Health Care Systems, Issues
Osterweis M., McLaughlin CJ, Manasse HR, Hopper CL. The U.S. Health
Workforce: Power, Politics and Policy. Association of Academic
Health Centers. 1996. (W 21 U61 1996 )
Isaccs SL, Knickman JR. To improve health and healthcare 1998-1999.
The Robert Wood Johnson Foundation Anthology. Jossey-Bass, 1998.
Federal government has regulated health care systems since early 1900's
- Department of Health and Human Services (DHHS) -- responsible for numerous
healthcare regulatory, grant and information programs
Public Health Service manages:
Agency for Health Care Policy and Research
Agency for Toxic Substances and Disease Registry
Centers for Disease Control and Prevention
Food and Drug Administration
Substance Abuse and Mental Health Services
Health Resources and Services Administration
National Institutes of Health - the lead
health and medical research organization of the US government.
National Library of Medicine
Indian Health Service
- Social Security Administration
- Administration for Children and Families
- Health Care Financing Administration (Medicare program and
Medicaid programs admin.)
- Occupational Safety and Health Administration
Accreditation: required for reimbursement for many patient
groups; validates quality of care; provides competitive edge
Regulatory mechanisms of Health Occupations
- American Board of Medical Specialties
- Commission on Accreditation of Allied Health Education Programs
- American Medical Association
- National League of Nursing
- State Licensure of Practitioners
Continuum of Care
- Primary - the care provided at the point of first contact (encounter) with
the health care provider in outpatient (ambulatory) setting
- Secondary care - implies care by a specialist usually through
referral from a primary care physician
- Tertiary care - care provided at facilities with advanced
technologies and specialized intensive care units (e.g. academic med.
centers which also conduct researc)
- Ambulatory care -- comprehensive term for all types of health care
provided in an outpatient setting. More and more care is delivered in
this setting (including so-called "drive-in" surgeries...
Issues and Dilemmas
- Rapidly changing relationships between institutions, professionals,
regulators, purchasers and payers
- Public's reaction to health maintenance organizations policies (viewed as
"rationing" care)
- Prevention versus treatment -- the lion's share of funding goes for
latter not for former
- Ongoing Nursing Shortage
- Over-utilization of emergency rooms for routine care (very expensive
care but in many communities only recourse for individuals without insurance
because they can not (at least in theory) be turned away from emergency
care)
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Health professionals concerns:
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Professional autonomy
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Role of science in health professions
(e.g. evidence-based care)
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Relationship between compensation and
independent practice
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Private nature of most of health care
system
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Minimalist attitude toward oversight by
state and Federal agencies
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Economic interests of the professions
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Competition among the health professions
(e.g. nurse practitioners versus physician assistants; pharmacist
versus "hospitalist" physician)
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Importance of protecting the public's
health from ill-prepared or incompetent professionals
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Lack of uniform regulatory language and
laws among states (barriers to effective practice and mobility, use of
telemedicine and other healthcare technologies)
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and??????
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Concerns of health consumers:
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Cost
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Access to affordable health insurance
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Access to quality healthcare
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Patient safety
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Access to high quality health information
(how do you recognize the good, the bad, the ugly... :)
-
and???
Sherrilynne Fuller, PhD
Professor
Biomedical and Health Informatics
School of Medicine and
Information School and
Director, Health Sciences Libraries
University of Washington 35-7155
Seattle, Washington 98195
206-543-5531
206-543-3389 (FAX)
sfuller@u.washington.edu
Updated 1/12/06