+1(978)310-4246 credencewriters@gmail.com
  

I’m working on a education & teaching writing question and need a reference to help me learn.

one

page

summary from the powerpoints and article

Chapter 1
International Physician and Health System Practice:
Can U.S. Reform Efforts Learn from Other Nations?
Origins of Medical Group Practice
• Egyptian Medical Practices
– Egyptians believed that medicine alone would only
relieve suffering. When paired with magic,
medicine allowed the patient to recover strength
and vitality.
– The Egyptians employed physicians, at public
expense, to care for workers building the
pyramids, mines, and quarries.
Origins of Medical Group Practice
• Greco-Roman Medical Practices
– Greeks emphasized the relationship between the
healthy human body and the harmonies of nature.
– The early Romans did not practice rational
medicine but relied on folk remedies.
• After the fall of the Roman Empire, physicians in the
Islamic Empire established the hospital as a place to
treat the sick.
Origins of Medical Group Practice
• Organized labor, technology, dearth of hospitals in
the late nineteenth century hastened the growth of
medical group practice.
Medical Group Practice in the U.S.
• How physicians are paid explains how the financing
of healthcare services affects medical group practice.
– Fee-for-service: Physicians receive fees for
services they provide from Medicare, Medicaid,
and employer-based health insurance plans.
– Prepaid Health Plans: Health maintenance
organizations (HMOs) pay physicians a per capita
rate for the patients that they agree to serve.
Medical Group Practice in Other Nations
• The German and Dutch healthcare systems are the
most comparable to the U.S. system.
• Canada, Germany, the Netherlands, Sweden, and the
United Kingdom have implemented various elements
of managed competition.
• Canada’s tax-funded healthcare achieves universal
access, high quality, and moderate costs.
Lessons for the U.S. Healthcare System
• The U.S. healthcare system has been unique among
high-income countries in relying on voluntary,
employer-based health insurance for most of its
population.
• The Patient Protection and Accountable Care Act of
2010 (PPACA) requires individuals to buy health
insurance if they are not covered by employer-based
insurance, Medicare, or Medicaid.
Lessons for the U.S. Healthcare
System
• The PPACA established the Patient-Centered
Outcomes Research Institute (PCORI), which
identifies and conducts research that compares the
clinical effectiveness of medical treatments.
– PCORI lacks any authority to restrict the
proliferation of healthcare technology, a major
driver of costs. An agency with such authority
would be a proven way to limit the continuous
health inflation that has plagued the U.S.
Reforming the Medical Liability System
• A recent Harvard University study estimates the
medical liability system cost the U.S. about $55.6
billion in 2008.
• Most countries use a tort system of medical liability
to compensate patients and to deter malpractice by
physicians and other health care professions.
• Some countries have adopted no-fault compensation
systems.
Reforming the Medical Liability System
• Costs associated with defensive medicine (i.e., the
costs of additional medical services to minimize the
physician’s liability risks) are driven by physician
perceptions about risk.
• Perceived risks of medical liability severely hamper
the reporting of medical errors, undermining quality
improvement efforts that would help mitigate medical
liability.
Reforming the Medical Liability System
• It has been recommended that no-fault medical
liability insurance be made compulsory for both
physicians and hospitals to increase provider
accountability.
Tax Funded Models for Direct Provision
of Health Services
• The United Kingdom
– All residents are covered under the National
Health Service (NHS), funded through national
taxes.
– General practitioners may be independent
contractors or salaried employees.
Tax Funded Models for Direct Provision
of Health Services
• Sweden’s National Health Service
– All citizens, immigrants and foreign residents are
covered.
– Over 90% of physicians belong to the Swedish
Medical Association (SMA), a union and
professional organization that negotiates general
employment conditions (e.g., salaries, benefits,
working hours).
Tax Funded Models for Direct Provision
of Health Services
• Sweden’s National Health Service
– Physicians in private practice set their own fee-forservice rates, but must adhere to county and
national guidelines if they are reimbursed by the
NHS.
– Patients may receive care from physicians, district
nurses and other mid-level providers.
Tax Funded Models for Direct Provision
of Health Services
• Canada
– Indirectly provides health services through a taxfunded public system, which is accessible by all
Canadians.
– In 2009, there were about 2.4 physicians per 1,000
people in Canada.
– Most general practitioners and specialists are paid
on a fee-for-service basis.
Compulsory Insurance Model for
Indirect Provision of Health Services
• Germany
– Every German is eligible to participate in the
statutory, social insurance system.
– The chief system for financing healthcare is
through contributions toward statutory, social
health insurance funds (SHIs).
– The unemployed, homeless, and immigrants are
covered through a special sickness fund financed
through general revenues.
Compulsory Insurance Model for
Indirect Provision of Health Services
• Germany
– The Federal Ministry for Health and parliament are
in charge of healthcare at the national level.
– Most general practitioners and specialists are selfemployed and paid based on fee-for-service.
Compulsory Insurance Model for
Indirect Provision of Health Services
• The Netherlands
– All citizens are covered under the Algemene Wet
Bijzondere Ziektekosten (Exceptional Medical
Expense Act), which provides funding for longterm, disability, and chronic psychiatric care.
– Citizens are required by law to enroll in a plan of
their choosing.
Mixed Models for Provision
of Health Services
• Argentina
– Combines tax-funded, direct provision of health
services through compulsory social and private
health insurance with indirect provision of services.
• Brazil
– Relies on both a public and a private subsystem,
covers 75% of the population through the public
health sector. Relies on taxes to provide or contract
for health services.
Mixed Models for Provision
of Health Services
• Greece
– A combination of tax-funded, direct provision and
social insurance-funded, indirect provision of care.
State and national taxes fund the national health
service.
• Indonesia
– A complex mix of private expenditures; taxfunded, direct provision, compulsory social
insurance; and voluntary private insurance.
Mixed Models for Provision
of Health Services
• Mexico
– The System of Social Protection in Health (SSPH)
is funded by federal taxes, contributions from
municipal governments.
• Turkey
– In 2005, all healthcare facilities part of the Social
Insurance Organization (SSK) were transferred to
the Ministry of Health.
Mixed Models for Provision
of Health Services
• The United States
– The current system comprises a voluntary,
employer-based private insurance subsystem,
social health insurance for the elderly, and taxfunded, direct and indirect provision of care.
– The federal government is the single largest
health-care insurer and purchaser.
Chapter 2
Organization and Operations of
Medical Group Practice
Organization
• Taxonomy of Medical Groups: Must contain at least
three practitioners working within a common
organizational structure.
• Groups
– Share expenses and services
– Almost always bill under a single tax I.D. number
• The many organizational forms of medical groups
have evolved in response to the needs and interests
medical practitioners.
Considerations for Structuring Practices
• Organizational forms offer different advantages and
disadvantages to physicians and patients.
• Every state has adopted statutes that govern the
formation and operation of corporations, partnerships,
and other forms of commercial ventures.
• In some states, professional organizations are referred
to as “service corporations” (SC) or “professional
associations” (PA).
Organizational Forms
• General partnerships are the simplest form; created by
a contract (partnership agreement).
• Corporations are artificial persons created by the law.
Shareholders are individuals with an interest in the
corporation.
• Limited liability partnerships (LLP) are a variation
that have some characteristics of a corporation and
general partnership.
Organizational Forms
• Physician Hospital Organizations (PHO): a hospital
or parent company acquires a medical group through
the purchase of the group practice’s assets, employs
the physicians directly.
• Management Service Organization (MSO): entities
that provide management service support to practices
through a contract relationship.
• Practice Management Company (PMC): serves to
amalgamate practices under one corporation.
Organizational Forms
• Independent Practice Associations (IPA): share risks
with managed-care plans, accept a defined number of
patients, agree to provide care at a fixed price.
• Faculty Practice Plans: group practices within a
university setting or integrated delivery system (IDS).
Referred to as “clinics without walls.”
• Joint Ventures (JV): special partnerships entered into
for a specific project or service.
Governance
• As groups grow, the need for a more centralized form
of governance becomes important.
• The governing body of the medical group must deal
with a number of stakeholders.
• Board members are selected by election.
• Benchmarks are tracked to monitor the progress of
the group’s performance.
• A clear mission statement that is consistent with the
values of the organization’s members is important.
Operations
• Administration: falls into three board domains
1. Strategic-mission oriented or competitive in
nature
2. Adaptive, reactive, or proactive
3. Operative, maintenance, or implementation
Operations
• Five general areas of competency for the
administrator:
– Professionalism
– Leadership
– Communication
– Organization/analytical
– Technical and professional knowledge
Risk Management
• Purpose of risk management is mitigation of risk.
• Risk management activities include:
– Purchase of insurance
– Antitrust, fraud and abuse, criminal acts of all
kinds, Health Insurance Portability and
Accountability Act (HIPPA) violations
– Development of quality assurance programs
– Contract administration
Medical Records
• The maintenance and safekeeping of a patient’s
medical record is the principal function of the
medical records unit.
• These records contain proof of what was done, who
did it, how it was done, why it was necessary, where
it was done, plan for future care.
Quality Improvement
• The issue of the quality of service provided by group
practices is paramount to group-practice operations
and the future of healthcare.
• There are many opportunities to evaluate the practice:
– Patient satisfaction surveys
– Malpractice claims review
– Benchmarking clinical/nonclinical data
– Review and understand national data (National
Institutes of Health)
Research
• Many medical groups are engaged in significant
research which is regulated by the Food & Drug
Administration (FDA)
• Key players in research department:
– Principal investigator (PI)
– Director
– Research nurses
– Support staff
– Institutional review board (IRB)
Healthcare Reform
• There is increasing recognition that the healthcare
system has to change, and at the center of this change
is the physician.
• Payment for outcomes, not just activities, changes the
strategic focus.
• Currently, physicians are largely paid based on
production of services. Few physicians are prepared
to make an abrupt switch to other reimbursement
methods.
Healthcare Reform
• The Patient Protection and Affordable Care Act of
2010 (PPACA) focuses on the following:
– Meaningful use: electronic connectivity to improve
patient care and efficiency.
– Value-based purchasing: electronic records and
contemporaneous recording of care information
will improve quality of care.
– Accountable care organizations (ACOs): deliver
high quality lower cost care.
Emergency Preparedness in Medical Groups
• Most medical groups have emergency plans and need
to focus on the following:
– Basic management of resources
– Organization
– Delegation of authority
– Coordination
– Communication
– Evaluation
Emergency Preparedness in Medical Groups
• Organizations need to consider:
– Communication: with staff, patients, families and
external agencies
– Resources and assets: critical supply procurement
Emergency Preparedness in Medical Groups
• Organizations need to consider:
– Safety and security: Must control movement of
patients, staff, visitors, and volunteers. Hazard
material management.
– Staff responsibilities: job action sheets, checklists
to assist staff members.
Emergency Preparedness in Medical Groups
• Organizations need to consider:
– Utility management: Alternative means to
provide potable and nonpotable water, sanitation,
fuel, and electricity.
– Patient and clinic support activities: A process
of swift triage of those patients able to be
discharged. Special needs population
management. Personal hygiene and sanitation.
Chapter 3
Physician Leadership in
Medical Group Practice
The Evolution of Group Practice
as a Preferred Model
• The Mayo brothers formed the first group practice in
the U.S. in 1892
– Became known as the Mayo Clinic
• Health Maintenance Organizations (HMOs) were
formed in the late 1930s
– Such as Kaiser Permanente
The Evolution of Group Practice
as a Preferred Model
• The Institute of Medicine (IOM) published “To Err is
Human” in 2000
– Illustrated the distressing error rate in the
healthcare industry.
• With the election of Barack Obama as U.S. President
and with a Congress controlled by the Democratic
party, momentum began to build again for healthcare
reform.
The Evolution of Group Practice
as a Preferred Model
• The ranks of the uninsured and underinsured were
swelling
– By early 2009, almost 50 million Americans
uninsured
– President Obama determined to move towards
universal coverage.
External Challenges
• Reimbursement:
– Group practices continue to face increasing
reimbursement pressures.
– Continuing declines in Medicare reimbursement
rates associated with reduced payments to
physicians and hospitals.
External Challenges
• Payer and Purchaser Concerns:
• The employment-based commercial healthcare
system under siege.
• Both large and small employers face significant
economic challenges at a time requiring
increased competition in a global economy.
External Challenges
• Competing in an individual, consumer-driven
marketplace, where consumers have choice and
incentive regarding provider selection, is having a
substantial influence.
Internal Leadership Challenges
• Recruitment and Retention:
– Most pressing concern to physician leadership is
the recruitment and retention of outstanding
physicians.
– Recruiting process has become increasingly
important as physicians in several specialties are in
short supply
Internal Leadership Challenges
• Cost Control and Efficiency:
– Declining reimbursement and rising costs of labor
and technology have increased the focus on
efficiency.
– Correlation between enhanced efficiency and
improved quality and safety is also becoming more
apparent.
Internal Leadership Challenges
• Credibility and Effectiveness:
– Physician leaders traditionally have been selected
because of seniority or perceived influence as well
as clinical credentials.
– In several large group-practice settings, chief
medical officers and other physician leaders may
now be full-time physician leaders.
Internal Leadership Challenges
• Pace of Change:
– Healthcare culture quickly transforming
– Internal dynamics within group practices
constantly evolving
– Helping physicians and members of the healthcare
delivery team move out of their traditional comfort
zones requires comprehensive change management
skills.
Internal Leadership Challenges
• The Disruptive Physician:
– Issues with the “problem physician” range from
quality-of-care concerns to behavioral issues that
impact colleagues and staff.
– Disruptive physician often insists on focusing on
his or her individual needs at the expense of group
goals and patient care.
Skills, Knowledge, and Competencies
• Leadership Styles: Six predominant leadership styles
brought forward by D. Goleman in 2000
1. Coercive: Demands immediate compliance
2. Authoritative: Mobilizes people toward a vision
3. Affiliative: Creates harmony and emotional
bonds
Skills, Knowledge, and Competencies
• Leadership Styles (continued)
4. Democratic: Forges consensus through
participation
5. Pace setting: Sets high standards for performance
6. Coaching: Develops people for the future
Collaboration and Teamwork
• The ability to collaborate as team member and partner
is a critical competency required in physician leaders
who desire to take their organizations to the next
level.
The Future
• Succession Planning/Talent Development:
– Building a depth of leadership talent and
prioritizing educational and development
opportunities for young clinicians with leadership
potential is very helpful.
The Future
• Leadership Lessons include
– Change sponsorship is a major role for today’s
leaders.
– An enterprising vision of success should be
articulated and shared.
– Set ambitious goals for yourself and for teams.
– Tear down barriers to success
– Embrace failure and learn from it.
The Future
• Leadership Lessons include
– Celebrate achievements.
– Know your people and let your people know you.
– Go see your yourself what is really going on.
– Connect the dots constantly.
– It takes hearts and minds to succeed.
The Future
• Leadership Lessons include
– Skeptics can become champions.
– Be accountable and hold others accountable.
– Leading change is hard work.
– Patients and staff depend on leaders being
successful.
THE UNITED STATES
HEALTH CARE SYSTEM
Combining Business, Health, and Delivery
CHAPTER
1
Health and Health
Care in America
An Introduction
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Objectives
1. Define health and health care.
2. Compare the medical and wellness
models of health.
3. Identify major demographic categories
of the American population.
4. Describe key indicators of the health of
the American population.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Objectives
5. Describe the size and scope of the
health care industry in the United
States.
6. Describe recent health reform efforts.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health and Health Care in the
United States
• Medical Model
– Assumes that illness and disease require
treatment.
– Health care focuses on the diagnosis
and treatment of disease.
– Western medicine is the answer to
health.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health and Health Care in the
United States
• Wellness Model
– Focuses on the prevention of disease
and the maintenance of well-being.
– Health is defined as the optimal
functioning of each human being in their
own mind, body, and spirit.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Table 1.1
Demographic Characteristics of United States Residents
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Trends
• Demographic data includes personal
characteristics, such as age, race, and
gender.
• According to data released in 2015, the
U.S. population had grown to 316.1
million residents in 2013.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Trends
• Americans are living longer:
– Life expectancy from birth is 78.8 years.
– Men who reach age 65 can expect to
live to age 82.9.
– Women who reach age 65 can expect to
live to age 85.5.
– Baby boomers.
â–ª Between 2010 and 2030, 76 million will
reach age 65.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Trends
• An aging population:
– Increases demand for home health care
and geriatric care.
– Quality of life becomes a major factor.
– Need for preventive health care
becomes more important
– Information on exercise, diet, and
alternative treatments is sought
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Trends
• Women need more health care over
their lifetime.
– Reproductive health care in addition to
general health care
– More often single head of household
– More often live in poverty
– Tend to live longer than men
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Trends
• In 2010, 2 percent of respondents who
reported themselves as “white” also
reported themselves as one or more
other races.
• The Hispanic population has nearly
doubled since 1990.
• The Hispanic population is also younger
than the total population.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
How Healthy Are Americans?
• Epidemiology
– Study of the nature, control, and
determinants of disease, disability, and
death in the human population
• Centers for Disease Control and
Prevention
– Federal agencies responsible for
collecting and interpreting health care
statistics
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
How Healthy Are Americans?
• 2014 National Health Interview Survey;
America’s health is good.
• Level of education and family income
are closely related to good health.
– Those with annual incomes above $75k
were twice as likely to be in good health
as those with annual incomes below
$20k.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
How Healthy Are Americans?
• In 2010, 7% of Americans reported
that they did not receive health care
due to cost.
• In 2014, this decreased to 5.4%.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
How Healthy Are Americans?
• The morbidity and mortality of the
leading causes of disease has steadily
declined by almost 50%.
• Healthier lifestyles account for much of
that decrease.
• New vaccines have improved health
outcomes.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
How Healthy Are Americans?
• Diseases such as measles, mumps,
chicken pox, whooping cough, tetanus,
and diphtheria, have been virtually
eradicated.
• Healthy outcomes are directly related
to being able to get medical care when
needed.
• Prevention has the widest impact on
the daily lives of the population.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Health Care Industry
• The health care industry encompasses
all workers who provide health care
services directly or who provide support
or business services.
• Facilities include physicians’ offices,
hospitals, long-term-care facilities, and
laboratories.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Health Care Industry
• In 2013, the U.S. spent $2.9 trillion on
health expenditures, or 17.4% of the
country’s gross domestic product
(GDP).
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Employment
• The U.S. Department of Labor forecasts
that half of the fastest-growing
occupations between 2012 and 2022
will be in health services.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Employment
• Four categories of health care
occupations:
– Professional and related occupations
– Service occupations
– Office and administrative support
occupations
– Management, business, and financial
occupations
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Employment
• Three reasons for continued growth in
health care employment:
– The aging of the population increases
demand for health services.
– Advances in medical technology.
– Continued interest to manage costs.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Delivery Systems
• Three major places of employment:
– Hospitals
â–ª 4.8 million employed
– Nursing and residential care facilities
â–ª 3.3 million employed
– Physicians’ offices
â–ª 6.8 million employed
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Delivery Systems
• Long-term care (LTC) is one of the
fastest growing sectors of health care.
– LTC means providing services for more
than 90 days.
– In 2012, more than 8 million people
received paid services
– As many as 7 million people receive
unpaid care.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Delivery Systems
• Mental Health
– One of every five adults has a mental
illness, according to the 2013 National
Survey on Drug Use and Health.
– Estimates state half of the people with
mental illness get treatment.
– Expenditures exceeded $132 billion.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Delivery Systems
• Public Health
– Safety
– State and national campaigns
– Laws
– Immunizations and dental care for lowincome patients
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Policy
• Health care policy attempts to address
the issues of access, quality, and costs
(see Figure 1.1 Policy Trade-Offs).
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Figure 1.1 Policy Trade-Offs
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Policy
• In March 2010, the Patient Protection
and Affordable Care Act intends to
improve health care for Americans in
three ways.
– The act includes provisions to expand
access to care by increasing access to
insurance.
â–ª Individuals must have coverage.
â–ª Employers required to provide coverage.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Policy
• In March 2010, the Patient Protection
and Affordable Care Act intends to
improve health care for Americans in
three ways.
– The act mandates ways to control
health care costs.
– The law seeks to improve the health
care delivery system’s performance and
quality.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Policy
• The Affordable Care Act has been
amended twice and provisions
challenged at the Supreme Court.
• Act did reduce the number of people
who are uninsured.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Policy
• Managed care combines health care
delivery with health care services.
– Manages patient’s utilization of services
and the price paid for those services
• Objective is to provide only necessary
services.
– Concern is patients may not receive
needed care.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Health Care Policy
• Policy making can be informed by
ethical theories, however, fairness and
equality are not easy to achieve.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
This Book’s Approach
• Two viewpoints:
– Health care is a set of delivery systems
that provides health care services to
those who need them.
– Health care is a set of related
businesses; all of which must operate as
profitable entities.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
This Book’s Approach
• Health care is an encounter between a
patient and a provider.
– Takes place in various settings
depending on what types of services the
patient needs
• See Figure 1.2 Organization of this
Book.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Figure 1.2 Organization of this Book
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
THE UNITED STATES
HEALTH CARE SYSTEM
Combining Business, Health, and Delivery
CHAPTER
5
Health Care Providers
Physicans and Nurses
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Objectives
1. Describe the roles of the physician and
nurse in providing health care
services.
2. Compare and contrast the different
type of physicians and nurses.
3. Describe the demographic
characteristics of physicians and
nurses.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Objectives
4. Outline the education and training
process of physicians and nurses.
5. Identify the requirements for licensure
and explain the difference between
licensure and certification.
6. Identify employment settings for
physicians and nurses.
7. Describe the major issues facing the
professions of physician and nurse.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Introduction
• In the U.S. almost 16 million people are
employed in the health care industry.
• Physicians and nurses make up a
quarter of all health care employees.
• In 2010, Americans made over a billion
office visits to physicians.
• Nursing employs 3 million people as of
2012.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Physician’s Role in Health
Care Delivery
• Diagnose and treat patient illnesses
– Begins with medical history
▪ Record of a patient’s health, physicians’
visits, symptoms, prescribed treatments,
regular medications, and family medical
history.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Physician’s Role in Health
Care Delivery
• Diagnose and treat patient illnesses
– Physical examination
â–ª Diagnostic tests
– Interpretation of patient data
– Treatment
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Physician’s Role in Health
Care Delivery
• Diagnose and treat patient illnesses
– Give advice about preventive health
care
– Make suggestions about diet and
hygiene
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Physicians and Medical
Specialties
• Doctors of Medicine (MD) or Doctors of
Osteopathy (OD)
– MDs practice allopathic medicine
â–ª Fight disease with drugs and surgery
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Physicians and Medical
Specialties
• Doctors of Medicine (MD) or Doctors of
Osteopathy (OD)
– ODs practice osteopathic medicine
â–ª Focus on preventing and understanding
disease through understanding the body
in a holistic way
– Physicians are described either as
primary care providers or as specialists.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Physicians and Medical
Specialties
• Primary Care
– Primary care physician
â–ª Sees patients regularly for preventive
care and to treat common health
problems.
– The main primary care areas are:
â–ª Internal medicine
â–ª General and family practice
â–ª Pediatrics
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Physicians and Medical
Specialties
• Primary Care Areas
– Internal medicine
â–ª Focuses on problems associated with the
body’s organs
– General and family practitioners
â–ª Diagnose and treat a variety of illnesses
in patients of all ages
– Pediatricians
â–ª Focus their efforts on children
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Physicians and Medical
Specialties
• Specialty Care
– A specialist is a physician who is an
expert in a particular medical field.
– Most surgeons specialize in a particular
type of surgery.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Table 5.1 Medical Specialties
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Characteristics of U.S. Physicians
• Approximately 691,400 physicians in
active practice (2012)
• Demographic data as of 2014:
â–ª 35% women
â–ª 12% Asians
â–ª 5% Hispanics
â–ª 4% African-Americans
– Diversification with population is
important.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment and Earnings of
Physicians
• 21% were self-employed in solo
practice last year.
– 17% had an ownership share.
• 14% employed in private practice
• Nearly 21% were employed by
hospitals
• Remaining physicians work in
government or are teachers,
administrators, and researchers
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment and Earnings of
Physicians
• 44,000 physicians are employed as
hospitalists
– Providing care to hospitalized patients
• 49% work more than 50 hours per
week
– 13% work 60 to 70 hours per week
• The need for physicians will grow by
more than 18% through 2022.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment and Earnings of
Physicians
• Median annual net income for
physicians in primary care is $220,942.
• Median annual net income for specialty
fields is $396,233.
• Income level varies
– Number of years in practice, geographic
region, hours worked, specialty
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Education and Training
• Undergraduate degree (usually premed or science)
• Completion of four years of medical
school
– 2 years of basic science and 2 years of
clinical experience
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Education and Training
• There are currently 171 medical schools
in the U.S.
– 141 are allopathic
– 30 are osteopathic
– Less then 1/2 of applicants are accepted
– 96% graduate
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Education and Training
• Final stage is residency
– Now referred to as Graduate Medical
Education
â–ª Previously called internship and residency
• It is paid on-the-job training.
• Depending on the specialty, residency
can last from 1 to 7 years.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Education and Training
• Medical school is expensive
– Median cost of attendance for the class
of 2015 is between $227,000 and
$298,000
– 84% of students borrow money.
– Average debt for a 2014 graduate is
$176,348.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Licensure and Certification
• U.S. Medical Licensing Examination
(USMLE)
– Three-step exam required for licensure
in the United States.
• Each state’s specific requirements for
licensure are in its Medical Practice Act.
– License granted by Board of Medical
Examiners
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Licensure and Certification
• Reciprocity agreement
– Licensing requirements of the first state
are accepted elsewhere.
• To stay licensed, the physician must
pay an annual renewal fee.
• Require physicians stay current in the
field by completing additional education
CME (Continuing Medical Education).
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Licensure and Certification
• To revoke a physician’s license, the
conditions include:
– Unprofessional conduct
– Commission of a crime
– Personal incapacity to perform one’s
duties
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Licensure and Certification
• Board certification is voluntary.
• The two organizations that control
board certification are:
– American Board of Medical Specialists
– American Osteopathic Association
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• Nurse’s role is to “take care of people”.
• Nursing process is a framework that
provides a systematic method to
deliver patient care.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• The five stages in the nursing process
are:
– Assessment
– Diagnosis
– Care planning
– Implementation
– Outcome evaluation
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• Assessment
– Gathering of medically pertinent
information
– Sources include:
â–ª Patient
â–ª Family
â–ª Medical records
â–ª Other providers
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• Nursing diagnosis
– Information reviewed
– Problem identified
– Diagnosis made
– North American Nursing Diagnosis
Association (NANDA)
â–ª Classification and formatting system for
nursing diagnosis
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• Care planning involves two steps:
– Writing client goals
– Planning interventions to achieve the
goals
– Nursing Outcomes Classification (NOC)
– Nursing Interventions Classification
(NIC)
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• Nursing Outcomes Classification (NOC)
– 490 identified outcomes that are
responsive to nursing care
• Nursing Interventions Classification
(NIC)
– 554 interventions are identified
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
The Nurse’s Role in Health Care
Delivery
• Plan implementation
• Outcome evaluation
– Ongoing so modifications can be made
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Characteristics of U.S. Nurses
• 90% are women
• Less than 5% of nurses are under the
age of 25
• Average age of RNs is 45
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Characteristics of U.S. Nurses
• More than 75% of RNs are white
• African-Americans represent 10% of
RNs
• Asians around 8%
• Hispanics approxmately 5%
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Significant differences in the types of
nurses
– Tasks/responsibilities
– Extent of training and education
– Requirements for professional licensing
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Nurses’ Assistants and Aides
– The nursing assistant or aide is not
actually a nurse.
– Nurses’ aides and home health aides are
referred to as NAs and CNAs.
– In 2012, there were 1.5 million nurses’
aides.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nursing Assistants
• Nurses’ Assistants and Aides
– NAs provide the most basic level of
patient care.
– A NA may obtain the credential of CNA
(Certified Nursing Assistant).
– Not required to obtain a state license
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Licensed Practical or Licensed
Vocational Nurse (LPN/LVN)
– 738,000 LPNs were employed in 2012.
– Duties incluce basic bedside physical
care of the patient, as well as vital signs
and medication administration
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Licensed Practical or Licensed
Vocational Nurse (LPN/LVN)
– Educational programs last about a year
â–ª 90% of programs are at
technical/vocational schools or
community colleges.
– A LPN must pass a national licensure
exam to practice.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Registered Nurse (RN)
– Majority of nurses
â–ª 2.7 million in 2012
– Observe, assess, and record symptoms,
reactions, and progress
– Administer IV medication and blood
– Perform patient assessments and plan
care
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Registered Nurse (RN)
– Major differences between the LPN and
the RN involve supervision, legal
responsibilities, and IV therapy.
– RNs are encouraged to complete the
BSN (Bachelor of Science in nursing).
– RNs must pass a national licensure
exam.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Advanced Practice Nurses
– Provide higher level of care
– Requires master’s degree in clinical
specialty
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Advanced Practice Nurses
– Nurse practitioner (NP)
â–ª 205,000 in U.S.
â–ª Key providers in communities and
populations not adequately served by
physicians
â–ª Can order and interpret x-rays and tests
â–ª Can prescribe medication
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Advanced Practice Nurses
– Clinical nurse specialist (CNS)
– Certified nurse-midwife (CNM)
â–ª 11,000
â–ª Provide prenatal care to healthy women,
deliver babies, and provide postpartum
care
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Types of Nurses
• Advanced Practice Nurses
– Certified registered nurse anesthetist
(CRNA)
â–ª 48,000 in the U.S.
â–ª Central role in anesthesiology
â–ª Sole provider of anesthetics in nearly
100% of rural hospitals
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Education and Training
• Nursing education has two components.
– Classroom instruction
– Supervised clinical experience
• Majority of RN programs are at the
associate degree in nursing (ADN) and
BSN levels.
• 55% of nurses have bachelor’s degrees
or higher.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Licensure
• In each state, the State Board of
Nursing specifies what requirements
are necessary.
• Nurse Practice Acts contain the states’
requirements for practice.
• All 50 states require that nurses be and
remain licensed in order to practice.
• National registry exam (NCLEX)
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment Options for Nurses
• Hospitals
– Staff nurse
â–ª Entry-level
– Nurse supervisors
â–ª Plan work schedules and assign duties
â–ª Provide training
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment Options for Nurses
• Medical offices
– Prepare patients for the health
examination
– Assist with the exam
– Maintain patient records
– Perform many diagnostic tests
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment Options for Nurses
• Long-Term Care and Home Health
– Increased demand due to aging
population
– RN usually has an administrative or
supervisory role.
– LPNs perform direct patient care tasks.
– Home health care offers opportunities to
work independently.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment Options for Nurses
• Public Health
– Provide primary care services to the
community
â–ª Immunizations
â–ª Screenings
â–ª Pediatric care
– Important role as educators
– Requires at least a bachelor’s degree
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Employment Options for Nurses
• Other Opportunities
– Business side of health care
â–ª Management positions
â–ª Marketing
â–ª Quality assurance
â–ª Education
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Issues in Health Care Delivery
• Insufficient supply of health care
providers of all types
• States have developed incentive
programs where they will pay for
medical school if the physician
promises to practice in an underserved
area.
continued on next slide
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Issues in Health Care Delivery
• Problems retaining people in health
care professions
– Burnout
â–ª Profession demands a great deal of
empathy from practitioners
â–ª Stress and overwork
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Issues in Health Care Delivery
• Problems retaining people in health
care professions
– Injury
â–ª Back, needlestick
– Allergies
– Abuse
â–ª Physical
â–ª Verbal
– Wide variance in compensation
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved
Issues in Health Care Delivery
• Matching the supply of clinical providers
to the demand for their services also
causes gaps.
• Access to care and quality while still
controlling costs.
– RN is replaced with the less expensive
LPN.
The United States Health Care System:
Combining Business, Health, and Delivery, Third Edition
Anne Austin | Victoria Wetle
Copyright © 2017, 2012
by Pearson Education, Inc.
All Rights Reserved

Purchase answer to see full
attachment

  
error: Content is protected !!