Deck 13: Health Care Delivery in the United States

Question 1

Using Table from this chapter, identify two different health care facilities in your community for each of the levels of care. Briefly describe each facility and determine whether each one is private, public, or voluntary.
Table The Spectrum of Health Care Delivery
Sources: Cambridge Research Institute (1976). Trends Affecting the U.S. Health Care System. Washington, DC: U.S. Government Printing Office; U.S. Public Health Service (1994). For a Healthy Nation: Return on Investments in Public Health. Washington, DC: Author; Turnock, B. J. (2009). Public Health: What It Is and How It Works, 4th ed. Sudbury, MA: Jones Bartlett Learning; Shi, L., and D. A. Singh (2010). Essentials of the U.S. Health Care System, 2nd ed. Sudbury, MA: Jones Bartlett Learning.

Answer 1

Health care facility:
Health care facility is the place where the health care will be provided. The places includes primary health care centers, hospitals, public clinics or outpatient care centers, private clinics, and specialized centers. These are the different type of health care facilities available in the local community of Mr. X.
Levels of care:
•Population based health activities
•Primary care ( stage 0)
•Secondary care ( stage 1)
•Tertiary care ( stage 2)
•Restorative care ( stage 3)
•Long term care ( stage 4)
•End-of-life care (stage 5)
Population based health activities (care):
Population based health sector is conducting health camps in schools, to educate people about health issues, and to conduct public and private health camps. It is considered as public and voluntary services.
Primary health care:
Primary health centers, public and private health clinics, outpatient care centers are included in primary health care level. It is the public and private centers.
Secondary health care:
Secondary health care level includes specialized treatment centers, home health centers, surgical centers, and emergency rooms. It is highly privatized centers.
Tertiary health care:
Tertiary health care includes general hospitals, specialized attention on patients with chronic and psychiatric diseases. This level will show some special attention in chronic diseases. It is a public center.
Restorative care:
Restorative care is caring the person who has undergone a surgery. It is to take care of the post-surgical care. It is a private center.
Long term care:
Nursing homes, home for mentally retarded people acts as a long-term care centers. People with chronic diseases will also include in long term care. It is a private center.
End-of-life care:
It is the care for the people who are having less than six months to live. It is public, private, and voluntary services.

Question 2

What are the domains of practice noted in the spectrum of health care?

Answer 2

Spectrum of health care:
The various types of health care providers and facilities available under the health care system are termed as spectrum of health care.
1. Public health practice based on population:
Aim of this practice is to prevent diseases and health promotion. Public, school, and community health programs and public health clinics are examples.
2. Long-term practice:
Long-term practice is classified in to two types as given below:
•Restorative care
•Long-term care
3. Medical practice:
Medical practice is classified into three types as given below:
•Primary care:
Primary care facilitates the first-contact treatment, clinical preventive treatment, and ongoing treatment for common diseases.
•Secondary care:
It is classified into two types as given below:
•Acute care:
It is an intense medical care for short-term which requires hospitalization.
•Sub-acute care:
The acute care requires a nursing intervention for some period. Hence, the after acute care is termed as sub-acute care. This does not require hospitalization.
•Tertiary care:
A kind of the subspecialty referral care necessitating vastly expertise facilities and personnel is termed as tertiary care.
4. End-of-life practice:
The care facilitates to those who are affected through serious diseases and their lifetime will end by less than six months.

Question 3

What are three major problems facing the health care system in the United States?

Answer 3

Health care system:
Health care system refers to the organized group of people, resources, or institutions that offers services related to health care for achieving the health requirement of the citizens or target population.
The following are the three major issues faced by U country health care system:
•Cost containment
•Access to health care
•Quality of health care
The 60-degree of the above figure (K's equilateral triangle) represents the equal priorities for above three major issues. It means, access is equally important like cost containment and quality and vice versa. However, the increase in one side of the angles leads to compromise on one or both the angles.
For example, the quality health care service should be accessible within a travelled distance with affordable cost. The high quality health care system is only available in single place within the country and high cost is not accessible and affordable by all citizens.

Question 4

Have you ever experienced a situation similar to the one described in the scenario? If so, briefly describe it.

Question 5

Visit an HMO in your area and find the answers to the following: (a) What type of HMO is it? (b) How does one enroll? (c) What does it cost? (d) What services are provided? and (e) Why should someone get his or her health care from an HMO instead of the more traditional private-practice physician?

Question 6

How is the quality of health care services measured?

Question 7

Why have some questioned whether the United States really has a health care system?

Question 8

Is there a demand for health care workers in the United States today? If so, why?

Question 9

Explain how each of the following types of reimbursement works: fee-for-service, packaged pricing, resource-based relative value scale, prepaid health care, and prospective reimbursement.

Question 10

Make an appointment to interview three health care workers in your community who have different types of jobs. Ask them what they like and dislike about their work, what kind of education they needed, whether they are happy with their work, and whether they would recommend that others seek this line of work. Summarize your findings in a written paper.

Question 11

In what type of facility are most health care workers employed?

Question 12

On what basic concept is insurance based?

Question 13

If we truly had a "health care system" in this country, how would this scenario be different?

Question 14

What is the difference between independent and limited (restricted) care providers?

Question 15

Explain the following insurance policy provisions: (a) a $200 deductible, (b) 20/80 co-insurance, (c) a $4,500 fixed indemnity for a basic surgical procedure, (d) an exclusion of the preexisting condition of lung cancer, and (e) a $10 copayment.

Question 16

Describe some of the major changes that have taken place in health care delivery over the years.

Question 17

What are the differences between allopathic and nonallopathic health care providers?

Question 18

What is the difference between Medicare and Medicaid?

Question 19

Obtain a copy of a local newspaper (the Sunday edition is best) and look through the "want ads" for health care worker jobs. In a one-page paper, briefly describe what you have found and summarize the status of health care position openings in your community.

Question 20

Define complementary and alternative medicine and give a few examples of each.

Question 21

What is covered in each of the four parts of Medicare-Parts A, B, C, and D?

Question 22

Do you think Chad did the right thing?

Question 23

What kind of education do limited (restricted) care providers have?

Question 24

What relationship does Medigap insurance have to Medicare?

Question 25

What is meant by third-party payment ?

Question 26

What is the difference between LPNs and RNs?

Question 27

What is the Children's Health Insurance Program (CHIP)?

Question 28

Create a list of all the health care providers from whom your family has sought help in the past 5 years. Group the individuals into the six provider groups outlined in the chapter. When appropriate, identify the providers' specialties and whether they were allopathic, osteopathic, or nonallopathic providers.

Question 29

What are advanced practice nurses (APNs)?

Question 30

Briefly explain the differences among health maintenance organizations (HMOs), preferred provider organizations (PPOs), exclusive provider organizations (EPOs), and a point-of-service option.

Question 31

If you were Chad, what would you have done? If you had zero-deductible health insurance, would it make a difference in what you would do?

Question 32

What are nonphysician practitioners?

Question 33

What are the advantages and disadvantages of managed care?

Question 34

Why has the cost of health care in the United States continued to grow faster than the cost of inflation?

Question 35

What role do public health professionals play in health care delivery?

Question 36

What is meant by the term consumer-directed health plans ? Give some examples.

Question 37

Make an appointment to interview an administrator in the local (city or county) health department. In the interview, find out what kind of people, by profession, work in the department. Also find out what type(s) of health care services and clinics are offered by the department. Summarize your findings in a two-page paper.

Question 38

What are the advantages of outpatient care facilities?

Question 39

What is the major result of the Affordable Care Act passed in 2010?

Question 40

Which of the options available to Chad do you think was the most expensive? Least expensive? Why?

Question 41

What is meant by a long-term care facility? Give two examples.

Question 42

What is meant by a spectrum of health care ?

Question 43

Why has the number of home health care agencies increased in recent years?

Question 44

Obtain a copy of the student health insurance policy available at your school. After reading the policy, summarize in writing what you have read. In your summary, indicate what type of reimbursement system is used to pay providers, list specifics about the premium costs, deductible, co-insurance, copayment, fixed indemnity, and any exclusions.

Question 45

What is the Joint Commission? What does it do?