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US Health Services Delivery Systems. Chapters 11 and 12 Tracey Lynn Koehlmoos, PhD, MHA. Where are we now?. Four central aspects of US Delivery System Continuum of Care (kinds of service) Managed Care (changes to industry) Special populations (mental health/disability)

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us health services delivery systems

US Health Services Delivery Systems

Chapters 11 and 12

Tracey Lynn Koehlmoos, PhD, MHA

HSCI 678 Intro to US Healthcare System

where are we now
Where are we now?
  • Four central aspects of US Delivery System
    • Continuum of Care (kinds of service)
    • Managed Care (changes to industry)
    • Special populations (mental health/disability)
    • Quality of Care (challenge to maintain)
chapter 11
Chapter 11
  • Specifics to come in future chapters
  • Overview of Continuum of Care
  • Tables showing payer/patient/provider relationships (look at these on your own)
continuum of care
Continuum of Care
  • Prenatal Care/Healthy Birth
  • Health Promotion
  • Primary Disease Prevention
  • Diagnosis of Disease
  • Treatment of Acute Disease
  • Secondary Disease Prevention
  • Tertiary Disease Prevention
  • Treatment of Chronic Illness
  • Rehabilitative Care
  • Long Term Care
  • Palliative Care
chapter 12
Chapter 12
  • The Three P’s
    • Health Promotion
    • Health Protection
    • Disease Prevention
  • Healthy People 2010: US DHHS goals
    • Increase quality and years of healthy life
    • Eliminate health disparities
health promotion
Health Promotion
  • The promotion of good health practices to preserve and enhance health status under which the individual has his or her initial contact with the health services system.
  • Most cost effective approach to intervention
  • US health services focus on crisis and curative medicine.
health promotion1
Health Promotion
  • Focuses on individual lifestyle to include:
  • Physical activity and fitness
  • Nutrition and overweight
  • Tobacco
  • Substance Abuse
  • Family Planning
  • Mental Health
  • Injury and violence prevention
  • Educational and community-based programs
availability of health promotion
Availability of Health Promotion
  • Depends on individual lifestyle choice
  • Separation of behavioral care from physical care
  • US system not designed to comprehensively offer and encourage the use of promotional services
  • Physician intervention is an effective technique of health promotion
more prevention
More Prevention
  • Many preventive services are not reimbursed or poorly reimbursed
  • Patient care limited to solving immediate problem
  • Providers are skeptical about impact
  • Under managed care and employer emphasis on wellness—maybe change will occur…
health protection
Health Protection
  • Focuses on health of the population rather than lifestyle choices, including:
    • Occupational health
    • Food safety
    • Oral health
    • Environmental health
health protection1
Health Protection
  • Falls into the Public Health sector
  • Interplay of health education and policy
    • Seatbelt laws, child care seat laws
    • Clean air standards, emissions testing
    • Food inspection, Restaurant inspection
disease prevention
Disease Prevention
  • Primary Prevention—preventing disease
    • immunizations
  • Secondary Prevention
    • Early detection and treatment
    • Mammography, Colonoscopy
  • Tertiary Prevention
    • Ameliorate seriousness of diagnosed disease
    • Insulin therapy (Type II), protease inhibitors (HIV)
the 3 p s and the system
The 3 P’s and the System
  • Applying what we know
    • Tobacco, inactivity, cocaine, obesity (bad for you)
    • How do we make people change?
  • Whose responsibility is it?
    • Individual, provider, society?
    • Blame the victim? Peer pressure?
  • Systemic Issues: More primary care?
    • Insurance coverage for prevention?
    • Intervention for the person or the community?
epidemiologic transition
Epidemiologic Transition
  • MAJOR CONCEPT for industrialized and developing nations
  • Coined by Olshansky and Ault (1986)
  • In health services context:

Switch from emphasizing contagious and communicable disease to focusing on chronic disease (now epidemic in US) such as heart disease and cancer.

reorientation toward primary care
Reorientation toward Primary Care
  • 2:1 ratio of specialists to generalists—emphasis on high-cost treatment
  • Managed care created a demand for more generalists as gate keepers
  • Med schools switch toward emphasizing primary care (mid-1990’s)
  • Medicare reimbursing fewer specialist GME spots—not really
technological advances
Technological Advances
  • Basic scientific research produces results that influence our ability to use the 3 P’s
  • Mapping DNA, monitoring disease—all give clues to how to promote a healthy population and prevent illness
  • Health Promotion, Protection and Disease Prevention are more cost-effective than curative treatment
  • Responsibility Conflict
  • Much of what kills us is preventable
  • 1st step in the Continuum of Care