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

                                           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
• National Institutes of Health  - the lead health and medical research organization of the US government.

Accreditation:  required for reimbursement for some patient groups;  validates quality of care; provides competitive edge 

• Joint Commission on Accreditation of Healthcare Organizations
• American Osteopathic Association Hospital Accreditation Program
• Commission on Accreditation of Rehabilitation Facilities
• Community Health Accreditation Program (accredits home health agencies)

Regulatory mechanisms of Health Occupations

• 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 research
• Ambulatory care -- comprehensive term for all types of health care provided in an outpatient setting

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)
• Nursing Shortage
• Health professionals concerns:        
  • Professional autonomy
  • Role of science in health professions (e.g. evidence-based care)
  • Relationship between compensation and independent practice
  • Private nature of most of health care system
  • Minimalist attitude toward oversight by state and Federal agencies
  • Economic interests of the professions
  • Importance of protecting the public's health from ill-prepared or incompetent professionals
  • lack of uniform regulatory language and laws among states (barriers to effective practice and mobility, use of telemedicine and other healthcare technologies)
  • and??????
• Concerns of health consumers:
  • Cost
  • Access to health insurance
  • Access to quality healthcare
  • Patient Safety
  • and???