Chap 13: Health Care System: Structure

Instructor’s Name

Semester, 200_

Chap 13: Structure

Chapter Objectives

• Define the term health care system.

• Trace the history of health care delivery in the United states from the mid-nineteenth century to the present.

• Discuss and explain the concept of the spectrum of health care delivery.

• List and describe the different levels of medical practice.

Chap 13: Structure

Chapter Objectives

• Distinguish between the different kinds of health care, including public health practice, medical practice, and long-term practice.

• List and characterize the various groups of health care providers.

• Explain the differences among allopathic, osteopathic, and nonallopathic providers.

• Define complementary and alternative medicine.

Chap 13: Structure

Chapter Objectives

• Explain why there is a need for health care providers.

• Prepare a list of the different types of facilities in which health care is delivered.

• Explain the differences among private, public, and voluntary hospitals.

• Explain the concept behind ambulatory care facilities.

Chap 13: Structure

Chapter Objectives

• Define home health care and explain the reason why this setting is being used more to deliver care.

• Explain what the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) does.

Chap 13: Structure

Health Care System: Structure

• American Delivery System– Variety of Providers– Variety of Settings

• Concerns– Informal Cooperation of Providers– Disease Treatment vs Health Care – Conglomeration vs System

Chap 13: Structure

Brief History of U.S. Health Care

Chap 13: Structure

Brief History of U.S. Health Care

18501850

TimelineTimeline

19971997

Chap 13: Structure

Brief History of U.S. Health Care

18501850

Before 1850 - Medical Treatment occurred in Before 1850 - Medical Treatment occurred in HomeHome

19971997

Chap 13: Structure

Brief History of U.S. Health Care

18501850

Treatment moved to Physician’s Office & HospitalTreatment moved to Physician’s Office & Hospital

1997199719001900

Home

Chap 13: Structure

Brief History of U.S. Health Care

18501850 1997199719111911

Home

Hospitals

1st Insurance

Chap 13: Structure

18501850

3.9% of GDP spent on Health Care3.9% of GDP spent on Health Care

1997199719111911

Home

Hospitals

19291929

1st Insurance

Brief History of U.S. Health Care

Chap 13: Structure

18501850

Age of MedicineAge of MedicineNIH EstablishedNIH EstablishedHill-Burton ActHill-Burton Act

1997199719111911

Home

Hospitals

1st Insurance

2.9% GDP

19301930 19501950

Brief History of U.S. Health Care

Chap 13: Structure

18501850

Medicare & MedicaidMedicare & Medicaid

1997199719111911

Home

Hospitals

1st Insurance

2.9% GDP

19301930 19651965

Age of Medicine

19501950

Brief History of U.S. Health Care

Chap 13: Structure

18501850

Cost ContainmentCost Containment- Health Systems Planning- Health Systems Planning

-Health Maintenance Organization Act-Health Maintenance Organization Act

1997199719111911

Home

Hospitals

1st Insurance

2.9% GDP

19301930 19651965

Age of Medicine

19501950

Medicare &Medicaid

1970s1970s

Brief History of U.S. Health Care

Chap 13: Structure

18501850

American HealthAmerican Health Security Act of 1993Security Act of 1993

1980s1980s19111911

Home

Hospitals

1st Insurance

2.9% GDP

19301930 19651965

Age of Medicine

19501950

Medicare &Medicaid

1970s1970s

Cost Containment

19971997

Brief History of U.S. Health Care

Chap 13: Structure

18501850

14% GDP 14% GDP

1980198019111911

Home

1st Insurance

2.9% GDP

19301930 19651965

Age of Medicine

19501950

Medicare &Medicaid

19701970

Cost Containment

Increased Costs

19921992

Brief History of U.S. Health Care

Chap 13: Structure

Major Concerns in the U.S.

1. Medical Care Cost

2. Drug Abuse

3. Budget Deficit

4. Crime

5. Unemployment

6. AIDS

Chap 13: Structure

Health Care Spending (Select countries: 1960 & 1997)

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

$4,500

1960 1997

Australia

Canada

Finland

France

Ireland

Norway

Sweden

UnitedKingdonUnited States

Chap 13: Structure

Spectrum of Health Care Delivery

• Public Health Practice– education is primary component

• Medical Practice– primary– secondary– tertiary

• Long-term Practice– restorative care– long-term care

Chap 13: Structure

Public Health Practice

• Education– provides information– empowers– motivates

• Settings– Governmental health agencies– Voluntary health agencies– Social Services agencies– Schools– Business and industry

Chap 13: Structure

Spectrum of Health Care Delivery

• Public Health Practice– education is primary component

• Medical Practice– primary– secondary– tertiary

• Long-term Practice– restorative care– long-term care

Chap 13: Structure

Primary Medical Care

• Education

• Promotion of nutrition

• Safe water and sanitation

• Maternal and child health care

• Immunization

• Prevention and control of endemic disease

• Treatment

• Essential drugs

Chap 13: Structure

Secondary Medical Care

• Specialized care– provided by

physicians– hospital or

outpatient– emergency care

Chap 13: Structure

Tertiary Medical Care

• Highly specialized

• For those with unusual or complex conditions

• Specialized hospitals

• Academic health centers

Chap 13: Structure

Spectrum of Health Care Delivery

• Public Health Practice– education is primary component

• Medical Practice– primary– secondary– tertiary

• Long-term Practice– restorative care– long-term care

Chap 13: Structure

Long-term Practice

• Restorative care

• Long-term care

Chap 13: Structure

Health Care Providers

• Independent Providers– Allopathic – specific remedies include drugs or

medication– Osteopathic – recognition of reciprocal interrelationship

between the structure & function of the body– Nonallopathic– chiropractors, acupuncturists, naturopaths,

homeopaths

Chap 13: Structure

Health Care Providers

• Limited Care– have advance training in a health specialty

and are licensed to practice it

• Examples– dentists, optometrists, podiatrists, &

psychologists

Chap 13: Structure

Nurses

• Licensed Practical Nurses (LPN) &– 1-2 yrs of training & carry out non-technical

duties

• Registered Nurses (RN)– associate or baccalaureate degree & state

license

• Bachelor of Science in Nursing (BSN)– prepared for additional activities involving

independent judgment

• Advanced Practice Nurse (APNs)

Chap 13: Structure

Registered Nurses

Nurse Practitioner

(NP)

NP CNSClinical Nurse

Specialist (CNS)

Nurse MidwifeNurse

Anesthetist

Chap 13: Structure

Allied & Professional Health Care Providers• Allied Health Care Professionals

– provide services that assist, facilitate, & complement work of physicians

– dietitians, physical therapists, medical technologists, EMTs, & speech therapists

• Public Health Professionals– work in public health clinics & voluntary agencies– environmental health workers, administrators,

epidemiologists, health educators, & biostatisticians

Chap 13: Structure

Health Care Facilities

• Practitioner Offices – Privately owned practices

• Clinics

• Hospitals– Private– Public– Voluntary

• Ambulatory Care

Chap 13: Structure

Health Care Facilities

• Rehabilitation Centers– Long-term care options– Home health care

• Continuing Care– chronic, respite, hospice, & home care

• Accreditation

Chap 13: Structure

Chapter 13Chapter 13

Health Care System:Health Care System:

StructureStructure