Health Care Trends Flashcards
Scientific Management : Early 1900’s
Grew out of industrial revolution Time & Motion Studies Worker Efficiency (productivity) Monetary motivation Process efficiency (cost of therapist vs therapy aids)
Human Relations Movement
Studies of work environment
-increase productivity -> lighting & physical condition changes? vs. social relationship?
Maslow’s hierarchy of needs
Lack of empirical research that work productivity and job satisfaction were strongly correlated
Behavioral Science Movement (1950’s)
Worked to understand work performance and to study human behavior in organizations
- redesign routine jobs to allow a broarder range of roles
- be aware of informal groups and culture of an organization
Groupthink
Difficulty w/ autonomus decision making
Pareto Principle
20% of what happens in clinic produces 80% of the work.
i.e. nurture long standing relationships w/ physicians who refer to you, you can expand on that realtionship
Peter Principle
Next in line gets the job even if they may not be the most qualified
Systems Approach
looking at whole and parts : internal & external
Contingency Approach
Applying best available info to current situation
Learning Organization
Democracy style
Focuses on evolution of an orginization and values transparency, communication, and less hierarchal activity
Works best when everyone is a professional
Medical Model
Short term
Includes history, and physical, Dx, and tx to alliviate or cure an underlying medical condition
Educational Model
Services are aimed at adaptation and performance w/in the educational setting
Public Health Model
Achieve health or populations through
- prevention of disease: eating nutritious foods to prevent obesity and other related diseases
- slow progress of disease: to prevent disability and complications (secondary prevention)
- tertiary prevention used in advance levels of disease to limit disability and other complications
Social Model
Longer term maintenance and episodic restorative services (health promotion and prevention of further decline)
- clients w/ stable health conditions at risk from social isolation, reduced family support
- focus is on social barriers to prevention
OT Practice Settings Medical Model
Acute hospital (medical or psych) Acute rehab Subacute rehab Home health Nursing home Free standing out pt. or out pt. at a hospital Private physician office
OT practice Settings Public Health Model
Community Education -health insurance company -Public health agency (CDC, APHA) -Private industry Research -National institute for health
OT Practice Settings Educational Model
School system Pre school Day Care EI home health EI out pt. clinic
OT Practice Setting Community Model
Senior center Group home , I living center Retirement center Sheltered workshop Prevocational programs Community mental health center
United States Health Care Now
1st in health care spending
37th in overall health care performance
Challenges in US health care
Rising costs
Emphasis on outcome and accountability
Lack of services to meet specific needs
Imbalance in services available to different populations
Frequent advances in medical terminology
Increase government and public scrutiny of industry practices
FDR “Right to Health”
Ethical responsibility of an industrialized nation
FDR 1930’s
Creation of the first insurance company
-Blue cross & blue shield
FDR 1944 : Roosevelt’s Economic Bill
Set forth fundamental social and political rights part of which was the right to health
Health insurance became an employee benefit
Hill Burton Act (1946)
Promotes building of hospitals and later free-standing health facilities and later control over-growth and duplication of services (in 70’s & 80’s)
1950’s Funds For
Encouraging more schools and training of medical personnel
1965 National Insurance Established
Medicare (elderly) Medicaid (poor) Based on FFS initially -Fee for service -80/20 w/ no limit to costs
1972: Amendment to the Social Security ACT
Drove focus toward professional standards review to monitor and control costs and quality
!966 Allied Health Professional & Personnel Training ACT
Grant funding to establish schools
1970’s & 80’s Laws Changed d/t spiraling costs of FFS
Established Managed Care
- integrated delivery system between payor (insurance company) & care provider (physician or hospital)
- Intention to reduce spiraling costs
HMO = health maintenance organization PPO = preferred provider orginization POS = Point of service
1983 Amendment to Social Security Act
Focused on change to in pt. hospital care costs
Due to rising costs w/ new technology (ordered things like MRI’s that people didnt need to drive up the cost)
Many community hospitals closed
1986 PPS
Prospective Payment System
Medicare began to look at controlling costs
Predetermined rate is set for tx of specific illnesses in the hospital setting
Hospitals now paid for care based on DRG’s
Diagnostic Related Groups
-Also known as the product being provided
-467 categories initally
Closely linked to the patients ICD = international Statistical Classification of Diseasses
-in pt. psych issues
80’s Prospective Payment System
Pushed for less emphasis on hospitalization… incentive to move pt.’s out of hospitals fast as possible encourage expansion of community services
1986 Legislation
Expanded coverage of out pt. and rehab based OT services by expanding funding for medicare part B
-Medicare part A : in pt
-Part B : Supplementaty medical insurances
Includes OT services furnished in a SNF, rehab agency, public health agency, or by an I practicing therapist
1993 Clinton health care plan
Failed to Pass
Universal Health care through a national plan
-blocked by lobbyists representing AMA and private health insurance companies
1997 State Childrens Health Insurance
Program based on H Clinton
Program to cover uninsured children in families w/ too high income to qualify for medicare
1996 HIPPA
Health Insurance Portability and Accountability Act
- Assures insurance coverage during time of employment change
- Gives small businesses insurance options
- Protects patients privacy rights regarding their medical record
1997 IDEA
Mandates service delivery in the school system
Part B mandates services to 3-5 year preschool
Part C mandates services for 0-3 years
2003 Bush Ea\ra
Medicare prescription drug act (Part D)
HSA - Health savings account
2006 Massachusetts
1st state to require all adult residence purchase health insurance or face legal consequences
2008 HIPPA
Passed in 1996 but not really enacted until 2008 amendment
- gave more specific language to assure follow through
- added Mental Health Parity and Addiction Equity Act (MHPA)
2010 ACA -> Obamacare
Patient protection and affordable care act
- signed into lay March 2010
- goal of full enactment by 2017
- Requires most US citizens and legal immigrants to have healthcare coverage
Primary Practice Settings
61% Medical 27% Schools & EI 5% Academia 3% Mental Health 4% Other
OT’s in Practice Areas : Increase
General hospital neonate intensive care
EI centers
Psychiatric units of general hospitals
Rehab units in hospitals and nursing homes
OT’s in Practice Areas : Decrease
Community mental health & psych hospitals
Voc & pre-vocational programs
Rehab hospitals
