After reading the background materials conduct additional research and respond to the following questions in a 3-4 page paper: 1) Discuss the role of government in responding to historical trends that impact the delivery of care in hospitals. Our nation’s health system has experienced tremendous upheavals since the turn of the previous century.
Provision of care- including availability- payment mechanisms, education and training, and methods of delivery, including structure, have all been influenced by changes in funding and methods of leadership and management at the national, state and local levels (Kilpatrick, 1996) The public, private, non-profit debates have enveloped hospitals and health care providers for the last two decades (Kilpatrick, 1996) The delivery of health during the past century has fundamentally changed and evolved as a result of responding to various economic, domestic and international crises- resulting generally from wars and conflicts, technological advancements and financial constraints (Kilpatrick, 1996)
Physicians and other health professionals, while conscientiously and sincerely attempting to treat and alleviate illness and suffering, have labored without the benefit of an organized and efficient universal health care system (Kilpatrick, 1996) Systematic reinvention and health care reform leading to universal national health delivery was investigated by the Clinton administration during the first half of the administration but was subsequently rejected by the congress.
However changes have occurred in spite of the rejection, changes are reflected in the emergence of the mega health systems crossing traditional geographic boundaries; mergers; acquisitions; and affiliations; financial and organizational threats to Medicare and Medicaid programs, rapid and steady growth in managed care penetrations and various new designs for health education (Kilpatrick, 1996) 2) Describe expansion of hospitals in the United States. Managed care will be the driving force for massive changes in health care organization and delivery, it’s most notable impact will be on the aggressive formation of major health systems (Nauert, 2000) The logic and advantages of health system formation are enormous and will set the stage for unprecedented competition in the new millennium. The driving force for system formation is the rapid development of managed care and the need for market share growth with broadened regional coverage.
The onslaughts of cost control, ambulatory treatment and preventive programs have caused major declines in the hospital admissions and lengths of stay in competitive markets (Nauert, 2000) Specialty services and tertiary care have expanded significantly. Growing attention has been given to curative initiatives focused on cancer and heart disease. This trend will accelerate in the years ahead with the onslaughts of technology and the aging of America. Quaternary services will continue to grow for transplants, neonatal care and intensive care (Nauert, 2000) 3) Identify a minimum of three factors that have contributed to the evolution of health care delivery in the hospital setting. (a) Alternative Delivery System- technical developments, innovations in medicine and surgery, and patient care demands have proliferated an array of alternative delivery system (ADS) facilities.
The following are the broad grouping for ADS: primary care offered on an ambulatory basis in a non-hospital environment, hospital-based specialty programs offered on a brief stay or ambulatory basis, residential nursing and therapeutic programs for chronic diseases, non acute illnesses, and behavioral programs, in house nursing, pharmaceutical and support services along with related medical equipment programs and diagnostic and therapeutic services, drugs and devices using telecommunications and parcel delivery services (Nauert, 2000) (b) Medical and Surgical Breakthroughs- enormous medical advances will be made in genetics. These will be driven by DNA tests that will detail personal risks of virtually all diseases.
Discoveries will drive the use of preventive and curative drugs, diets and regular exams. Tremendous mortality reductions will occur in cancer, heart disease and other leading killers (Nauert, 2000) (c) Behavioral Health Care- Mental health and chemical dependency programs are evolving more rapidly than most other provider services. Notwithstanding pharmaceutical innovations, their costs are increasing at a rate far greater than the rest of the health care industry (Nauert, 2000) 4) Explain the difference between inpatient and outpatient facilities. Behavioral health care systems are being built to better integrate inpatient and outpatient care.
Strategies for developing the systems and procedures focus on reducing the use of inpatient care by minimizing stays, limiting admissions, making proper uses of highly effective medication and referring patients to outpatient and partial hospitalization programs and crisis intervention (Nauert, 2000) The resulting social and ethical inequities challenge providers of health care- clinical as well as management- to seek continuous improvement (Kilpatrick, 1996) The numbers of those who are without health insurance or who are underinsured continues to grow as downsizing, rightsizing, and cost containment drive the economic engine of our society (Kilpatrick, 1996) The emergence of managed care and capitation as the basis of coverage is causing a fundamental rethinking of the importance of respecting the core rights of the individual while maintaining a perspective for the common good.
Considerations of quality of life, and resource constriction must be examined and included in managerial decisions regarding education and practice (Kilpatrick, 1996) 5) Discuss how the increasing growth of an aging population impacts the evolution of hospital care. The 1991 Pew Commission report identified eight trends which were predicted to shape the delivery of health care. Some of the trends tend to focus more on the aging population of our country. a) Increased Organizational Complexity and Diversity- increasingly, health care organizations will change from hospitals to comprehensive systems of care, associations of physicians groups and capitated groups of patients (b) Spread of the Corporate Paradigm in Health Care- hundreds of networks, affiliations, and mergers have transformed the health care landscape into one unrecognizable a decade ago (c) Shift from Professional Values to Managerial Values- major focuses today in the control of health care delivery are toward economy, cost effectiveness and practices.
Effective health care management may supersede the leadership of decision making by physicians (d) Changing Nature of Long Term Care- development of affordable and high quality continuing care for the elderly. As our population’s longevity grows as a percent of the total population, not only will demand increase, but insistence upon alternatives and emphasis on quality will also affect this sector of the health care system (Kilpatrick, 1996)