.Hospital B.Nursing school C.Treatment center for mental illness

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer B. Nursing school Blackwell opened first school of nursing in 1860 –Enabled nursing to become established profession

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Highlights of Health Care History 1900s –Many discoveries E.g., blood groups, vitamins, penicillin and antibiotics, synthetic drugs to treat specific problems –Health care specialties developed E.g., physical and occupational therapy –Great advances in surgical techniques –Emphasis on scientific approach to medicine

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hopes for the 21 st Century Vaccine to prevent human immunodeficiency virus (HIV) Cure for acquired immune deficiency syndrome (AIDS) Cure for obesity Organ cloning

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hopes for the 21 st Century Cures for cancer and heart disease More effective treatment for mental illness Less invasive treatments Drugs with fewer side effects

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Specialization Effects on health care: –Improved diagnosis and treatment –More technical and fragmented medical practice –Increased health care costs –Break down of patient-provider relationships –Increased job opportunities for health care professionals

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Aging Population Life expectancy increase – years –Today 75 to 80 years Large number of “baby boomers” becoming older adults

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Aging Population Older adults –Heaviest users of health care services Needs of older adults: –Long-term care facilities –Home care services –Treatment for chronic conditions

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –“Chronic” describes a health condition experienced as a result of aging.

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer False Chronic –Conditions and illnesses that cannot be cured quickly Persist over period of time

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Increasing Costs of Health Care Costs increasing dramatically –Technological advances –Increased use of services due to aging population –Rising costs of pharmaceutical products –Increased use of expensive diagnostic tests –Lack of competition in some areas

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Increasing Costs of Health Care Costs increasing dramatically –Rising expectations of patients –More effective treatments Therefore, more patients seeking care –Poor geographic distribution of health care providers

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Costs of Health Care Sources of health care dollars, 2004

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Costs of Health Care Uses of health care dollars, 2004

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Health Care Facilities and Services Wide variety of health care facilities Many patient services for different needs Range in size from private individual office to national organizations Many options available for today’s health care professionals

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hospitals Traditional health care setting –Now high-tech facility limited to patients who need sophisticated treatment and 24-hour care Costs have increased dramatically –Major challenge: Controlling expenses

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hospitals Various levels of care provided –Trauma center –Emergency room (ER) –Intensive care unit (ICU) –Cardiac care unit (CCU) –General unit –Transitional care unit (TCU) –Rehabilitation unit

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question A patient who is hospitalized following a myocardial infarction (heart attack) would most likely be cared for in the _____. A.CCU B.ICU C.Trauma center

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer A. CCU Cardiac care unit (CCU)

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Accreditation of Health Care Facilities The Joint Commission –Private, non-profit organization –Encourages high standards –Provides guidelines –Performs on-site inspections –Accreditation voluntary But may be required to qualify for Medicare reimbursement

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ambulatory/Outpatient Services Patients do not require hospitalization Most surgeries today outpatient Majority of ambulatory services performed in physicians’ offices

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ambulatory/Outpatient Services Facilities that offer outpatient services: –Adult day care –Dental offices –Diagnostic centers –Emergency and urgent care centers –Health care services in companies, schools, and prisons

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Ambulatory/Outpatient Services Facilities that offer outpatient services: –Medical offices –Rehabilitation centers –Specialty clinics and offices –Surgical centers –Wellness centers

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Long-Term Care Facilities Individuals do not need hospital –But unable to live at home Fastest growing area of health care services

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Long-Term Care Facilities Nursing home –Skilled nursing facility –Intermediate nursing facility Adult foster home Assisted living residence Continuing care community

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Home Health Care Services Provide care to patients in their homes Tremendous growth in need for services Factors contributing to its growth: –Shorter hospital stays –Increase in older population –Medical equipment that can be used at home –Desire of individuals to stay at home

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Home Health Care Providers Examples of professionals who provide care at home: –Nurses –Physical therapists and assistants –Occupational therapists and assistants

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Home Health Care Providers Examples of professionals who provide care at home: –Speech therapists –Medical social workers –Nursing assistants and home health aides

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Hospice Palliative care and support for dying patients and their families Team of professionals and volunteers Medical, emotional, and spiritual support Make patient’s last days as pain-free and meaningful as possible

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question True or False: –Palliative care provides comfort and pain relief, but does not offer a cure.

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer True Palliative care relieves –But does not cure

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Consolidation of Health Care Services Combines facilities under one ownership to control costs –Buy supplies in large quantities –Share expensive equipment –Avoid duplication of lab and diagnostic services –Share knowledge and management expertise –Consolidate services

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Consolidation of Health Care Services Provides more consistent and coordinated care for patients –But reduces competition Thus, patients have fewer choices Can result in higher prices and lower quality

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Government Health Services Supported by taxpayers Conduct research, regulatory, and educational activities

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Government Health Services Examples of federal agencies: –National Institutes of Health (NIH) –Centers for Disease Control and Prevention (CDC) –Occupational Safety and Health Administration (OSHA)

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Which of the following service is provided by the National Institutes of Health? A.Make health care available for the uninsured B.Control the spread of diseases C.Conduct medical research

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer C. Conduct medical research Role of National Institutes of Health: –Conduct medical research

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Government Health Services Examples of state services: –License personnel and facilities –Provide laboratory services –Establish health data systems –Conduct public health planning

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Government Health Services Examples of local government services: –Collect vital statistics –Conduct sanitary inspections –Screen for diseases –Provide immunizations

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. New Approaches to Health Care Reasons for interest: –Search for alternatives to surgery and drugs –Desire to use natural products –Belief in mind-body connection –Focus on prevention rather than cure –More personal responsibility for health –Patient access to information –Desire for humanization of medicine

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Wellness Promotion of health through preventive measures and practice of good habits Leading causes of death influenced by lifestyle habits

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Wellness Wellness centers –Routine physicals –Immunizations –Exercise and nutrition classes

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Complementary medicine –Used together with conventional medicine Alternative medicine –Used instead of conventional medicine

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Integrative medicine –Conventional used with nonconventional practices for which there is scientific evidence of effectiveness

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Whole medical systems –Homeopathic –Naturopathic –Traditional Chinese Including acupuncture –Ayurveda

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Mind-body medicine –Patient support groups –Meditation –Prayer –Creative activities

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Biologically-based practices –Aromatherapy –Herbs –Dietary supplements –Natural products E.g., shark cartilage

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Manipulative and body-based practices –Chiropractic –Osteopathic –Massage –Reflexology

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Question Which of the following health care practices involves manipulating the spine to relieve pain or correct dysfunction? A.Naturopathy B.Acupuncture C.Chiropractic

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Answer C. Chiropractic Chiropractic care –Based on belief that pressure on nerves leaving spinal column causes pain and dysfunction

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Energy therapies –Biofield Qi gong Reiki –Bioelectromagnetic

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Complementary and Alternative Medicine Susceptible to fraud Signs of fraudulent products: –Claims to cure variety of problems –Claims to be miraculous and/or secret –Uses terms for which no definitions exist –Provides undocumented case histories –Requires payment in advance

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Holistic Medicine Expanded view of traditional medicine Emphasizes prevention of disease and personal responsibility for health

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Holistic Medicine All aspects contribute to health –Physical –Mental –Emotional –Spiritual

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Challenges in Health Care Today Access to health care –Unemployed or underemployed –Preexisting conditions –Recent federal legislation may alleviate problems –Concerns about cost of providing health care

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Challenges in Health Care Today Social conditions –Poverty –Homelessness –Violence –Substance abuse –Spousal, child, and elder abuse –Malnutrition

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Challenges in Health Care Today Maintaining quality of care –High costs encourage cutting expenses –Amount of care may be decreased –Decisions made by insurance companies rather than health care providers Preauthorization

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Challenges in Health Care Today Public health concerns –Antibiotic resistance Bacterial infections difficult or impossible to treat Considered by some to be most serious public health problem –Pandemics –Immunizations and treatments for cancer

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Challenges in Health Care Today Public health concerns –Reduction in rate of infant mortality –Addressing substance abuse issues Personal responsibility for health –Lifestyle choices influence incidence of heart disease, cancer, and stroke –Healthy habits should be encouraged

© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Implications for Health Care Professionals Stay informed about important issues Contribute to delivery of high-quality care Model good health habits Provide effective patient education