The Health Care Delivery System

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The Health Care Delivery System

• Prof. Chinazo Echezona-Johnson
• RNC, MSN, LL.B

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OBJECTIVES

• By the end of this session students will be able
  to
• Explain the concept of primary care
• Identify examples of secondary and tertiary care
• Explain the concept of preventive health care
• Identify two types of settings in which health
  care services are provided
• Define the difference between primary, secondary
  and tertiary health care
• Compare and contrast the two methods of financing
  health care

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INTRODUCTION
The U.S. Health Care Delivery System is large
and complex. The term health care delivery
systems refers to the processes that enable
people to receive health care and the provision
of health care services to patients by all health
disciplines

• With the awareness of health promotion and
  disease prevention,
• the rising cost of health care and improved
  quality outcomes, the focus of the health care
  industry is to manage the health of a community
  and not to manage illnesses.

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HEALTH CARE SETTINGS

• Health care providers offer their services in six
  different levels of care
• Primary
• Preventive
• Secondary
• Tertiary
• Restorative and
• Continuing care

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PRIMARY CARE

• Primary care is the medical care a patient
  receives upon first contact with the health care
  system, before referral elsewhere within the
  health care system.
• It focuses on health services provided to
  individuals

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SECONDARY TERTIARY CARE

• Also referred to as acute care (now overlapping)
• Secondary
• At the secondary level the patient usually comes
  under the care of a specialist, often in an
  emergency room setting, acute medical-surgical
  site or in a radiological procedure setting
• Secondary level specialties include such
  well-known areas of medicine as obstetrics and
  gynecology, dermatology, otolaryngology, and
  cardiology.

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TERTIARY

• At the tertiary care level, the patient receives
  highly specialized, high-technology care and
  treatment. The settings may include intensive
  care or sub-acute care units
• Complex programs and unusual procedures, among
  them open heart surgery, heart or kidney
  transplantation, and neurological surgery, are
  provided.

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TERTIARY

• These are the most costly levels of care. This
  is changing with the arrival of advance
  technology and managed care. Simple procedures
  are performed in the office instead of the
  hospital. Overhead cost is lowered.

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PREVENTIVE CARE

• Preventive care refers to measures taken to
  prevent diseases.
• Achieved through immunizations and identifying
  risk factors for illnesses (e.g.. cardiovascular
  disease (blood pressure screening, mental health
  counseling, community legislations seat belts,
  air bags)

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RESTORATIVE CARE

• Is a planned systematic program that focuses on
  helping each client regain and maintain the
  highest level of function
• It also focuses on enhancing the quality of life
  through the promotion of independence and
  self-care
• E.g.. Home care, spinal cord injury programs

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CONTINUING CARE

• Focuses on health, personal and social services
  provided over a prolonged period of time
• Typical patients are disabled, suffer terminal
  diseases and are unable to function independently
• E.g. Care provided to nursing home patients
• The need for continuing care is increasing in the
  US as people live longer and the number of
  children caring for aging parents decline

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DELIVERY SYSTEMHealth Care Agencies

• Health care agencies can be categorized as
• -inpatient or outpatient
• -institutional or community
• Example hospitals - inpatient services
• physicians office or ambulatory care center
• offer outpatient service, nursing centers offer
  institutional services

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HEALTH CARE SETTINGS

• Settings for health care have shifted from the
  traditional hospital to community based settings
• Changes in health care buine have occurred
  primarily because of
• Rising Consumerism the publics desire to
  participate more actively in the decision-making
  process
• More informed and assert their rights
• Expect and demand involvement in healthcare
  decisions
• New technology - internet

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HEALTH CARE SETTINGS

• Clients seeking health care have a tremendous
  array of settings to chose from
• Hospitals, psychiatric facilities, restorative
  care, home care, rehab centers, extended care,
  nursing homes, assisted living, respite care,
  adult care, hospice

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HOSPITALS

• Provide secondary and tertiary levels of care
• for the acutely ill patients in need of
  comprehensive and specialized health care
• number of days are limited based on DRG
  (Diagnosis-related Group)
• Hospitals are reimbursed a pre-determined
  amount based on diagnosis
• Discharge planning begins upon admission
• Scheduled discharge achieved following a
  critical pathway of multidisciplinary treatment
  plan

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PSYCHIATRIC FACILITIES

• Specialized centers for clients suffering from
  behavioral problems (combative, acting-out)
• Inpatient or outpatient
• Entry may be voluntary or involuntary
• Short stay

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RESTORATIVE CARE FACILITIES

• Focus is on early collaboration with client and
  family
• Restoration of previous levels of function or
• To reach a new level of function depending on
  illness or disability
• Examples TBI, Spinal cord injury

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HOME CARE

• Purpose promoting, maintaining and restoring
  health
• Services are planned, coordinated
• Focus is on client and family
• Early hospital discharge has made home care an
  essential aspect of the health care delivery
  system
• Scope of service has broadened to include both
  acute, short-term, long-term monitoring of
  problems associated with chronic illnesses

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HOME CARE

• Services provided
• Wound care (irrigation, packing, debridement)
• Respiratory care (vent, oxygen, trach care)
• Vital signs
• Elimination (ostomies, PD, catheters)
• Nutrition
• Rehabilitation
• Medications
• Laboratory studies (FS)

• Provision of professional and paraprofessional
  services and equipment to patients and families
  in their home.

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HOME CARE REIMBURSEMENT

• Agencies receive governmental reimbursement
• Types of reimbursement include
• Medicare, Medicaid, private insurance and private
  pay

• Medicare Government funded insurance coverage
  for 65yrs and older who meet the criteria
• Medicaid Federal and State funded, managed by
  the State
• Given to low income, low resources families

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EXTENDED CARE

• Encompass intermediate or skilled nursing care
• Clients receive extensive supportive care until
  they are able to return home or back to the
  community
• Caters to clients of all ages recovering from
  acute illness and with chronic illness and
  disabilities (brain, spinal cord injury)
• Medical conditions that cause someone to be
  unable to bathe, dress, or toilet independently
  will often result in a need for an extended care
  facility.
• E.g.. Townhouse Extended Care Facility

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EXTENDED CARE

• Despite its name, the extended-care facility
  provides short-term inpatient care.
• This type of facility is designed mainly to aid
  patients who have been hospitalized but no
  longer need the full complement of hospital
  services.
• Such patients still require professional nursing
  and medical supervision.
• Typically attached to a hospital, the
  extended-care facility may also serve those who
  are not acutely ill but who require skilled care.
  
• Encompass intermediate and skilled nursing care
• Clients receive extensive supportive care until
  they are able to return home or back to the
  community

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NURSING CENTERS

• Formerly termed nursing homes provides 24hr
  intermediate care
• Nursing, rehab, dietary, social services are
  provided for residents with chronic, debilitating
  injuries
• Care is aimed at helping residents maintain their
  highest level of functioning

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OTHER DELIVERY SETTINGS

• Respite Care provides short-term, temporary
  relief to those who are caring for family members
  requiring permanent placement in a facility
  outside the home.
• Adult Day Care The goals of the programs are to
  delay or prevent institutionalization by
  providing alternative care, thereby reducing the
  cost of health care. Centers are designed to
  provide care and companionship for seniors who
  need assistance or supervision during the day.
• Hospice is a type of family-centered care which
  focuses on the palliation of a terminally ill
  patient's symptoms.

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SUMMARY

• Health care delivery system comprises a variety
  of agencies and many health care professionals
• Health care delivery services can be
  categorized as primary, secondary or tertiary
• Health care settings can be grouped by the
  type of service provided
• Some sources of funding are Medicare, Medicaid,
  private insurance and private pay

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• Questions