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Health Care Issues

Health Care Issues. Legislation, Trends, Challenges for Respiratory Therapy Students. Coin of the Realm. Life--is made up of Words Federal Register (20,689 pp as of 4/20/06) Congressional Record Presidential Proclamations Newsletters Radio & TV Talk Shows Internet, Blogs

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Health Care Issues

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  1. Health Care Issues Legislation, Trends, Challenges for Respiratory Therapy Students

  2. Coin of the Realm • Life--is made up of Words • Federal Register (20,689 pp as of 4/20/06) • Congressional Record • Presidential Proclamations • Newsletters • Radio & TV Talk Shows • Internet, Blogs • Congressional Hearings • Laws & Regulations

  3. Words Have Power • Words affect all of us: • Big Government • Health Reform • Patients’ Bill of Rights • Market Forces • Ownership Society • WMD

  4. Law Making In Theory • Words as Law affect us • In theory it is a simple process: • Bill Dropped in Hopper • Referred to Subcommittee/Committee • Hearings • Rules Committee Determinations • Floor • Conference • Floor

  5. Allied Health and Nursing • Allied Health Funding is through Title VII, a health improvement act, but limited to section 755 • Nursing has an entire act unto itself, Title VIII

  6. Allied Health Funding • From these major legislative grants (Laws), Allied Health professions receive: • Scholarships • Traineeships • Student Loans • Special Project Grants • Formula Grants • Construction Grants • Training Institute Grants

  7. THEN AND NOW 19662006 62 Senate Democrats 44 Senate Democrats 38 Senate Republicans 55 Senate Republicans 295 House Democrats 202 House Democrats 140 House Republicans 232 House Republicans Lyndon B. Johnson George W. Bush Congressional Seniority No Seniority More Receptive Climate Less Receptive Budget Surplus Budget Deficit

  8. How Do You Get What You Want? • Persuasion? • Influence? • Power?

  9. ALLIED HEALTH LEGISLATION IMPERATIVES • Workforce • Current Personnel Shortages • Student Enrollment Declines • Faculty Shortages • Demography • Aging of Population • Fastest Growth in Oldest Cohorts • Epidemiology • Chronic Conditions/Disability

  10. What Is Allied Health? • It’s NOT: Nursing, Physician Assistants, Public Health, Chiropractic, Health Administration, Clinical Psychology, Social Work, or Counseling

  11. Why Workforce Reform is Critical • 60-70% of health care is labor costs • Big part of any employment sector • It Limits access, spurs cost increases, and directly affects quality

  12. Broad Trends Affecting the Health Care Workforce: • Changing Demographics • Shifting Epidemiology • Economic Disparity and Cost • Technological Innovations • Change from supply to market driven health system

  13. Demography - Aging Issues • Impact on demand for health care • Rising cost of care • Adequate workforce • Intergenerational equity • Uneven across the nation

  14. Triple witching Aging workforce Fewer new workers Care demands and needs of an aging population …but, the devil in the details Demography - Aging

  15. Demography - Aging

  16. Epidemiology

  17. Changes in Cause of Death, 1900–1999

  18. Trend: Epidemiology Issues • Dominantly chronic • Expensively acute • Bipolar patterns of disease and health • Less and less to do with health care--more with lifestyle changes

  19. Trend Three:Economic Disparity&Cost

  20. Economic Disparity

  21. Economic Disparity Issues • Larger and larger number cannot afford health care • Incumbents in health care become wealthier • Health policy and markets driven to serve those that have rather than need • Impact back on patterns of health and outcomes

  22. Technology Next generation of technology promises to reduce cost, move care to ambulatory settings and improve outcomes. • Biomedical • Information Technology

  23. Technology - IT The Most Important Step is to Recognize that Health Care is a Knowledge Based Service Enterprise

  24. Knowledge Business • 33 Million admissions • 4.8 Billion claims • 505 Million outpatient visits • 1.7 Billion prescriptions filled

  25. Biomedical • US investment in basic and applied biomedical leads the world • Commercial investment now surpasses public investment marking transition to application

  26. Growing Private Research Base

  27. Market Driven HealthFrom Supply Based to Demand Driven Cost DEMAND Consumer Satisfaction Quality

  28. Market Pressures Health care has been based on the individual: • Encounters • Financing • Ethics • Relationships • Outcomes

  29. New challenge: How to balance the tradition of individualism with the needs of: • Population health • System outcomes • Broader social needs • Desire to balance equity and choice

  30. Consumer Issues • Wants choice ….but at what price? • Increasingly willing to buy value… quality, access and cost • Needs are more segmented then care systems acknowledge…build it and they will come • Inevitable exposure to more costs … will look for help to address

  31. From a majority culture... Demography - Diversity To diversity... To multicultural.

  32. Diverse to Multicultural

  33. Continued Disequilibrium in Health Care • Costs--Total system costs are a huge burden • Variation--Enormous range in definition of quality • Over/under supply of care providers, hospitals, insurers. • Duplication--Substitutable inputs • Access--+15% uninsured

  34. How Did This Emerge? Past • Constantly expanding health system • Little accountability - cost or quality Transition from simple and independent to complex and highly interdependent

  35. What is driving the issue? Stressed care delivery system and institutions • Tighter resources • Lack of direction • Greater demands • Technology • Quality • Job cuts • Uncertainty • Inability to adapt and change rapidly

  36. Changing nature of work • Faster • Flatter • Flexible • Changing demographics • Race/Ethnicity • Aging Population • New values • Women in labor market • Gen X workers

  37. Next Generation Worker Want: Service oriented Anti-institutional Not hierarchical Flexible, change welcoming Diversity Technology New skills Community of work Hospital Image Staff is on strike, laid-off, or Angels of Mercy Large, cold, unresponsive institutions Work is stressful, highly structured, and un-fun Tied to a professional career, not open to change New Values

  38. Problems • Scope(s) of practice • Professional Models • Both unimaginative, traditional, turf building or turf keeping

  39. Angels of Mercy? • The historical success of a profession rests fundamentally on the growth of its particular source of wealth and status—its authority. Acknowledged skills and cultural authority are to the professional classes what land and capital are to the propertied. They are the means of securing income and power. Paul Starr--The Social Transformation of American Medicine

  40. Hippocratic Oath • What is the first statement in this oath? • We think it is, “above all (or first), do no harm” • But. . .

  41. I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

  42. Modern Version of the Oath • I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

  43. Beware Professional Interests: • Policy history is guided by the interests of individual professions • Population health concerns are secondary • Partnerships are accepted reluctantly • Guild mentality pervades everything • The future of health care should NOT be determined by internecine struggles • Most are subject to the same demographic, social, and economic pressures

  44. Transition Dynamics in Health CareCan our professional models survive?

  45. COST UNAWARE -------------------------COST ACCOUNTABLE • TECHNOLOGICALLY DRIVEN---HUMANELY BALANCED • INSTITUTION BASED---------------COMMUNITY FOCUSED • PROFESSIONAL-------------------------------------MANAGERIAL • INDIVIDUAL-------------------------------------------POPULATION • ACUTE---------------------------------------------------------CHRONIC • TREATMENT-------------------MANAGEMENT/PREVENTION • INDIVIDUAL PROVIDER-------------------------------------TEAM • COMPETITION ------------------------------------COOPERATION • DISAGGREATED--------------------------------------INTEGRATED

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