Trends in Healthcare
Dec 14, 2015
Cost containment• Trying to control the rising cost of
healthcare and achieving the maximum benefit for every dollar spent
Reasons for high health care costs
• Technological Advances– Transplants– Artificial hearts– Computers
• The Aging Population– More medications
– More chronic diseases
– Frequency of health care services
Health Related Lawsuits
expensive malpractice insurance
unnecessary diagnostic tests
defensive health care
The Big Issue
• Health care costs prohibit services to all individuals
• Everyone should have equal access to care regardless of their ability to pay
Methods of cost containment• Diagnostic Related Groups (DRGs)
– Congress uses this to control costs for government insurance such as Medicaid and Medicare
– Certain diagnoses who are admitted to hospitals are placed in one payment group
– Limits are placed on cost of care and the agency only receives this set amount
– If costs of care less than amount paid, agency keeps the extra money, if more the agency must accept the loss
Combination of Services
• Eliminate duplication of services
• Health care agencies join together or share specific services to provide care for larger number of people at a decreased cost per person
• Example: Labs
Outpatient Services
• Not admitted• Reduces hospital
length of stay• lowers the cost• Surgeries, xrays,
diagnostic tests, etc done as outpatient services
Prevention more cost effective than treatment!
• patient education• immunizations• regular physical
exams• incentives for
preventive health care services
• easy access for all individuals
• cost efficient• avoids emergency
rooms and acute care facilities
Methods to Conserve Energy
• Design and build new energy efficient facilities
• monitor/maintain Heating/cooling systems
• insulation and thermopane windows to prevent hot/cool air loss
Conserving Energy• Repair plumbing• replace energy
consuming lightbulbs• install infrared
sensors to turn water on and off
• alternative forms of energy such as solar power
• recycling
Agency for Health Care Policy and Research (AHCPR)
• This agency researches the quality of health care delivery and identifies the standard of treatment that should be provided.
Health Care Consumers
• Responsible for their own care
• Better informed of all of their options
• Preventive measures
Geriatric Care
• Care for the elderly• Experiencing rapid
growth due to a large number of people experiencing longer life spans due to advances in health care
• Baby BOOM generation – born after WW II
Increased Demand for Services
• Adult Daycare• Retirement
Communities• Assisted and
independent living facilities
• Other Organizations
OBRA
• Omnibus Budget Reconciliation Act of 1987
• Led to the development of many organizations with regulations in long term care and home health care
OBRA
• Established training and competency evaluations for nursing and geriatric assistants
• Must be certified or registered as a certified nursing assistant
OBRA
• Continuing education, evaluation of performance and retraining/or testing if CNA has not worked in Health care facility for over 2 years
• State registry• Patient/resident rights• Must comply with these
regulations
Telemedicine
• Involves use of video, audio and computer systems
• Allows interactive services between Health care worker’s in different locations
• Robotic surgery• Computers help patients
receive care in their own homes
Wellness
• State of being in optimum health and with a balanced relationship between physical, mental and social health
Promoting Wellness
• Physical Wellness– Diet – Exercise– Physical exams– Immunizations– Dental and vision care– Avoidance of alcohol,
tobacco, caffeine, drugs, environmental contaminants and risky sexual behavior
Emotional Wellness
• Understanding personal feelings and expressing them appropriately
• Accepting one’s limitations
• Adjust to change• Cope with stress• Enjoy life• Be optimistic
Social Wellness
• Show concern• Fairness• Affection• Tolerance• Respect for others• Communication• Sharing ideas and
thoughts• Honesty and integrity
Mental and Intellectual Wellness
• Be creative• Logical• Curious• Open minded• Use common sense• Obtain continual
learning• Question and evaluate• Learn from life’s
experiences• Be flexible • Be creative
Spiritual Wellness
• Values
• Ethics and Morals
• To find meaning
• Direction and Purpose in life
• Religious practices
Holistic Health Care
• Care that promotes physical, emotional, social, intellectual, and spiritual well-being by treating the whole
body, mind and soul
Holistic Health Care
• Each patient is unique• Variety of methods of
diagnosis and treatment
• Treatment directed toward protection and restoration
• Natural healing• Personal choices
Complementary and Alternative Methods of Health Care
• Complementary treatments are used in conjunction with conventional medical therapies
• Alternative methods of treatment are used in place of biomedical therapies
Integrative (integrated) Health Care
• Uses both mainstream medical treatments and CAM therapies to treat a patient
CAM Therapies
• Consider whole individual and recognize that the health of each part has an effect on the person’s total health status
CAM Therapies
• Each person has a life force or special type of energy that can be used in the healing process
• Skilled practitioners, rituals, and specialized practices are a part of therapy
CAM Therapies
• Antioxidants: Nutritional therapy that encourages the use of substances to prevent or inhibit oxidation and neutralize free radicals
• Heart disease, cataracts, and some cancers
Meditation
• Therapies that teach breathing and muscle relaxation techniques to quiet the mind and focusing attention or obtaining a sense of oneness within oneself
• Reduce stress, slow heart rate, decrease blood pressure
Ayruvedic Practitioners
• Developed in India, an ancient philosophy to determine a person’s predominant dosha (body type) and prescribe diet, herbal treatment, exercise, yoga, massage, etc. to restore harmony in the body
Chinese Medicine
• Ancient holistic-based healing practice based on the belief that a life energy (CHI) flows through every living person in an invisible system of pathways to link the organs with the universe
• Accupuncture, tai chi
Chiropractors
• Believe that the brain sends vital energy to all body parts through nerves in the spinal cord and when there is a misalignment of the vertebrae, exerts pressure, resulting in disease and pain
• Use spinal manipulation, massage and exercise
Homeopaths
• Believe in the ability of the body to heal itself through the actions of the immune system
• Use diluted substances to cause similar symptoms of the disease to activate the immune system
Hypnotists
• Help an individual obtain a trance-like state with the belief that the person will be receptive to verbal suggestions and able to make a desired behavior change
• Smoking cessation, weight loss, phobias, etc.
Naturopaths
• Use only natural therapies such as fasting, special diets, lifestyle changes, and supportive approaches to promote healing
• Avoid use of surgery or medicinal agents to treat disease
Play therapy
• Therapy that uses toys to allow children to learn about situations, share experiences and express their emotions
• Psychotherapy for children with limited language ability
Aromatherapy
• Use selected fragrances (concentrated essences or essential oils) that have been extracted from roots, plants, bark, and/or flowers to alter the mood and restore the body, mind and spirit
Tai Chi
• Based on the ancient theory that health is harmony with nature and the universe and a balanced state of yin (cold) and yang (heat)
• Series of movements and breathing techniques
National Center for Complementary and Alternative
Medicine
• NCCAM
• Researches various therapies and determines standards of quality care
State Requirements
• Some have established standards for CAMs• Forbidden in some states• Labeled as experimental• Require a license or certain educational
requirements before practicing• Learn the legal requirements for your state• Patient has the right to choose their care• Nonjudgmental attitude
National Health Care Plan
• The main goal is health care reform to ensure that all Americans can get health coverage
Pandemic• Outbreak of disease that
occurs over a wide geographic area and affects a high proportion of the population
World Health Organization
• WHO
• WHO is concerned about influenza pandemics occurring now and in the near future
Historically
• Influenza pandemics have killed large numbers of people
• Example: 1918 Spanish Flu Pandemic killed about 40 million people who contracted the disease
Avian (Bird) Flu
• Virus was identified as the cause of an epidemic.
• Virus jumped directly to humans
• H5N1 present in countries in Asia and elsewhere
• Passed from bird to bird and devastated flocks of birds in
11 countries
H5N1 and Humans
• Most cases resulted from persons who had contact with infected poultry or contaminated surfaces
• Spread from person to person rare
• Death rate in humans was 50-60 %
• Concern was mutation of the virus
Hantavirus
• Spread by rodents• Severe acute
respiratory syndrome (SARS), Monkeypox, Filoviruses such as Ebola virus, and Marburg virus can cause hemorrhagic fever
• WHO estimates that 2-7 million people worldwide could die from infections from these types of viruses
Pandemic Flu Plans
• Education- info about pandemics and ways to avoid its spread
• Antiviral drugs - must be stockpiled and ready for immediate use
• More research to develop and produce effective antivirals
• Development of protective public health measures- Influenza must be diagnosed rapidly. Strict infection control methods to limit the spread of the virus
Planning
• First Responders and Health Care personnel must be immunized so they can care for the infected individuals
• Quarantine measures- to control the spread of disease
• International cooperation- countries must be willing to work with each other to create international plans to limit the spread of lethal viruses and decrease the severity of a pandemic
Swine Flu (H1N1)
• Respiratory disease of pigs caused by Type A influenza virus
• First isolated in 1930• High levels of illness
and low death rates in pigs
• Do not normally infect humans, but sporadic infections have occurred
H1N1 in humans
• Most commonly occurs in persons with direct exposure to pigs
• Symptoms of swine flu are fever, lethargy, lack of appetite, coughing which are similar symptoms to the seasonal flu
• Some other symptoms maybe runny nose, sore throat, nausea, vomiting and diarrhea
H1N1
• You can not get H1N1 from eating pork
• It can be spread from pigs to people and people to pigs
• You may also have human to human transmission
• There are medications to treat the H1N1 virus
Who is at risk?
• Children under the age of 2
• People who suffer with heart disease or diabetes
• Asthmatics and pregnant women
• Teenagers and young adults are also more vulnerable
• Health Care Workers
Prevention
• Wash your hands• Stay away from
crowded areas• Cover your mouth
when you sneeze or cough
• REMEMBER: It is a treatable and curable disease