Chapter 11 The Health Care System Flashcards
who governed by; who benefits; how get it; special indications about it
Private/public:
Private and pub sys in US - diff than other countries
Private:
Public:
In US End up paying more than healthcare coverage than any other nation; voted on sys and how is and voting on hwo things run and what is covered
No single nationwide sys for healthcare coverage in US - no universal healthcare in country
Medicare not for all - not single payer healthcare sys in US and have be US citizen
Consists of private and public subsystems; private: consists of personal care services from various sources including nonprofit, for profit, volunteer agencies, focus on the individual; focus in public on pops and prevention of disease and illness divided in fed, state, and local programs
Not always mutually exclusive subsystems and functions sometimes overlap
Pub health nursing requires an understanding of the mission, organization, and role of the pub and private healthcare subsys and context in which they func to effectively collab with healthcare sys and with providers to meet healthcare goals
U.S. health care sys
focuses on individual; profit and nonprofit entities: some hospitals that are for profit: big company throughout US and when make money distribute how please; nonprofit: make money but any money made for most part put back into facility and people
Private:
focuses on populations: focuses on all people in US - fed programs; state programs - people in their state; local - assist the state by covering and giving services to people in a certain area; money from fed, state, local entities; funding and regulations are talking about the fed; states: do have some freedom - dictates what pieces of Medicaid implement: implement more/less: some have more options or less because more options for those who have private healthcare insurance
Public:
Most personal healthcare services provided in this sector; services include: health promotion, protection, early detection of disease, diagnosis and treatment of disease and cure, rehab and restorative care and custodial care; provided in clinics, physician offices, hospitals, hospital ambulatory centers, skilled care facilities and homes
Focus on the individual - hospitals, doc offices
Nonprofit and for-profit agencies
Models of services from HCP
APRN, NP, PA assuming primary prac roles in variety of settings
Voluntary or nonofficial agencies: nongovernmental/nonprofit entities who support health care provision and sometimes direct services; EX: AHA; many professional organizations like AMA, ANA, american Hospital association, american public health association sig role in advocacy and providing professional expertise
Private health care subsys
Matters because depending on Group prac - might be on own and physicians paid diff than if attached to hospital - hospital paid physicians on care
Solo practice:
Single specialty group practice:
Multispecialty group practice:
Integrated health maintenance model:
Community health center:
Models of services from HCP
Mandated by the U.S. Constitution - not explicitly addressing health/healthcare; fed government required to promote gen welfare; countries law makers and leaders required take care of citizens of US; Medicare and Medicaid - need have it because Constitution - not dictate level cover citizens, what has be offered, or levels to who; just have be taken care of
Required by law to address the health of populations by “promoting the general welfare of its citizens”
Federal policies and practices influence local and state governments in meeting health and social probs - fed is big umbrella that make all rules and regulations
Many laws enacted to respond to changing healthcare needs and concerns of pop
1979 fed health agency divided into dept of edu and HHS
Coordination of services under Department of Health and Human Services (HHS), currently second largest department of the federal government - HHS ringlead everything to make sure communicated to state and local govts so everything running as should
States use that and have ability run as should - decisions to do as want in stated
Fed - funded by fed govt
State - funded by state taxes and fed
Funding: fed and state level: talking about taxes; somethings paying for
Public health subsys Concerned with the health of the population and a healthy environment - scope of pub health: broad and encompasses activities that promote good health
Organized in fed, state, local levels to establish laws, rules, and regulations to protect public and more effectively provide services to those who are unable to obtain healthcare without assistance
Pub health care sys
States responsible for health of citizens and central authorities in pub healthcare sys; organizations and activities vary among states
Health commissioner/secretary of health appointed by the govener and directs most health agencies for state; health officer has degree and experience in pub health; in some states officer directs health department of state
US requires integrated sys fed and state levels work to benefit of all citizens so state govt highly dependent on fed level for resources and guidance
Funds attributed to medicaid (jointly funded by fed government and states) changed lot overtime and varies with respect to beneficiaries and services covered by each state; major impact on services states can provide to most vulnerable citizens; measured provisions of ACA: resulted in large numbers of US citizens receiving healthcare coverage through expansion of medicaid; each state allowed determine what implement: responsible for own pub healthcare laws
Most health-related activities are implemented and administered by the U.S. Department of Health and Human Services (HHS) - things available at hospital and state know some items dictated by fed level, not know until get into politics
Many federal agencies perform activities related to health:
Targets general population, special populations (young children), and some degree international health - not look at the specific indiv
Fed-level subsys
US Centers for Disease Control and Prevention (CDC)
US Public Health Service (USPHS)
Health Resources and Services Administration (HRSA)
National Institutes of Health (NIH)
Centers for Medicare and Medicaid Services (CMS)
Food and Drug Administration (FDA)
Environmental Protection Agency (EPA)
US Department of Agriculture (USDA)
Many others
Many federal agencies perform activities related to health:
States are responsible for the health of their citizens within area and central authorities in pub healthcare sys - within their state
Organizations and activities vary widely among the states - some health depts great and some not and have a lot depts/have none
Highly Dependent on fed level for funding and guidance: meaning rules have follow
Medicare gen driven by fed level
Medicaid gen driven by state - funded by fed and state level
States responsible for own pub health laws - make own laws and policies based on how voters wanted to go at the time
Health commissioner or secretary of health appointed by the governor and directs most health agencies in state
US requires integrated sys so fed and state levels work together to benefit all citizens; state health depts Highly dependent on the federal level for resources and guidance
Major provisions of ACA resulted in number US receiving healthcare coverage through Medicaid expansion; each state allowed determine if use expansions and programs enact: Responsible for its own public health laws
State-level subsys
Health officer is usually a physician with a degree and experience in public health
In some states, the health officer directs the state health department
Health commissioner or secretary of health appointed by the governor and directs most health agencies in state
Example: funds attributed to Medicaid (jointly funded by the federal government and states) changed over time and vary in respect to beneficiaries and services covered by each state; major impact on services that states can provide to most vulnerable citizens
US requires integrated sys so fed and state levels work together to benefit all citizens; state health depts Highly dependent on the federal level for resources and guidance
Gen Responsible for the direct delivery of public health services and protection of the health of citizens
Dependent on state and fed dollars and donations; not directly make money by self
Deliver care under guidance of fed, state govt to people in one area
Not in every community
Care on state guidance
Local health departments
Organization varies widely depending on community size, economics, and partnerships with the private health care system, as well as health care facilities business support, health care needs, transportation, and the number of citizens requiring public health care
Health officer or administrator appointed by local government directs local health dept subsys
Professional staff members: public health nurses (largest group staff members), health inspectors (largest group staff members), dentists, social workers, epidemiologists, nutritionists, health educators - interdisciplinary team carries out dept
Services fall into the following four major categories:
Local health dept subsys
Not in every community/county - not all have place go to address certain health issues
Local health departments
Half of the states require that the health officer have a medical degree
Health officer or administrator appointed by local government directs local health dept subsys
