The Health Care System
Chapter 11
The Health Care System
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U.S. Health Care System
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Figure 11-1
U.S. Health Care System (Cont.)
Private health care subsystem
Focus on the individual
Nonprofit and for-profit agencies
Models of services
Solo practice
Single specialty group practice
Multispecialty group practice
Integrated health maintenance model
Community health center
Voluntary or nonofficial agencies
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U.S. Health Care System (Cont.)
Public health care system
Mandated by the U.S. Constitution
Focus on the population
“promote the general welfare of its citizens.”
Federal policies and practices influence local and state governments
Coordination of services under Department of Health and Human Services
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Public Health
Public health refers to the efforts organized by society to protect, promote, and restore the people’s health.
Concerned with a healthy population
Concerned with a healthy environment
Scope is broad
Encompasses activities that promote good health
Organized into multiple levels (federal, state, local)
Provides services for those unable to obtain health care without assistance
Establishes laws, rules, and regulations to protect the public
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Public Health System
Federal level subsystem
U.S. Department of Health and Human Services
Surgeon General and numerous other agencies
Targets general population, special populations, and international health
IOM Report, HHS in the 21st Century: Charting a New Course for a Healthier America (2008), recommended transformation of system
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Current HHS Strategic Plan
Transform health care
Advance scientific knowledge and innovation
Advance health, safety, and well-being of the American people
Increase efficiency, transparency, and accountability of HHS
Strengthen the nation’s health and human services infrastructure and workforce
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Public Health System (Cont.)
State level subsystem
State health departments
Responsible for the health of their citizens
Central authorities in the public health care system
Dependent on federal level for guidance and resources
Establish own state laws
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Public Health System (Cont.)
Local health department subsystem
Local health departments (LHD)
Responsible for direct delivery of public health services and protection of the health of citizens
Not all communities have LHDs
Responsible for:
Community health services
Environmental health services
Personal health services
Mental health services
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Health Care Providers
Provider organizations
Any organization that provides health care to the community
Health care professionals
The interprofessional health care team
Professionals and nonprofessionals
Nontraditional health care providers
Complementary and alternative therapies
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Quality Care
To Err Is Human: Building a Safer Health System (IOM, 1999) focused on safety within the health care delivery system
Crossing the Quality Chasm (IOM, 2001) focused on developing a new health care system for the twenty-first century, one that improves care
Leadership by Example (IOM, 2003) was a report requested by Congress that examined the federal government’s quality enhancement processes
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Quality Care (Cont.)
Who Will Keep the Public Healthy? (IOM, 2003) brought public health into the forefront by focusing on issues including globalization, rapid travel, scientific and technological advances, and demographic changes
In-depth exploration of educational needs for improved public health
Need for appropriately prepared public health professionals
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Quality Care (Cont.)
Who Will Keep the Public Healthy? (Cont.)
New content areas for public health professionals:
Informatics, genomics, communication, cultural competence, community-based anticipatory research, global health, policy and law, and public health ethics
Old content areas for public health professionals:
Epidemiology, biostatistics, environmental health, health services administration, and social and behavioral science
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Quality Care (Cont.)
Health Professions Education (IOM, 2003), the education of all health professionals is viewed as a bridge to quality care.
Provide patient-centered care
Work in interdisciplinary teams
Employ evidence-based practice
Apply quality improvement
Utilize informatics
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Quality Care (Cont.)
Priority Areas for National Action (IOM, 2003) identified priority areas that should be addressed to improve quality
Patient and family engagement
Population health
Safety
Care coordination
Palliative care
Overuse
Access
Health systems infrastructure capabilities
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Quality Care (Cont.)
Keeping Patients Safe: Transforming the Work Environment (IOM, 2004) addressed critical quality and safety issues with a focus on nursing care and nurses
Focused on nurses in acute care and the work environment for safer patient care
Also looked at nursing shortage, health care errors, patient safety risk factors, nurse’s role in quality improvement, and work environment threats to patient safety
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Quality Care (Cont.)
The Future of Nursing. Leading Change, Advancing Health (IOM, 2011) focuses on the nursing profession and how it might fit into the change process
Nurses should practice to the full extent of their education and training.
Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
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Quality Care (Cont.)
The Future of Nursing. Leading Change, Advancing Health (Cont.)
Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States.
Effective workforce planning and policy making require better data collection and an improved information infrastructure.
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Accreditation
Joint Commission
National Committee for Quality Assurance (NCQA)
Health Plan Effectiveness Data and Information Set (HEDIS)
American Healthcare Commission
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Agency for Healthcare Research and Quality (AHRQ)
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… the ultimate test of the public health subsystem is whether it effectively serves the people by their measurements, not those of the public health profession.
– Koop (1989)
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Critical Issues in Health Care Delivery
Managed care
Information technology
Telehealth
Electronic medical records (EMRs)
Social media
Consumer advocacy and client rights
Client/consumer-centered health care
Coordination and access to care
Disparity in health care delivery
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Critical Issues in Health Care Delivery (Cont.)
Globalization and international health
World has no real boundaries
CDC active in responding to preparedness and international travel
WHO fosters collaborative global initiatives
ICN gives nursing perspective
Health care reform
The Clinton Health Reform Initiative
Patient Protection and Affordable Care Act of 2010
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Future of Public Health
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What services?
Who has access?
Who pays?
How is it delivered?
What is the role of government?
Impact on Community Health Nursing
Principles of change that focus on quality, access, and cost…
The need for patient-centered care
The need for stronger primary care services
The need to deliver more care in the community
The need for seamless, coordinated care
The need for reconceptualized roles for health professionals
The need for interprofessional collaboration
– The Future of Nursing. Leading Change,
Advancing Health (IOM, 2011)
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