What is the health care delivery system
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What is the Health Care Delivery System?. A mechanism for providing services that meet the health-related needs of individuals. Three levels of Health Care. Primary Secondary Tertiary. Primary Care.

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What is the health care delivery system l.jpg
What is the Health Care Delivery System?

A mechanism for providing services that meet the health-related needs of individuals.

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Three levels of Health Care

  • Primary

  • Secondary

  • Tertiary

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Primary Care

  • Goal: To decrease the risk to a client (individual or community) of disease or dysfunction.

  • Approach: General health promotion. Protection against specific illnesses.

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Secondary Care

  • Goal: To alleviate disease and prevent further disability.

  • Approach: Early detection and intervention.

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Tertiary Care

  • Goal: To minimize disability associated with chronic or irreversible conditions.

  • Approach: Restorative and rehabilitative activities to attain optimal level of functioning.

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The U.S. System

Health care services are delivered and financed by three sectors:

  • The public (official, voluntary, and nonprofit agencies)

  • Public/private

  • Private (hospitals, extended-care facilities, hospices, schools, etc.)

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Extended-care facilities

Home health care agencies


Out-patient settings


Industrial Clinics

Managed care organizations

Community nursing centers

Rural primary care hospitals

Health Care Settings

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Health Care Team Members

Health care is delivered by a multidisciplinary team, all working together. Examples include:

  • Physician (MD)

  • Nurse (RN, LP/VN)

  • Nurse Assistant (CAN)

  • Registered Dietician (RD)

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Economics of Health Care

The U.S. health care system has a diverse base:

  • 32% private insurance

  • 14.8% medicaid

  • 18.8% Medicare

  • 11.8% Other public programs

  • 17.4% Out of Pocket

  • 4.5% Other private

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Private Insurance Model

  • Basis of U.S. system

  • Individual pays monthly premiums for coverage and receives access on an as needed basis

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Managed Care Model

  • Developed to provide coordinated care with an emphasis on prevention

  • A system of providing and monitoring care wherein access, cost, and quality are controlled before or during delivery of service

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HMOs, PPOs and EPOs

  • Health Maintenance Organizations (HMOs) have a single point of entry. Entry into the health plan through a point designated by the plan.

  • Preferred Provider Organizations (PPOs) allow individuals to access health care from within a pool of providers.

  • Exclusive Provider Organizations (EPOs) are similar to PPOs except that care is intended to be delivered exclusively from within the selected pool of providers.

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Federal Insurance Plans

  • Medicare: Provides health care coverage for elderly persons and disabled persons.

  • Medicaid: Federal and Local administered program that provides health care services for the poor.

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Factors Influencing Health Care

  • Cost

  • Access

  • Quality

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Cost Issues

Many factors influence costs:

  • An oversupply of specialized providers

  • A surplus of hospital beds

  • The passive role assumed by most consumers.

  • The aging of the population.

  • The increased number of people with chronic illnesses.

  • Unnecessary use of services (e.g. additional diagnostic testing) and increase in health-related lawsuits.

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Access Issues

Many factors influence an individuals ability to access the health care system:

  • Inadequate or cost of insurance

  • Cultural barriers

  • Limited access to ancillary services (e.g. child care, transportation)

  • Certain preexisting conditions making it difficult to obtain insurance

  • Shortage of providers in rural or inner city areas

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Quality Issues

Many factors influence the quality of care individuals receive:

  • The litigious environment and response toward defensive practice (e.g. ordering all possible tests).

  • The widely held American belief that more is better.

  • Lack of access to and continuity of services result in subsequent misuse of acute services.

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The U.S. Healthcare system faces some serious challenges:

  • Public’s disillusionment with providers

  • Public’s loss of control over health care decisions

  • Changes in practice settings

  • Decreased use of hospitals and related impact on quality of care

  • Ethical issues

  • Health care needs of vulnerable populations

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Nursing’s Responseto the Challenges

The nursing profession has responded to the multiple challenges in health care delivery by proposing a plan for reform.

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Nursing’s Vision for the Future

To provide health care services that emphasize PREVENTION and PRIMARY HEALTHCARE for clients, thereby helping to reduce costs and increase the quality of health care