transforming the Public’s Healthcare Systems
Chapter 5 Transforming the Public’s Healthcare Systems
Evolving U.S. Healthcare Delivery System
Healthcare delivery system
Transforms resources into essential services to meet the healthcare needs of certain populations
Settings
Hospitals
Physicians’ offices
Shelters
Specially equipped vans or shopping malls
Evolving U.S. Healthcare Delivery System (cont.)
Reimbursement
Private insurance companies
Managed care organizations
Government agencies
Foundations
Patient
Affordable Care Act (ACA) of 2010
Types of healthcare systems
Private
Public
Military
Private Healthcare Delivery
Fee-for-service
Hill-Burton Act
Tax Equity and Fiscal Responsibility Act of 1982
1983 Amendments to the Social Security Act
Diagnosis-related groups (DRGs)
Prospective payment system (PPS)
Third-party payers
Insurance companies
Health maintenance organizations (HMOs)
Preferred provider organizations (PPOs)
Managed care organizations (MCOs)
Public Health Care
Defined as the health outcomes of a group of individuals
Shattuck
1850 Report of the Sanitary Commission of Massachusetts
1872 Public Health Association formed
Social Security Act of 1935
Local health departments
Centers for Disease Control and Prevention (CDC)
Military Health Care
National Defense Authorization Act (2005)
Care provided:
Ambulatory care
Military base and regional clinics
Hospital service
Base dispensaries or sick bays
Simple hospitals services
Regional hospitals
Advanced care
Types of programs
TriCare
Veterans Administration
Healthcare Reform
Legislative initiatives were proposed seven times during the 20th century
Based on the need to control healthcare costs while providing access to quality healthcare services
Nursing and healthcare reform
ACA
Current U.S. Healthcare Delivery System
Interrelated systems
Horizontal and vertical integration of services
Levels of care
Preventive care
Primary care
Secondary care
Tertiary care
Restorative care
Healthcare Providers
Physicians
Nurses
Physician assistants
Specialized care providers
Technicians/therapists
Other providers
Pharmacists
Social workers
Healthcare Settings
Acute care facilities
Short-term specialized care facilities
Long-term care facilities
Ambulatory care sites
Daycare centers
Hospices
Retirement communities
Complementary/alternative health care
Issues Affecting the Delivery of Healthcare Services
Deregulation
Emphasis on secondary and tertiary healthcare services
Increasing consumerism
Technological advances
Increasing longevity of Americans
Defensive health care and government regulation
Managed Care
MCOs
Capitation
HMOs
PPOs
Point-of-service plans (POSs)
Integrated healthcare systems
Patient Care Outcomes
Defined as the consequences of care that the patient receives or does not receive
Outcome studies
Look for trends over time in patient status and adverse events
Data obtained used as a basis for decisions
Development of policies and procedures
Community-Based Healthcare Settings
Shelters in the community
Role of nurse
Abuse shelters
Homeless shelters
Disaster shelters
Ambulatory care centers
Ambulatory emergency/trauma
Primary care centers
Ambulatory surgery centers
Health Politics and Policy
Government policy
Healthy People
Healthy People 2020
ACA
Public opinion and special interest groups
Nursing and healthcare policy
American Nurses Association (ANA)
New Nursing Opportunities
Advanced practice registered nurses (APRNs)
Entrepreneurs
Data management and evaluation
Research
Community focused and community based
Prevention and risk reduction focus for all BSN nurses
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