© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 1

2 12 C H A P T E R COST, ACCESS, AND QUALITY: CRITICAL HEALTH CARE ISSUES

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 3 Participants in Health Care Delivery  Patients (Figure 12-2, Figure 12-3)  Providers—individuals or organizations  Payers (Figure 12-6, Figure 12-7)

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 4 Source: U.S. Census Bureau, 2007b Participants in Health Care Delivery (cont.)

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 5 Government-Sponsored Health Care Programs Source: U.S. Census Bureau, 2005a Participants in Health Care Delivery (cont.)

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 6 Health Care Costs  Rising yearly (Figure 12-8)  U.S. spends more per person than other countries  Most money is spent on hospital services.

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 7 Source: Data from Goldman & Alpert, 2005 Health Care Costs (cont.)

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 8 Reasons for Rising Costs  Technological advances  Physicians have high salaries; more specialists  Providers monopolize the market  Administrative/insurance costs  Inability to identify true costs  Aging population

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 9 Financial Barriers to Care  Uninsured  Underinsured  Not being able to pay co-pays or deductibles

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 10 Structural Barriers to Care  Not enough providers/facilities  Logistical issues (transportation, etc.)

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 11 Personal Barriers to Care  Personal characteristics  Cultural or spiritual differences  Language barriers  Health literacy

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 12 Quality  U.S. lags in several quality measures.  Errors are a leading cause of death.  Quality is multi-dimensional (Figure 12-9).  Care should be patient-centered.

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 13 Addressing the Issues  Healthy People 2010 (Figure 12-10)  Core Measures  The Leapfrog Group  The National Quality Forum

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 14 Current Rationing Methods  Based upon price or cost to the patient  Creating a hassle for the patient

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 15 Examples of Overt Rationing  Oregon’s health care initiative  2004 Flu vaccine shortage

© 2010 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 16 Nursing Implications  Manage resources efficiently  Advocate for and educate patients  Utilize evidence-based practice