organization of health care delivery in the us - ambulatory and primary care Flashcards
1
Q
Characteristics of the U.S. Health Care System
A
- Huge, complex system
- No central governing agency
- Little integration and coordination
- Technology-driven, acute care focus
- High cost, low outcomes
- Private sector more prominent
2
Q
Factors Influencing Health Care Systems
A
- Political climate
- Economic development
- Technological advancement
- Social and cultural values
- Physical environment
- Population characteristics (demographics, health trends)
3
Q
Philosophical Basis
A
- Market justice + social justice
- Access for those who cannot afford
- Multiple players (Medicare, Medicaid, private insurance)
- Unequal access
- High legal risks influencing providers
4
Q
Ambulatory/Outpatient Health Care Services
A
- Ambulatory = outpatient (no overnight stay)
- Includes:
- Diagnostic procedures
- Consultations
- Treatment
- Preventive care
- Interventions/procedures
- Rehabilitative services
5
Q
Growth of Ambulatory Care Services
A
- Managed care’s focus on quality and cost containment
- Medicare’s Prospective Payment System led to shift to ambulatory care
6
Q
Role of Ambulatory Care Services
A
- First point of entry, primary health care functions
- Provides referrals and care coordination
- Mandated by EMTALA to provide emergency care
- Reduces overall health care costs unless inpatient care is needed
7
Q
Ambulatory Health Care Providers
A
- Physicians (general/family, solo/group practices)
- Dentists
- Optometrists
- Physician Assistants
- Nurse Practitioners
- Midwives
- Social Workers
- Pharmacists
8
Q
Facilities Providing Ambulatory Health Care Services
A
- Teaching/community hospital outpatient clinics
- Hospital emergency departments (EMTALA compliance)
- Ambulatory Surgical Centers
- Diagnostic/Imaging Centers
- Specialty Centers
- Health Departments
- Community pharmacies
- Home Intravenous Services
- Home Care Services
- Women’s Health Centers
- Mobile Clinics/Stations
- Free clinics/voluntary agencies
- School and prison health services
9
Q
Outpatient-Related Ambulatory Services
A
- Clinics (general or disease-specific)
- Pharmacotherapy Services (anticoagulation, COPD, asthma, diabetes, hyperlipidemia, hypertension, pain management, MTM)
10
Q
Ambulatory Care Services in Community Pharmacies
A
- Independent, chain, supermarket pharmacies
- Mini-clinics (e.g., Walmart)
- Optometric services
- MTM
- Health promotion and disease prevention
- Prescription services
- Special programs (e.g., Walmart $4 Prescription Program)
11
Q
Emergency Services
A
- Hospital ED (non-urgent, urgent, emergent)
- Emergency Medical Services (EMS)
- Emergi-centers (24/7)
- Urgi-centers (12 hrs/day)
12
Q
Problems in the Emergency Room
A
- Overcrowding
- Long waiting times
- Patient dumping/diversions
- Risk of hospital-acquired diseases
- Unnecessary loss of lives
13
Q
Problems in the Ambulatory Care Setting
A
- Lack of coordination between providers
- Polypharmacy
- Untreated indications
- Lack of integration with public health
14
Q
Ambulatory Care vs. Primary Health Care
A
- Ambulatory care = outpatient care
- Primary health care = first level of care
- Primary care integrates with public health
15
Q
Primary Health Care Providers in the U.S.
A
- Primary care physicians
- Family Medicine/General Practitioners
- Nurse Practitioners (general/specialists)
- Physician Assistants
- Registered Nurses
- Pharmacists
