Smaller Sections Flashcards
Outpatient care services
Outpatient services: Any health care service that does not require an overnight stay in a health care institution.
More than primary care services by a primary care provider
Who are primary care providers? They see patients in an outpatient setting & can be:
Pediatricians
Family medicine doctors
General practitioners
Internists
Not all outpatient care is primary care.
Outpatient care and ambulatory care are used interchangeably.
Remember, hospitals offer outpatient services, too. They had to transition to offering more outpatient services to make up for losses from the prospective payment system from CMS and the lower hospitalization rates resulting from managed care plans.
The benefits of primary care
Increase access, reduce costs, and improve quality
The number of primary care providers (PCP) in relation to the population is related to reduced health care costs
There are better health outcomes when a PCP coordinates a patient’s care and better self-reported health by patients
States with more primary care providers have:
Fewer emergency department visits
Fewer days in the hospital
Lower total healthcare expenditures
Lower death rates
Less smoking
Lower obesity rates
Higher usage of seat belts
Hospital requirements
Hospital: An institution with at least six beds, that delivers diagnostic and therapeutic services for medical conditions.
Hospitals offer inpatient (overnight stay) & outpatient services.
Majority of hospitals are private nonprofit
In the U.S., hospitals must:
Be licensed
Have an organized physical staff
Provide continuous nursing service with registered nurses (R.N.s)
Have a governing body that is responsible for hospital conduct
Maintain medical records on each patient
Have pharmacy services and provide food to meet patients’ needs
Have a Chief Executive Officer (CEO) responsible for operations
For hospitals to have non-profit status, they must not give profits to sole individual, and they must provide a social, community, or educational good to the community.
Access and Utilization Measures:
Average length of stay (ALOS) in the United States is 4.8 days.
Sharp declines in ALOS became possible with the growth of alternative services (home health, subacute long-term care).
No evidence that quicker discharge from hospitals harms patients.
Long-Term Care Services/Supports
The largest share of Millennials and younger (Gen Z and younger) are racial and ethnic minorities.
The most common age for whites is 58 years of age.
Black, Indigenous and other people of color will be the workforce that subsidizes future Social Security, Medicare and Medicaid for older, White adults.
As of 2021, all salaried income up to $142,800 is taxed for Social Security
MOSTLY MEDICAID! We pay for it with our tax dollars.
LTCSS are primarily financed by:
Medicaid (MOSTLY)
Medicare
Private funds
Yes, we have an aging population which creates demand for long-term care services and supports!
LTCSS refer to a set of health and social services delivered over a sustained period to people who have lost some capacity for personal care.
LTCSS are organized as:
Institutional Care (skilled nursing facilities, assisted living facilities)
Community-based Services & Supports
Informal care (friends/family)
Formal care (home/personal care aide, nurse)
KNOW Activities of Daily Living (ADLs)
The U.S. is projected to spend 14.9% of its GDP on LTCSS by 2050
Race, Class, & Gender in LTCSS: Providers
Formal Care is given by healthcare professionals and paraprofessionals
Community-based services (e.g., home care, adult day care, meals, transportation)
Much formal care from home care aides is provided by immigrant women of color (40% of all LTCSS personnel)
Home care and personal care aides earn minimum wage, often need to serve multiple clients to have enough hours to live, without travel compensation.
Over 48,000 work-related injuries and illnesses are reported to the federal government are from home care workers (Delp et al., 2010); they also lack sick leave, insurance and were not protected in the CARES Act 2020 or the FFCRA 2020.
Informal Care is unpaid labor by family, friends and neighbors
Health care workforce
NURSES
Largest number of healthcare professionals in the U.S.
CNAs
RNs (AA or BS)
LPN/LVN
APN
NPs
CRNAs
CNM
CNS
Post WWII the U.S. Government gave funding to increase nurse workforce: Nursing Training Act, 1964/1971 and Health Manpower Act 1968
Is there a nursing shortage? There is a lot of turnover due to little job satisfaction, mobility, & wage growth
PRIMARY CARE PHYSICIANS
The racial-ethnic makeup of the primary care physicians does not reflect US at large
