TRENDS IN HEALTH CAREHTR objective 02.04

COST CONTAINMENTWhy does health care cost so much? And what can be

done to bring the costs associated with health care down??

COST CONTAINMENT MEANS TRYING TO CONTROL THE RISING COST OF

HEALTH CARE AND MAXIMIZING EVERY DOLLAR SPENT

Technological Advances are expensive (heart, lung, kidney, and liver transplants, artificial hearts, Computers to examine internal body parts, people are surviving illnesses that used to be fatal, and are then requiring expensive and life long care…)

Aging population (increased use of pharmaceutical agents, more chronic diseases, need frequent health care services)

Increases in health related lawsuits also increase cost! Malpractice insurance is expensive! Doctors order diagnostic tests even though they might not be necessary

Doctors make every effort to avoid lawsuits by practicing “defensive” medicine

COSTS COULD RISE TO LEVELS THAT PROHIBIT PROVIDING SERVICES TO ALL INDIVIDUALS….

even though everyone SHOULD have equal access to health care regardless of ability to

pay.

SUMMARIZE In your own words, explain the concept of cost containment.

What are two reasons that the costs of health care are so high?

METHODS USED TO CONTROL COSTS

DRG’s, combination of services, outpatient services, mass or bulk purchasing, early intervention and preventive services, energy conservation

DRG’S DIAGNOSTIC RELATED GROUPS

Attempts by Congress to control costs for Medicare and Medicaid

Payment is based on diagnosis

Certain amount paid for each disease condition

Agencies providing care for less can KEEP the extra money

Agencies accept loss if care costs more than payment allowed.

COMBINATION OF SERVICES

Health care agencies share servicesCare can be provided to a larger number of people at a decrease in cost per person

Example??Lab Corp

OUTPATIENT SERVICES

Patients receive care without being admitted to hospitals or other care facilities

Hospital care is EXPENSIVE

Reducing the length of stay or decreasing the need for hospital admission lowers the cost.

Example? Open heart surgery patients used to spend several weeks in the hospital and now stay on average 5-7 days

Less expensive home care or transfer to a skilled care facility is used for those who require additional assistance

Examples of outpatient services are surgery, x-rays, diagnostic tests

MASS OR BULK PURCHASING

Buying equipment and supplies in larger quantities at reduced prices

Combine purchases of different departments in an agency

Combine purchases of several different agencies

Major health care system purchasing medical supplies for hundreds or thousands of health care agencies can obtain much lower prices than an individual agency

Computerized inventory can be used to determine when supplies are needed and to prevent overstock and waste.

EARLY INTERVENTION/PREVENTIVE SERVICES

Providing care before acute or chronic illness occurs

Preventing illness is ALWAYS cheaper than treating illness

Methods to prevent illness include Patient education Immunizations Regular physical examinations to detect problems early Easy access for all individuals to preventive health care services

People with limited access to health services and restricted finances use expensive emergency rooms and acute care facilities much more frequentlyProviding early intervention and care to these individuals is much more cost effective.

ENERGY CONSERVATION

Monitoring the use of energy to control costs and conserve resources

Major expenses for every health care industry/agency are electricity, water, and/or gas

Most large health care facilities perform energy audits to determine how resources are being used and to calculate ways to conserve energy

Methods used include designing and building new energy efficient facilities, constantly monitoring and maintaining heating/cooling systems, using insulation and thermopane windows to prevent hot/cool air loss, repairing plumbing fixtures immediately to stop water loss, replacing energy consuming light bulbs with fluorescent or energy efficient bulbs, installing infrared sensors to turn water faucets on and off, and using alternative forms of energy such as solar power.

Recycling is a form of energy conservation and most health care facilities recycle many different materials.

SUMMARIZEList three of the ways we try to control health care costs.

Give an example of each of the cost control measures you listed.

IT IS IMPORTANT TO NOTE:

The quality of health care should not be lowered simply to control costs.

AHCPRAGENCY FOR HEALTH CARE POLICY AND

RESEARCH

Federal Agency established in 1990

Its purpose is to research the quality of health care delivery and identify the standards of treatment that should be provided.

Every health care worker must make every effort to provide quality care while doing everything possible to avoid waste and keep expenses down.

Health care consumers must be more responsible for their own care, learn about all options for health care services, and follow preventive measures to avoid or limit illness and disease.

OTHER TRENDS

Wellness

Alternative and complementary methods of health care

National Health Care Plan

Home Health Care

Geriatric Care

Telemedicine

HOME HEALTH CARE

Rapidly growing field DRG’s result in shorter hospital stays so patients need care at home Home Health Care is less expensive to provide Can include:

Nursing care Physical and occupational therapy Respiratory therapy Social services Nutritional and food services Homemaking services

GERIATRIC CARE

Care for the elderly

Rapidly growing field….WHY?? Individuals are living longer Baby boom generation are reaching geriatric status

Will lead to growth of different facilities Adult day care centers Retirement communities Assisted/Independent Living Facilities Long Term Care Facilities

OBRA

Omnibus Budget Reconciliation Act of 1987

Federal law that created regulations regarding long term care and home health care

Requires states to establish training and competency evaluation programs for nursing/geriatric assistants

Nursing assistants in long term care must: Complete mandatory state approved training program Pass written and or competency examination Obtain certificate of registration (certification)

Other requirements

Continuing education Periodic evaluation of performance

Retraining or testing if CAN doesn’t work in a facility for more than two years

States must maintain a registry of qualified individuals.

OBRA also identifies patient’s/resident’s rights. This was done to require certain standards of care.

TELEMEDICINE

Uses video, audio, and computer systems to provide medical and or health care services

New technology allows interactive services between health care providers even though they are in different locations EMT’s providing care to a heart attack

victim use technology to transmit medical data such as an EKG to the emergency room physician who can monitor the data and direct the care of the patient.

Surgeons using a computer can guide a remote-controlled (robotic) arm to perform surgery on a patient miles away

A surgeon can direct the work of another surgeon by watching the procedure on video beamed by a satellite system.

As consumers become more computer literate, more health care services will be provided electronically.

Telemedicine machines, operating over telephone lines, are “user friendly”, compact, and less expensive than when they were developed.

People with chronic illnesses or disabilities can receive care in the comfort of their homes: Decreases the need for trips to medical care facilities Can test blood sugar levels, oxygen levels, blood

pressure measurements, and other vital signs, transmitting results to nurse or physician.

Can use online courses to learn to manage illness Can schedule an “appointment” and talk “face to face”

with health care provider using video conferencing Electronic reminders to take medicine or perform

diagnostic tests Receive answers to health related questions Provides access to specialists thousands of miles away.

SUMMARIZE

What is Home Health Care?What is geriatric care?What is OBRA and what does it do?Define telemedicine and give one example.

WELLNESS

Defined as the state of being in optimal health with balanced relationship between physical, mental, and social health.

People are more aware of the need to maintain health and prevent disease. Improves quality of life Saves MONEY

Recognize the importance of: Exercise, good nutrition, weight control, and health living habits!

Development of wellness centers, weight loss centers, health food stores, nutrition services, stress reduction counseling, and habit cessation management

WAYS TO PROMOTE WELLNESS

Physical Wellness: well balanced diet, regular exercise, routine physical examinations, immunizations, regular dental care and vision care, avoid alcohol, tobacco, caffeine, drugs, environmental contaminants, and risky sexual behavior.

Emotional Wellness: understanding personal feelings and expressing them appropriately, accepting one’s limitations, adjusting to change, coping with stress, enjoying life, and maintaining an optimistic outlook.

Social Wellness: showing concern, fairness, affection, tolerance, and respect for others, communicating and interacting well with others, sharing ideas and thoughts, and practicing honesty and loyalty.

Mental and Intellectual Wellness: being creative, logical, curious, and open-minded; using common sense; obtaining continual learning, questioning and evaluating information and situations; learning from life experiences; and using flexibility and creativity to solve problems

Spiritual Wellness: using values, ethics, and morals to find meaning, direction, and purpose

HOLISTIC HEALTH CARE

The trend toward wellness has led to holistic health care

Treatment of the WHOLE person by promoting physical, emotional, social, intellectual, and spiritual wellness through treatment of the whole body, mind, and spirit.

Treatment is directed toward protection and restoration

Patient is responsible for choosing his or her own care

Health care workers must respect the patient’s choices and provide care that promotes the well being of the whole person.

ALTERNATIVE AND COMPLEMENTARY METHODS OF

HEALTH CAREAyuveda

Chinese Medicine

Chiropractic Care

Homeopathy

Hypnotism

Naturopathy

INTRODUCTION The most common method of health care in the US is the biomedical or

WESTERN system of health care.

It is based on evaluating the physical signs and symptoms of a patient, determining the cause of disease, and treating the cause.

A major trend in health care is the use of alternative or complementary health care therapies. Alternative therapies are methods of treatment used instead of biomedical therapies. Complementary therapies are used along with conventional medical therapies.

Interest in holistic health care has increased the use of alternative/complementary therapies. We must consider the whole individual and recognize that the health of each part has an effect on the person’s total health status. Skilled practitioners, rituals, and specialized practices are a part of the therapy. Many therapies are based on cultural values or beliefs.

AYURVEDAAyurvedic practioners:Use an ancient philosophy, Ayurveda, developed in INDIA to determine a person’s predominant body type (dosha).

Prescribe diet, herbal treatment, exercise, yoga, massage, minerals, and living practices to restore and maintain harmony in the body.

CHINESE MEDICINEChinese medicine practioners:Use an ancient holistic-based healing practice based on the belief that a life energy (CHI) flows through every living person in an invisible system of meridians (pathways) to link the organs together and connect them to the external environment or universe.

Use acupuncture, acupressure, tai chi, and herbal remedies to maintain the proper flow of energy and promote health.

CHIROPRACTIC CAREChiropractors:Believe that the brain sends vital energy to all body parts through nerves in the spinal cord.

Misalignment of the vertebrae (bones) places pressure on spinal nerves, which results in disease and pain.

Use spinal manipulation, massage, and exercise to adjust the position of the vertebrae and restore the flow of energy.

HOMEOPATHYHomeopaths:Believe in the ability of the body to heal itself through the actions of the immune system

Use minute diluted doses of drugs made from plant, animal, and mineral substances to cause symptoms similar to the disease and activate the immune system.

HYPNOTISM

Hypnotists:Help an individual obtain a trancelike state with the belief that the person will be receptive to verbal suggestions and able to make a desired behavior change.

NATUROPATHY

Naturopaths:Use only natural therapies such as fasting, special diets, lifestyle changes, and supportive approaches to promote healing.

Avoid the use of surgery or medicinal agents to treat disease.

CAM: MOST THERAPIES ARE NONINVASIVE AND HOLISTIC

Often less expensive than traditional western therapies

It is essential to learn the legal requirements of your state regarding the different types of CAM.

Patient’s have the right to choose their own type of care.

Caregiver’s should be

NON JUDGEMENTAL!

As more patient’s choose CAM, it is increasingly important for health care providers to become aware of and understand those types of treatment.

SUMMARIZE

Define alternative therapy.Define complementary therapy.List and describe two types of alternative or complementary therapy.

NATIONAL HEALTH CARE PLAN

The high cost of health care and a large number of uninsured individuals has created a demand for a national health care plan.

Many types of plans have been proposed. Four such plans are as follows: One plan involves Nationalized medicine (government would pay for all health care

services and levy taxes to pay for them) The second plan involves the creation of health care cooperatives that allow the

consumer to purchase health care at a lower cost. The third plan is based on Managed care and would require employers to provide

coverage with the federal government subsidizing insurance for the poor. The fourth plan allows each state to establish it’s own health care plan paid for by

employers, individuals, and/or government subsidies.

The main goal in health care reform is to ensure that all Americans can get health coverage.

PROBLEMS WITH A NATIONAL HEALTH CARE PLAN

Cost of creatingFact that those with insurance may pay more to cover uninsured individuals

Lack of free choice to consumers in choosing their own health care providers

Regulations will have to be created to establish a national health care system

ARE WE SEEING THE DEVELOPMENT OF A NATIONAL HEALTH CARE PLAN IN THE

US NOW???What is it called?How will it affect us? Is it a good thing or a bad thing? Is it important to all of us to know what is happening with the development of our national health care plan?

What impact do you think it will have on health care in our nation?