Midterm Flashcards
Private Sector Involvement in Health Services
Government Involvement in Health services
Which is most/lest
Entreprenuerial–most private
welfare
comprehensive
socialist
communist–most government
Canada
- –Type of system
- gov vs private
- who delivers service
- funding
- access
- problem
- Welfare
- extensive governmental control–access to quality health service
- service delivery in private hands
- Fund: tax, some out of pocket
- Access: Universal
- Problem: waiting lists
Government more than private
UK
- –Type of system
- gov vs private
- who delivers service
- funding
- access
- problem
- Comprehensive
- central government control
- local government arranges comprehensive care
- funding: TAXES–single payer
- access: UNIVERSAL
- problem: financial shortfalls
Government more than private
Germany
- –Type of system
- gov vs private
- who delivers service
- funding
- access
- problem
- Socialist
- DECENTRALIZED (more private)
- state and federal government regulated
- universal access via private insurance funds
currently private insurance is growing
Government more than private
Communist
- –Type of system
- gov vs private
- who delivers service
- funding
- access
- problem
communist
government total control
universal access but service unequal
government more than private
NO LONGER EXISTS
US
- –Type of system
- gov vs private
- who delivers service
- funding
- access
- problem
- Entrepreneurial
- DECENTRALIZED
- -large private non governmental component, smaller central government control - Private service delivery
- Selected tax funded beneficiaries (payroll, state/federal revenue), private programs
- Access income related
Private more than government
Which country?
Welfare
Canada
Which country?
Comprehensive
UK
Which country?
Socialist
Germany
Which country?
Communist
former soviet union
Which country?
Entrepreneurial
US
US Healthcare system: how diff than the world?
4
- Fed gov not responsible for health service planning (Dept of Health and Human Services only for ppl who cannot care for themselves)
- Most expenditure/person for healthcare in the US
- Not universal healthcare, public pay less of total than in other nations
- Multi-payer system: lead to inefficiencies
concerns with universal health services?
5
- How to ensure access
- cost
- quality
- quantity
- Efficiency
EU- The European Union –
improvement of social, economical and political strength
improves its members social, economic and political strength–wants to see promotion of its members
How much of GDP does the US spend on healthcare?
15.2% (but less paid for by government because more from private pay)
Gross domestic product (GDP) is the total value of all domestically produced goods and services. Its like the nation’s total wealth.
US has a federalist form of government,
what does this mean?
Separation in authority of local, state, and the federal government and favors decentralization of health services
(system of government in which sovereignty is constitutionally divided between a central governing authority and constituent political units (ie: states)
Capitalism
3
Economic philosophy: supports market orientation
- Free Market Economy
- Competition (control prices)
- reward indvs success–>benefit society as a whole
How the US healthcare system became so different:
These economic, political, and orientation factors allowed for the development of the US. Entrepreneurial health care system
The public portion of the system to those who were most needy
The private portion to those who could afford to pay for services themselves
What led to the funding gap?
- -1980 to 1985 health care cost increased (more in 1990)
- -Shift to low paying service sector jobs
–>Increased # of individuals without health insurance
thus->Providers shift costsfrom uninsured/underinsured to COORPERATE and GOVERNMENTAL payers who could pay
–businesses now had high costs for benefits, government unable to meet demands with federal deficit
What is the funding gap?
Rising Healthcare Costs
Decrease Salaries from lower paying jobs
increase number of uninsured and underinsured americans
Government and Private Industry Response to rising costs of healthcare :
Early 1980s
MEDICARE: fixed payment system for inpatient hospitalizations
PRIVATE businesses: managed care
What is the fixed payment system Medicare adopted in the early 1980s?
Medicare determine amount to pay for the service
–issue: clinicians using low cost treatments so then government said it would take back 10% if return in 30 days
What is the managed care system private business adopted in the early 1980s?
PCP refer to specialist –hopefully only for needed use
Healthcare system changes:
now
(4)
- Structural changes (i.e. Medicare, Medicaid, and private payers)
- Facility and “brick and mortar changes”(from hospital to ambulatory)
- Work force composition changes (less highly qualified staff- Physician’s Assistants, Nurse Practitioner’s, increase use of technology)
- Procedure changes in regards to health care delivery
( ie REDUCE LOS)
What we need to do in this healthcare system:
5
- understand the changes
- flexible, willing to try to understand what impact the changes in health care will have on your practice
- Success in health care today requires common sense, clinical and technical skills, as well as basic understanding of business and managerial skills .
- Understand your role in the health care delivery system, perfect your craft, and contribute as needed validating your role, and adding value to the system.
- Leadership skills are essential and creates opportunities for improvement and innovation.
Physical therapists are well suited to be leaders of change in the American health care industry and will continue to be called upon to in the future to champion such change
Direct service delivery
examples
Hospitals, home care agencies, public health departments, physicians, nurses, physical and occupational therapists
Indirect service delivery
examples
I.e.. Pharmaceutical company, medical equipment manufacturer, medical researcher, medical waste disposal company
3 ways to classify providers:
1) Type of care provided (preventative, primary, specialty)
2) Type of setting (acute, home health, subacute)
3) Patient care process of continuum of care (acute hospital–> homecare –> outpatient)
Preventative Care
what is it?
Routine health care
–check-ups, patient counseling and screenings to prevent illness, disease and other health-related problems
cheaper than corrective care
How does ACA address preventative care?
March 23, 2010 most plans
required to cover a set of preventive services at NO COST to the subscriber
(no copayment or coinsurance or their deductible)
Adults, women, children (after September 23, 2010)
Primary Care
what does it include?
Primary care is often the INITIAL POINT OF CONTACT within the healthcare delivery system
primary care health providers have DIRECT ACCESS to pt
Health promotion
Disease prevention
Health maintenance
Counseling
Patient education
Diagnosis and treatment of acute and chronic illnesses in a variety of health care settings
(e.g. office, inpatient, critical care, long-term care, home care, day care, etc.)
Does primary care have to be through physician?
No
Besides general practice physicians, the role of primary care providers have been extended to others
E.g. Geriatricians, Pulmonologists, Physiatrists, all can provide primary care in addition to their specialty practice
Non-physician providers with advanced practice can also provide primary care
I.e. Advance practice Nurses, Social works, Physical Therapists
Can PT be primary care?
YES
APTA new vision statement:
In 2013, APTA’s Vision Statement for the Physical Therapy Profession is supported by Guiding Principles to Achieve the Vision, which demonstrate how the profession and society will look when the vision is achieved
“Transforming society by optimizing movement to improve the human experience”
Specialty Care
What is it?
Provides for services, equipment, and facilities NOT offered at the primary care level
Includes specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment.
ie
- Specialized medical management
- Diagnostic laboratories
- Imaging
- Surgical and rehabilitative services (PT, OT, Speech)
- Sports medicine
- Day care
- Hospice
- Respite
- Substance abuse services
How can a PT deliver al types of care? (3 care types)
Preventative care- education on falls and back injury prevention)
Primary care – Evaluation of patients who are high risk for falls and/or back injury
Specialty Care- Treatment of patients with balance/vestibular dysfunction or acute lower back pain
Type of settings
What are the 3 types to categorize healthcare?
1) Ambulatory (outpatient) care
2) Inpatient care
3) Homecare
Ambulatory Care
what is it
able to arrive and depart from the care setting on the day of service
-outpatient basis
can be preventative, primary, specialty
ie rehab day programs
Inpatient Care
what is it
administered to a patient who remains in a hospital setting
(acute, post acute, skilled nursing facility)
Acute Care:There are two levels of service provision
- Secondary care
- Tertiary care
also Post acute inpatient care
Acute Care:There are two levels of service provision
- Secondary Care
- Tertiary Care
also Post acute inpatient care
Acute Care:There are two levels of service provision
- Secondary care
- Tertiary care
What is secondary care?
GENERALLY NOT HAVE FIRST CONTACT WITH PATIENTS
medical specialists / other health professionals who generally do not have first contact with patients
ie Diagnostic laboratories General and routine surgical services Women’s health services Inpatient rehabilitation
Acute Care:There are two levels of service provision
- Secondary care
- Tertiary care
What is tertiary care?
specialized consultative health care, typically on referral from a PRIMARY or SECONDARY HEALTH PROFESSIONAL
Typically occur in a facility that has personnel and facilities for advanced medical investigation and treatment
Offer a HIGHER LEVEL OF CARE
Post acute inpatient care
what is it
Pt continue to need skilled level of inpatient care but who DO NOT require the INTENSITY or VARIETY of services available in the secondary or tertiary acute care setting
ie
- -Surgical recovery centers
- -Long term rehabilitation centers (L.T.A.C’s)
- -Long term care hospitals
- -Skilled nursing facilities
- -Inpatient hospice facilities
Home Care
what is it
within the home setting
The fastest growing segment of the healthcare delivery system.
growing for PT, but a lot of paperwork
Continuum of Care
providing a diversity of services in a variety of settings to:
1) provide pt better ACCESS to a variety of specialized care needed throughout the recovery process.
2) Improve the COST EFFICIENCY - matching the resources used with care required
–>these support ambulatory and home based
services along continuum should be smooth and progressive, pt should transition between services settings without problems
–> Often transitions are not coordinated and difficult for patients to navigate