Project Presentation
CHAPTER 2:
HEALTH DELIVERY SYSTEMS – OUTLINE
Medical Practice
Some of the most common healthcare practitioners include Chiropractors, Dentists, Medical, Optometrist, Osteopath, and Podiatrist.
Physicians can be categorized as generalists or specialists. A generalist is trained in family medicine, general practice, general internal medicine, and general pediatrics. Generalists are considered primary care physicians
Medical Practice Cont.
Medical specialists are divided into 6 categories:
subspecialties of internal medicine
broad medical specialties
obstetrics and gynecology
surgery,
hospital-based radiology anesthesiology,
psychiatry
Nursing Practice
Nurses represent the largest number of healthcare professionals with 4 million registered nurses.
Four key responsibilities of registered nurses:
1. Perform physical exams and health histories before making critical decisions
2. Provide health promotion, counseling, and education
3. Administer medications and other personalized interventions
4. Coordinate care in collaboration with a wide array of healthcare professionals
Allied Health Professionals
Allied health encompasses a broad group of health professionals who use scientific principles and evidence-based practice for the diagnosis, evaluation, and treatment of acute and chronic diseases; promote disease prevention and wellness for optimum health; and apply administration and management skills to support healthcare systems in a variety of settings.
They are health professionals (other than registered nurses, physicians, and physician assistants) who have received a certificate, an associate degree, a bachelor degree, a master degree, a doctorate, or postdoctoral training in a healthcare-related science.
Allied Health Professionals Cont.
Major occupations usually considered to be allied health professionals:
Audiology
Clinical Laboratory Science
Diagnostic Medical Sonography or Imaging Technology
Dietetics and Nutrition
Emergency Medical Technology
Allied Health Professionals Cont.
Other occupations:
Health Information Management
Occupational Therapy
Optometry
Pharmacy
Physical Therapy
Respiratory Therapy
Speech-language Pathology
Surgical Technologist
Organization and Operation of Modern Hospitals
Integrated Delivery Systems (IDSs) – healthcare systems that combine the financial and clinical aspects of healthcare and use a group of healthcare providers, selected on the basis of quality and cost management criteria, to furnish comprehensive health services across the continuum of care.
Managed Care Organizations - a type of healthcare organization that delivers medical care and manages all aspects of patient care or the payment for care by limiting providers of care, discounting payments to providers of care, or limiting access to care.
Types of Hospitals
Major criteria used to classify hospital types are:
Functionality
Location
Number of beds
Specialization
Types of ownership
Types of Hospitals Cont.
Functionality – How a hospital functions within the community; teaching, acute care, long-term.
Specialization – Hospital might specialize in a type of service and treatment, e.g. rehabilitation, long-term acute care, and general hospital
Type of Ownership – Examples include government-owned, voluntary hospital, and proprietary hospital.
Organization of Health Services
Board of Directors – works with the chief executive officer and leaders of the medical staff t develop the hospital’s strategic direction, its mission, vision, and values.
The board of directors’ other responsibilities include the following:
Establishing bylaws in accordance with the organization’s legal and licensing requirements
Selecting qualified administrators
Approving the organization and makeup of the clinical staff
Monitoring the quality of care
Organization of Health Services Cont.
Medical Staff – primary objective is to provide high-quality patient care to the patients
Administrative Staff - The CEO or chief administrator is the leader of the administrative staff. The CEO implements the policies and strategic direction set by the hospital’s board of directors
Patient Care Services – This constitutes the largest clinical department in terms of staffing, budget, specialized services offered, and clinical expertise required.
Organization of Health Services Cont.
Diagnostic Services - include clinical laboratory, radiology, and nuclear medicine. Therapeutic services include clinical laboratory services, radiology, and radiation therapy.
Rehabilitation Services – Dedicated to eliminating the patient’s disability
Ancillary Support Service – Include pharmaceutical services, food and nutrition services, health information services, patient advocacy services, environmental services, and engineering and plant operations.
Other Types of Healthcare Services
Managed Care Organization
Three types:
Health Maintenance Organizations (HMOs)
Preferred Provider Organizations (PPOs)
Point of Service (POS)
Other Types of Healthcare Services Cont.
Accountable Care Organizations - describes groups of providers who are willing and able to take responsibility for improving the overall health status, care efficiency, and healthcare experience for a defined population
The following are the three ACO models:
1. Medicare Shared Savings program that gives Medicare fee-for-service providers an opportunity to become an ACO
2. Advance Payment ACO model designed as a supplementary incentive program for selected participants
3. Pioneer ACO model created for early adopters of coordinate care, though CMS is no longer accepting applications for this model
Other Types of Healthcare Services Cont.
Ambulatory Care – preventive or corrective healthcare provided in a practitioner’s office, a clinic, or a hospital on a nonresident basis
There is Home-Based Ambulatory Care Services and Community-Based Ambulatory Services
Types of Home-Based Ambulatory Care Services:
Emergency Services and Trauma Care
Outpatient Surgical Services
Outpatient Diagnostic and Therapeutic Services
Observation Services
Other Types of Healthcare Services Cont.
Voluntary Agencies – Provide healthcare and planning services at the local level and to low-income patients.
Subacute Care – offers patients access to constant nursing care while recovering at home.
Long-Term Care – healthcare rendered in a non-acute-care facility to patients who require inpatient nursing and related services for more than 30 consecutive days.
Biomedical and Technological Advances in Medicine
Telehealth - use of electronic information and telecommunications technologies to support and promote long-distance clinical healthcare, patient and professional health-related education, public health, and health administration.
Electronic Health Records and Health Data
Analyzed health data have the following benefits:
Reducing healthcare costs
Predicting epidemics
Biomedical and Technological Advances in Medicine Cont.
Avoiding preventable deaths
Improving quality of life
Reducing healthcare waste
Improving efficiency and quality of care
Developing new drugs and treatments
Artificial Intelligence (AI) – AI is the ability of a computer program or machine to think and learn; not meant to replace the physician, but to assist the physician in making better clinical decisions or replace human judgment in functional areas in healthcare such as radiology.
Policy Making and Healthcare Delivery
Healthy People 2020 – sets out a plan to improve the nation’s health with a vison of “a society in which all people live long, healthy lives”.
National Institute of Health – nation’s medical research agency, with the following goals:
Foster fundamental creative discoveries, innovative research strategies, and their applications as a basis for ultimately protecting and improving health
Develop, maintain, and renew scientific human and physical resources that will ensure the nation’s capability to prevent disease
Expand the knowledge base in medical and associated sciences to enhance the nation’s economic well-being and ensure a continued high return on the public investment in research
Exemplify and promote the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science
Policy Making and Healthcare Delivery Cont.
National Academy of Medicine - was established in 1970 as a nongovernmental agency to provide unbiased advice to decision makers and the public.
Center for Disease Control and Prevention – Leading federal agency charged with protecting the public health and safety through the control and prevention of disease, injury, and disability.
Leads in the following services:
Detecting and responding to diseases and conditions
Promoting healthy living
Providing information for travelers’ health
Educating for emergency preparedness
Policy Making and Healthcare Delivery Cont.
Local, State, and Federal Policies
Local Level – leaders decide where the public funds will finance community health centers and municipality hospitals
State Level – decision of access, eligibility and level of treatments, where state/federal dollars will be spent, and how to provide services to people with special needs and funding for mental health facilities
Federal Level – six agencies provide healthcare to over 100 million Americans (Medicare, Medicaid, State Children’s Health Insurance Program [SCHIP], Veterans Health Administration [VHA], TRICARE, and Indian Health Service [IHS]).
Policy Making and Healthcare Delivery Cont.
Patient-Centered Outcomes Research Institute (PCORI)
Three goals of PCORI:
Substantially increase the quantity, quality, and timeliness of useful, trustworthy information available to support health decisions
Speed the implementation and use of patient-centered outcomes research (PCOR) evidence.
Influence clinical and healthcare research funded by others to be more patient centered
Modern Healthcare Delivery in the United States
Social Security Act of 1935 - the Social Security bill included only one reference to health insurance as a subject that the new Social Security Board might study. The Social Security Act was passed in 1935.
Public Law 89–97 of 1965 – In 1965, passage of a number of amendments to the Social Security Act brought Medicare and Medicaid into existence.
Medicare is a federal program that provides healthcare benefits for people age 65 and older who are covered by Social Security; Medicaid was established to support medical and hospital for persons classified as medically indigent.
Modern Healthcare Delivery in the United States Cont.
Public Law 92–603 of 1972 – To curtail Medicare and Medicaid spending, Public Law 92-603 required concurrent review of these program’s patients.
Utilization Review Act of 1977 – Made it a requirement for hospitals to conduct continued-stay reviews for Medicare and Medicaid patients.
Peer Review Improvement Act of 1982 - Peer Review Improvement Act redesigned the PSRO program and renamed the agencies peer review organizations (PROs).
Modern Healthcare Delivery in the United States Cont.
Tax Equity and Fiscal Responsibility Act of 1982 – It required extensive changes in the Medicare program. Its purpose was to control the rising cost of providing healthcare services to Medicare beneficiaries.
Public Law 98–21 of 1983 - The PPS for acute hospital care (inpatient) services was implemented on October 1, 1983, according to Public Law 98–21. Under the inpatient PPS, reimbursement for hospital care provided to Medicare patients is based on diagnosis-related groups (DRGs).
Health Insurance Portability and Accountability Act of 1996 - Addresses issues related to the portability of health insurance after leaving employment, establishment of national standards for electronic healthcare transactions, and national identifiers for providers, health plans, and employers.
Modern Healthcare Delivery in the United States Cont.
American Recovery and Reinvestment Act of 2009 – It is considered one of the major health information technology laws that provided stimulus funds to the US economy in the midst of a major economic downturn.
Patient Protection and Affordable Care Act of 2010 - was signed into law on March 23, 2010, and is the most significant healthcare reform legislation of the first decade of the 21st century.