Chapter 4 The Health Care Delivery System Fundamentals of Nursing: Standards & Practices, 2E.
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Chapter 4 The Health Care Delivery System Fundamentals of Nursing: Standards Practices, 2E
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Transcript of Chapter 4 The Health Care Delivery System Fundamentals of Nursing: Standards & Practices, 2E.
Chapter 4
The Health Care Delivery System
Fundamentals of Nursing: Standards & Practices, 2E
Copyright by Delmar, a division of Thomson Learning 4-2
What is a Health Care Delivery System?
It is a mechanism for providing services that meet the health-related needs of individuals.
Nursing is a major component of the U.S. health care delivery system.
Copyright by Delmar, a division of Thomson Learning 4-3
Types of Health Care Services
Primary: health promotion and illness prevention
Secondary: early detection and intervention
Tertiary: restorative and rehabilitative care
Copyright by Delmar, a division of Thomson Learning 4-4
Health Care Settings - Public Sector
Federal Level• U.S. Department of Health and Human
Services
State Level• Department of Health
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Local Level Health Units• Communicable disease control• Health records maintenance• Individual health services• Environmental health and safety• Public health education
Copyright by Delmar, a division of Thomson Learning 4-6
Health Care Settings - Private Sector
HospitalsExtended care facilitiesHome health agenciesHospicesOutpatient settings
Copyright by Delmar, a division of Thomson Learning 4-7
SchoolsIndustrial clinicsManaged care organizationsCommunity nursing centersRural primary care hospitals
Copyright by Delmar, a division of Thomson Learning 4-8
Health Care Team
Nurse (RN) Physician (MD, DO) Physician assistant (PA) Pharmacist (RPh) Dentist (DDS, DMD) Dietitian (RD) Social worker (SW)
Copyright by Delmar, a division of Thomson Learning 4-9
Respiratory therapist (RT) Physical therapist (PT) Occupational therapist (OT) Chaplain Unlicensed assistive personnel (UAP)
Copyright by Delmar, a division of Thomson Learning 4-10
Roles of the Nurse
Caregiver Teacher Advocate Manager Expert Case manager Team member
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Economics of Health Care
Private insurance Managed care
• primary care providers• health maintenance organizations• preferred provider organizations• exclusive provider organizations
Copyright by Delmar, a division of Thomson Learning 4-12
Federal government insurance plans• Medicare• Medicaid
Canadian health insurance
Copyright by Delmar, a division of Thomson Learning 4-13
Factors Influencing the Delivery of Health Care
CostAccessQuality
Copyright by Delmar, a division of Thomson Learning 4-14
Cost
Four major factors increase the cost of health care• an oversupply of specialized providers• a surplus of hospital beds• the passive role assumed by most
consumers• inequitable financing of services
Copyright by Delmar, a division of Thomson Learning 4-15
Access - Limiting Factors
Inability to obtain insurance Cultural barriers Shortages of health care providers Limited access to ancillary services Parents’ inability to take time from work
to transport children to health care providers
Copyright by Delmar, a division of Thomson Learning 4-16
Quality
Estimated that 30%-40% of diagnostic/medical procedures performed in U.S. are unnecessary
Inappropriate use of resources A 1998 study revealed that 72% of
nurses surveyed stated that the quality of care at their hospital had declined due to cost-containment measures.
Copyright by Delmar, a division of Thomson Learning 4-17
Challenges Within the Health Care System
Disillusionment with professionals• Americans believe major problems of the
health care system are greed and waste.• Americans are suspicious of professionals.• Consumers are becoming increasingly tired
of paying the high cost of care, and question medical practices and fees.
Copyright by Delmar, a division of Thomson Learning 4-18
Positive Perception of Nurses• Several studies verify the public’s trust
in nurses.• The public believes that if nurses were
allowed to use their skills, they would significantly enhance quality of care and reduce costs.
Copyright by Delmar, a division of Thomson Learning 4-19
Loss of Control• Consumers have expressed a loss of
personal control within the health care system.
• Some feel terrorized by the system.• Many American workers state that their
greatest concern is the possible loss of health care coverage.
Copyright by Delmar, a division of Thomson Learning 4-20
Decreased Hospital Use• shorter lengths of stay• technologic advances• greater availability of outpatient facilities• more services available in outpatient
settings• expectations/demands of third-party payers
Copyright by Delmar, a division of Thomson Learning 4-21
Changing Practice Settings• Most nurses currently practice in hospitals
and will continue to do so in the future.• Nursing employment outside the hospital
continues to increase rapidly.• Larger numbers of nurses will be needed for
primary care, public health, extended care facilities, and the home setting.
Copyright by Delmar, a division of Thomson Learning 4-22
Ethical Issues• The U.S. is struggling with a major
ethical conflict of cost containment versus compassionate quality care.
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• Today, the U.S. health care delivery system is faced with the dilemma of citizens’ needs being greater than available resources.
• Nurses continue to advocate for ethical distribution of resources as health care reform progresses.
Copyright by Delmar, a division of Thomson Learning 4-24
Vulnerable Populations• Children• The elderly• People with AIDS• The homeless• Others living in poverty
Copyright by Delmar, a division of Thomson Learning 4-25
Nursing’s Response to Health Care Challenges
Nursing’s Agenda for Health Care Reform
Standards of care Advanced practice Public versus private programs Public health Community health Long-term care
