Chapter 03 Public Health and Primary Health Care Systems and Health Care Transformation

1Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 03

Public Health and Primary Health Care Systems and Health Care

Transformation


Objectives

1. Describe the trends that are influencing the evolution of the health care system in the early decades of the twenty-first century.

2. Define public health and primary health care, and explain the nursing roles in each.

3. Evaluate the effectiveness of the United States primary health care system to meet the established goals of Alma Ata as the basis for primary health care.


Objectives, Cont’d

4. Describe the current public health system in the United States.

5. Compare and contrast the responsibilities of the federal, state, and local public health systems.


Definitions(Box 3-1)

Disease prevention Disparities Electronic health record Globalization Health


Definitions, Cont’d(Box 3-1)

Health promotion Institute of Medicine Primary care Primary health care Public health


Current Health Care Systems in the United States

Indicators that continue to cause disparities in the United States’ health care system: Cost Access Quality


Cost 2008 “Great Recession”

Weakening of national and global economy Loss of 7 million jobs in the United States National health spending expected to grow 6.1%

per year, reaching $4.5 trillion by 2019• Per capita spending increasing from $8046 in 2009 to

$13,387 in 2018 Increases in public spending Decreases in private spending By 2012, expect public payment for health care

services will account for more than 50% of total health care purchases in the U.S.


Cost, Cont’d


Cost, Cont’d Aging Baby Boomer population

Will increase Medicare expenditures Medicaid recipients can be expected to

decline as jobs are added to the economy. Percentage of workers covered by employer-

sponsored insurance should rise. Premiums increase Higher co-pay and deductible expenses

Costs will rise Rise in percentage of uninsured


Access Rise in uninsured people to 46.3 million in 2008 Government programs play significant role in

meeting the needs of the uninsured Increasing demands leave some states struggling

with budget Strong relationship between health insurance

coverage and access to health care services Groups who face greatest barriers to access:

Poor Minority group members Non-English speakers


Access, Cont’d Medically underserved

56 million in the United States lack adequate access to primary health care (2007)

Safety net Community health centers

American Recovery and Reinvestment Act of 2009 (ARRA)


United States Health Spending


Life Expectancy


Quality To Err is Human: Building a Safer Health

System (IOM, 2000) 98,000 deaths a year attributed to preventable

medical errors• 7,000 of which are due to preventable medication errors

Keeping Patients Safe: Transforming the Work Environment of Nurses (IOM, 2003) Long work hours pose most serious threat

Cultivating a culture of safety Sentinel events reporting Hospital Compare


Trends Affecting the Health Care System

DemographicsTechnology

Global Influences


Demographics Aging Baby Boomer generation

Cost of Medicare expected to rise Rise in foreign-born population Lack of diversity in health care workforce

Pew Commission


Technology Examples:

Telehealth Electronic medical records Personal Health Record (PHR) Health Information Exchanges (HIEs)

Benefits: Cost-effective Improved care Reduce medical errors

Pitfalls: Concerns about privacy and security Unclear reimbursement for services provided at distance


Global Influences Globalization Infectious disease outbreaks World Health Organization (WHO)

International Health Regulations (2005)


Organization of the Health Care System

Primary Health Care SystemPrimary Care

Public Health SystemThe Federal SystemThe State SystemThe Local System


Primary Care Versus Primary Health Care

Primary Care Care provided by health

care professional Care provided at the

individual level

Primary Health Care (PHC) Broad range of services Emphasis is on

prevention Care provided at the

community level


PHC Workforce Multidisciplinary team of health care

providers. Team members include:

Primary care generalistsand public health physicians

Nurses Dentists Pharmacists Optometrists Nutritionists Community outreach workers

Mental health counselors

Translators Other allied health

professionals Community members

also important to the team


PHC Initiative Declaration of Alma Ata (1978)

Goal of attaining a level of health that permitted all citizens of the world to live socially and economically productive lives

Healthy People 2020


Primary Care First level of the private health care system Delivered in a variety of community settings Americans access it through insurance

programs Managed care

Managed Care Act of 1973 HMOs, PPOs, and POS Medicare Advantage Program


Primary Care Workforce Primary care developed in the 1960s

Needed to reexamine role of general practitioner Primary care generalists include:

Family physicians General internists General pediatricians Nurse practitioners (NPs) Clinical nurse specialists (CNSs) Physician assistants (PAs) Certified nurse-midwives (CNMs) Doctorate in Nursing Practice (DNP)


Public Health System Mandated through laws that are developed at

the national, state, or local level Organized into many levels in the federal,

state, and local systems At the local level, health departments provide

care that is mandated by state and federal regulations.


Federal System U.S. Department of

Health and Human Services (HHS)

Office of Global Health Affairs

U.S. Public Health Service (PHS)

Health Resources and Services Administration (HRSA)

National Institutes of Health (NIH)

Agency for Health Care Research and Quality (AHRQ)

Food and Drug Administration (FDA)

Centers for Disease Control and Prevention (CDC)

Centers for Medicare and Medicaid Services (CMS)

Departnent of Homeland Security (DHS)


State Health Department Stand ready for disaster prevention or

response Health care financing and administration Direct assistance to local health departments

Ongoing assessment of health needs Board of examiners of nurses


Local Health Department Direct responsibility to the citizens on its

community or jurisdictions Variety of services and programs offered

depending on the state and local health codes that must be followed, the needs of the community, and available funding and other resources

Chapter 03 Public Health and Primary Health Care Systems and Health Care Transformation

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