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Health Care Delivery System:
Societal Trends and Economics
Dr. Jayesh Patidar
www.drjayeshpatidar.blogspot.com
Change & Health Care Delivery
Rapid and Constant
Nurses must embrace change
Nurses must contribute to problem solving
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Why Did Health Care Delivery Need to Change?
Rising health care cost
Increasing elderly population
Expanding technology
Emphasis on acute care rather than prevention
Insurance reimbursement that rewarded
increased spending
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Health Care Delivery Changes:Cause and Effect
Cause:
Consumer demands
Technological advances
Governmental scrutiny
Impact on Nursing:
Challenge theoretical viewpoint, practice models,
and patient services
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Approaches Introduced to Control Costs
Managed-care strategies HMO’s, PPO’s
Changes in reimbursement methods Change to prospective payment system (DRG’s)
Hospital restructuring
Mergers Corporatization
Integrated Health Care Delivery Systems
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Do We Need National Health Care?
Improved access to care
Competitive free-market
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Questions to Ponder
How does futile care contribute to increased costs?
How can preventive health care and wellness education lower costs of later acute care?
Should health care adopt corporate business practices? Telemedicine
For-profit organizations
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Health Care Trends
Graying of America
Technological advances
Globilization
Delivery System changes
Social evolution
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Globilization and Nursing
Spread of a common culture around the world
Universal sharing of attitudes, products, industry, and stocks
Role of Nursing:
Learn about health care beliefs and practices of other cultures
International Nursing Forums to share nursing practice
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Social Changes and Nursing
Consumer control Desire to make own choices
Conventional vs. Alternative therapies
Question health information Research independently
Demand more preventive care
Judge value of health care Service orientation
Aging Majority population
Multiple health care needs
New technology Telemedicine
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Current Trends affecting the Vision of Nursing
Dominant role in health care delivery
systems
Geriatrics a prominent specialty
Leadership role in
determining/implementing policy
Provide holistic care (integration of multiple
facets)
Technology enhanced quality care
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Current Trends (continued)
Quality care based upon outcome criteria
Emphasis on case-management
Increased nursing involvement in making policy and governmental decisions affecting health care
Education more user-friendly
Expanding cultural knowledge and practice
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Health Maintenance Organizations
Staff Model
Group Model
Network Model
Independent Practice Association
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Preferred Provider Organization (PPO)
Another type of Health Plan
Use of physicians who have agreed to
provide services at a lower price to the
insurer
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Ethics and Nanotechnology
Need new delivery systems which incorporate demands of advanced technology
Need lower-tech, higher-touch therapeutic interventions to offset technology
Need to combine alternative care approaches with conventional medical treatments
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Types of Health Care Organizations
Acute Care Hospitals
Psychiatric Hospitals
Community Mental Health Centers
Long-term Care Facilities
Day Care Centers and Homes for Elderly
Ambulatory Care
Home Health Care
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Organizational Structures
Centralized
Decentralized
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Organizational Charts
Maps that determine who reports to whom
Shape dependent upon size and
governance style
Reflect formal communication patterns
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Organizational Approaches to Getting Work Done
Committee structure
Participative management
Shared governance
Self-governance
Unions
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Nursing Care Delivery Patterns
Functional
Team
Primary
Patient-focused
Case-managed
What are the pro’s and con’s?
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Delegation
Who can delegate?
What can be delegated?
When should delegation be used?
How can you determine if delegation is
effective?
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Nursing Assignments
JCAHO Require that staffing be based on organized
system
Patient Classification or Acuity System
ANA Identified principles of staffing
Patient care-related
Staff-related
Institution/organization-related
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Nursing Shortages and Staffing
What constitutes a staffing crisis?
What can be done when there is a staffing
crisis?
What are your responsibilities when staffing
is short?
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Nurse’s Role in Decreasing Health Care Costs
Challenge: provide excellent care with
fewer dollars
Knowledge about equipment/service costs
Resource utilization
Promote preventive health care
Consumer education
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Computers and Health Care
Telemedicine
Use of computer technology and
telecommunications to provide contact between
the provider and the consumer.
Primary goal: provide access to rural and
underserved communities.
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Computers in Healthcare
Information Superhighway
“term used to describe the explosion of electronic
information retrieval and communication taking
place through computers and modems.”
What is important to remember when
using electronic data?
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Role of Nursing in Telehealth/Telemedicine
Active involvement
Practice issues when care transcends state
lines
Triage from emergency care facilities
Home care services
Hospice care
Video assessments and vitals through
telemonitoring
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Realities of Health Care Financing
Expenditures are continuing to increase
Managed care has not reduced the growth of Medicare beneficiaries and overall spending
Reasons for continued increases Inflation
Increased demand for services
Expensive technological advances
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How is Health Care Financed?
Self-payment
Third-party payment
Health care assistance
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Health Care Financing and the Role of the Nursing
Nurses are involved in the decision-making
process
Patient/consumer advocacy
Need to understand budget process
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Questions to Ponder
Why must nurses be involved in fiscal
management?
What does the budget have to do with
nursing practice?
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Terms to Know
Budget
Operating budget
Capital budget
Personnel budget
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Budgets and Cost Control
Unit cost
Standard costs
Target or budget costs
Cost variance report
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Reasons for Cost Problems
Poor quality
Theft
Carelessness
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“Costing Out” Nursing Services
Used to understand the cost of treating a
patient relative to the revenue received
from treating that patient.
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Quality and Patient Care
Why must quality be controlled?
What is the best way to control quality?
(prospective vs. retrospective)
Who is responsible for quality?
How is quality measured?
What is the bottom line?
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Quality
JCAHO Mission: “enhance the quality of health care provided to
the public”
Quality Assurance Method of monitoring and improving consumer-oriented
services
Unique to each institution
Unit based and requires individual involvement
Definition: What does quality mean to you?, to consumers?
Evaluation perspectives: Structure
Process
outcome
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Computerization
Mainframe
PC
PDA
We must balance the use of this technology
with increased personal contact (touch) to
maintain the human element of nursing.
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Nursing Informatics
1994 ANA Recognition
A specialty that “integrates nursing science,
computer science, and information science in
identifying, collecting, processing, and managing
data and information to support nursing practice,
administration, education, research, and the
expansion of nursing knowledge” (ANA, 1994)
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Theories Associated with Nursing Informatics
Nomenclature, Classification and
Taxonomy
General Systems Theory
Change Theory
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Buzzwords for the Future
Preventive medicine
Preventive care
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THANK YOU
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