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Fiscal year 2002, Sustaining community health: the experience of health care system leaders. Hospitals are also employers, and in the case of two Lawndale, Illinois, hospitals, collaboration with the local development corporation and other neighborhood organizations in 1999 made affordable local housing available to employees, helping to facilitate community development (University of Illinois, 1999). Conclusion. 1998. To deliver the type of health care envisioned in Crossing the Quality Chasm (IOM, 2001b), health care professionals must be trained to work in teams, to utilize information technology effectively, and to develop the competencies necessary to deliver care to an increasingly diverse population. Additionally, the media may be a powerful tool for familiarizing the public with health and health care issues and a conduit for raising important questions, stimulating public interest, or even influencing the public's health behaviors. In addition, an estimated 1,300 public hospitals nationwide (Legnini et al., 1999) provide free care to those without insurance or resources to pay. Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. As the committee observed in Chapter 1, American medicine and the basic and clinical research that inform its practice are generally acknowledged as the best in the world. 1. Each of the 6 components of health is somehow integrated, which incorporates social, physical, emotional, spiritual, cognitive, and cultural health. Publicly funded insurance is provided primarily through seven government programs (see Table 51). In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library. SOURCE: Brewster et al. Additionally, those with no insurance all year paid nearly 60 percent of costs out-of-pocket, whereas those with some private insurance paid 40 percent of costs out-of-pocket in 1996 (Zuvekas, 2001). The involvement of AHCs in the communities is also likely to increase in the coming years. The National Community Care Network Demonstration Program, sponsored by the Hospital Research and Education Trust (HRET), reports on hospitals across the country that are supporting activities beyond the delivery of medical care to improve health status and quality of life in local communities. Some are based in the public sector; others operate in the private sector as either for-profit or not-for-profit entities. DoD's dual health care mission is carried out through a direct care system that comprises 530 Army, Navy, and Air Force Military Treatment Facilities (MTFs) worldwide. In particular, managed care rules have changed to allow increased coverage of care provided in emergency departments. DHHS (2002). The Emerging Infections Program (EIP) is a collaboration among CDC, state public health departments, and other public health partners for the purpose of conducting population-based surveillance and research on infectious diseases. Untreated ear infections, for example, can have permanent consequences of hearing loss or deafness. (See Capitation/Discounts and Utilization Controls) Health care services are paid for by the insurance company and the patient. Medicare excludes coverage of routine dental care, and many state Medicaid programs do not provide dental coverage for eligible children or adults. 2002, Medicaid and Other State Healthcare Issues: The Current Situation, NASBO analysis: Medicaid to stress state budgets severely into fiscal 2003, Early release of selected estimates based on data from the JanuaryJune 2001 National Health Interview Survey, Information for Health: A Strategy for Building the National Health Information Infrastructure, Nurse Staffing and Patient Outcomes in Hospitals. That committee further identified core safety-net providers as having two distinguishing characteristics: (1) by legal mandate or explicitly adopted mission they maintain an open door,' offering access to services to patients regardless of their ability to pay; and (2) a substantial share of their patient mix is uninsured, Medicaid, and other vulnerable patients (IOM, 2000a: 3). . Seedco and the Non-Profit Assistance Corporation (N-PAC). . Second, they are the principal providers of specialized services and serve as regional referral centers for smaller towns or cities and rural areas. At this time, governmental public health agencies are still called on to play a role in assurance broader than that which may be compatible with their other responsibilities to population health. In general, hospitals in rural areas report the highest percentage of vacant positions. For example, racial differences in cervical cancer deaths have increased over time, despite the greater use of screening tests by minority women (Mitchell and McCormack, 1997). The most common conditions fall into the broad categories of schizophrenia, affective disorders (including major depression and bipolar or manic-depressive illness), and anxiety disorders (e.g., panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and phobia). Defining the right level of immediate and standby capacity for emergency and inpatient care depends in part on the adequacy and effectiveness of general outpatient and primary care. What is stands for: Health Maintenance Organization What it is: In an HMO plan, you typically must select a primary care physician (or "PCP") from a local network of health . This number represented about 15 percent of the total population of 274 million persons at that time and 17 percent of the population younger than 65 years of age; 10 million of the uninsured are children under the age of 18 (about 14 percent of all children), and about 32 million are adults between the ages of 18 and 65 (about 19 percent of all adults in this age group). 2002. of those objectives, a healthcare delivery system concept model was developed (see Figure 3) that is comprised of three major components: primary . As seen in Figure 1, there are four standard components of healthcare information systems: operational, financial, administrative, and patient information. The first sector of health care is primary care. Medicare provides coverage to 13.5 percent of the population, whereas Medicaid covers 11.2 percent of the population (Mills, 2002). Health Care Systems differ from nation to nation depending upon the level of economic development and the political system in place. With start-up funding from a local foundation, its own fundraising, and annual corporate sponsorships ranging from $35,000 to $150,000 from local hospitals and businesses, the coalition launched a Safe Communities initiative with a 52-member community advisory panel. Recommended Content: Reserve Health Readiness Program (RHRP) | Health Care Administration & Operations The Reserve Health Readiness Program provides services to members of the National Guard or Reserve and to active duty service members enrolled in TRICARE Prime Remote, including medical readiness, dental readiness, and deployment services. 2000. As the committee has noted, health-related (mostly health care-related) spending in the United States amounted to $1.3 trillion in 2000, about 13.2 percent of the gross domestic product (Levit et al., 2002). Over the same period, medical and surgical bed capacities were reduced by 17.7 percent, ICU bed capacities were reduced by 2.8 percent, and specialty bed (including burn bed) capacities were reduced by 3.4 percent. A healthcare delivery system refers to the way people, institutions, and resources are organized to offer medical services to address the diverse health needs of the targeted populations. A consistent body of research indicates that African-American and Hispanic physicians are more likely to provide services in minority and underserved communities and are more likely to treat patients who are poor, Medicaid eligible, and sicker (IOM, 2001c). Counseling to address serious health riskstobacco use, physical inactivity, risky drinking, poor nutritionis least likely to be covered by an employer-sponsored health plan. As with other types of health services, insurance is a strong predictor of access to and use of dental services, and minorities and low-income populations are much less likely to have dental insurance or to receive dental care. org/about/community/services/, www.nasbo.org/Publications/PDFs/medicaid2003. Figure 3-3 provides a basic model that identifies the essential components that form the basis of the U.S. health care system. Such services include immunizations and screening tests, as well as counseling aimed at changing the personal health behaviors of patients long before clinical disease develops. 2000. U.S. Office of Management and Budget (OMB). This reflects the divergence and separate development of two distinct sectors following the Second World War. As with other forms of safety-net care, the urgency of providing treatment to the severely mentally ill erodes funds available for prevention purposes. This oversight is often reflected by health insurance coverage restrictions that exclude oral (more). The shortage of hospital-based nurses reflects several factors, including the aging of the population, declining nursing school enrollment numbers (Sherer, 2001), the aging of the nursing workforce (the average age increased from 43.1 years in 1992 to 45.2 years in 2000) (Spratley et al., 2000), and dissatisfaction among nurses with the hospital work environment. However, the increase in health spending also reflects the success of federal and state efforts to enroll more low-income children in Medicaid and the State Children's Health Insurance Program, increased enrollment in Medicare as the population ages, and some erosion of unpopular cost-control features imposed by managed care plans. Half of such funds come from dedicated funding at the federal, state, and local levels in the form of various block grants to state safety-net programs. As the proportion of old and very old increases, the system-wide impact in terms of cost and increased disability may well overwhelm the human and financial resources available to care for chronically ill patients. Substance abuse, like mental illness, exacts enormous social costs across all segments of society. This change has been a challenge to the multiple roles of public health departments as community-based primary health care providers, safety-net providers, and providers of population-based or traditional public health services. While there Provide greater resources to the Department of Health and Human Services Office of Civil Rights to enforce civil rights laws. 2001. Needleman J, Buerhaus PI, Mattke S, Stewart M, Zelevinsky K. 2001. 1998. A 1998 finalist for the Foster G. McGaw Prize for Excellence in Community Service co-sponsored by AHA, the Franklin Community Health Network (FCHN) in Farmington, Maine, took the lead in developing a coalition and providing seed money to start a Rural Schools Equity Campaign (AHA, 2002). 2002. Unfortunately, data on the program's progress are incomplete and inconsistent across the country, despite federal requirements for state reports (GAO, 2001a). Objective The WHO developed a manual outlining the preliminary organizational and health professionals' readiness to implement electronic medical records (EMR). To support the system, the United States spends more per capita on health care than any other country ($4,637 in 2000) (Reinhardt et al., 2002). The relentless focus on controlling costs over the past decade has squeezed a great deal of excess capacity out of the health care system, particularly the hospital system. The committee recommends that bold, large-scale demonstrations be funded by the federal government and other major investors in health care to test radical new approaches to increase the efficiency and effectiveness of health care financing and delivery systems. In early 2001, Medicaid and the State Children's Health Insurance Program (SCHIP) provided health care coverage to 23.1 percent of the children in the United States, and this figure had risen to 27.7 percent according to data from the first-quarter estimates in the National Health Interview Survey (NCHS, 2002). However, some studies have demonstrated that EPSDT has never been fully implemented, and the percentage of children receiving preventive care through it remains low for reasons ranging from systemic state or local deficiencies (e.g., a lack of mechanisms for follow-up, issues related to managed care contracting, and confusing program requirements) to barriers at the personal level (e.g., transportation and language) (GAO, 2001a; Strasz et al., 2002). What are the primary objectives of a health care delivery system? The IOM Committee on the Changing Market, Managed Care and the Future Viability of Safety Net Providers defined safety-net providers as [t]hose providers that organize and deliver a significant level of health care and other health-related services to uninsured, Medicaid, and other vulnerable patients (IOM, 2000a: 21). However, the higher rates of uninsurance among racial and ethnic minorities contribute significantly to their reduced overall likelihood of receiving clinical preventive services and to their poorer clinical outcomes (Haas and Adler, 2001). The fourth component is health care. Smith V, Ellis E, Gifford K, Ramesh R, Wachino V. 2002. Additionally, data show that as many as 50 percent of children who have an EPSDT visit are identified as requiring medical attention, but if they are referred for follow-up care, only one-third to two-thirds go for their referral visit (Rosenbach and Gavin, 1998). coordination in healthcare is imperative. Aiken L, Clarke S, Sloane D, Sochalski J, Busse R, Clarke H, Giovannetti P, Hunt J, Rafferty A, Shamian J. The Population Health Care Delivery Model. Crossing the Quality Chasm (IOM, 2001b) formulated the case that information technology is critical to the redesign of the health care system to achieve a substantial improvement in the quality of care. To ensure healthy patients, you must have healthy health care systems. Manic-depressive illness is reported to exist in 1 percent of adults. In addition to the linkages between the health care delivery system and governmental public health agencies, health care providers also interface with other actors in the public health system, such as communities, the media, and businesses and employers. Fragmentation of health plans along socioeconomic lines engenders different clinical cultures, with different practice norms (Bloche, 2001). A survey of 69 hospitals belonging to the National Association of Public Hospitals indicated that in 1997, public hospitals provided more than 23 percent of the nation's uncompensated hospital care (measured as the sum of bad debt and charity care) (IOM, 2000a). For individuals with Medicare, the following services are covered by Medicare Part B: Number of eligible children. As patterns of health care delivery change, old reporting systems are undermined, but the opportunities offered by new types of care systems and technologies have not been realized. A term used to describe how a national, regional, or local health care system is organized, administered, provided, and paid for, sometimes to a circumscribed system such as that under the auspices of a specific medical and hospital insurance carrier or health maintenance organization. These risk behaviors are estimated to account for more than half of all premature deaths; smoking alone contributes to one out of five deaths (McGinnis and Foege, 1993). 1994. Total spending on drug abuse treatment equaled $5.5 billion in that year, compared with estimated social costs of drug abuse of $116.9 billion. The EIP sites have performed investigations of meningococcal and streptococcal diseases and have established surveillance for unexplained deaths and severe illnesses as an attempt to identify diseases and infectious agents, known and unknown, that can lead to severe illness or death (CDC, 2002). The convergence and potentially adverse consequences of these new and powerful dynamics lead the committee to be highly concerned about the future viability of the safety net. Consumer demands for more choice and greater flexibility are weakening restrictions on access to providers and limitations on services. Although the trend toward inclusion of clinical preventive services is positive, such benefits are still limited in scope and are not well correlated with evidence regarding the effectiveness of individual services. But how is organized in different countries? Even when insured, limitations on coverage may still impede people's access to care. 1999. The number of eligible children fell by more than half a million between 1995 and 1996. Cagney KA, Kerner J. Federal and state policy makers should explicitly take into account and address the full impact (both intended and unintended) of changes in Medicaid policies on the viability of safety-net providers and (more). 2001. The Internet already offers a wealth of information and access to the most current evidence to help individuals maintain their own health and manage disease. For children, too, being uninsured tends to reduce access to health care and is associated with poorer health. The U.S. Preventive Services Task Force calls these interventions vitally important.. The latter rely on health care providers and laboratories to supply the data that are the basis for disease surveillance. This chapter has outlined the main areas in which the health care delivery system and the governmental public health agencies interface. Between 1991 and 1996, the number of children eligible for the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program increased by roughly 5.7 million, with the highest number (23.5 million children) occurring in 1995. 2000. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. However, hospitals play a uniquely important role by serving as the primary source of emergency and highly specialized care such as that in intensive care units (ICUs) and centers for cardiac care and burn treatment. This committee was not constituted to make specific recommendations about health insurance. This rule reduced the cost of health insurance coverage. Among physicians, about 3 percent are African American, 2.2 percent are Hispanic, and 3.6 percent are Asian (AAMC, 2000). Delivery of high-quality care to chronically ill patients is especially challenging in a decentralized and fragmented system, characterized by small practices (AMA, 1998). The four basic components are financing, insurance, delivery, and payment. 2001. Health care delivery systems differ depend- ing on the arrangement of these components. In 1988, about three-quarters of adults with employment-based health insurance had a benefit package that included adult physical examinations. The existing health-care delivery system in the United States is a conglomerate of health practitioners, agencies, and organizations, all of which share the mission of health-care delivery but operate more or less independently. Medical screening. CDC, National Center for Infectious Diseases Surveillance Resources, Program Information on Medicare Medicaid, SCHIP & Other Programs of the Centers for Medicare & Medicaid Services, Medicare program information, Section III.B.1, State Children's Health Insurance Program: Fiscal year 2001 annual enrollment report, National Estimates of Expenditures for Substance Abuse Treatment, 1997, Health-care costs jump at CalPERS: big premium increase may signal trend, Mental health service utilization by African Americans and whites: The Baltimore Epidemiologic Catchment Area Follow-up, Clinical Guidelines for Major Depressive Disorder, Frequent overcrowding in U.S. emergency departments, Mental Health: A Report of the Surgeon General, Objective 18: mental health and mental disorders, Oral Health in America: A Report of the Surgeon General, 2002 CMS Statistics. the IOM Committee on the Consequences of Uninsurance (IOM, 2001a) found the following: Federal and state policy makers should explicitly take into account and address the full impact (both intended and unintended) of changes in Medicaid policies on the viability of safety-net providers and the populations they serve. Academic health centers (AHCs) serve as a critical interface with governmental public health agencies in several ways. Health care is a priority and source of concern worldwide. (1998). Support the use of interpretation services where community need exists. O'Malley AS, Mandelblatt J, Gold K, Although assurance is a core function of public health, governmental public health agencies often do more than assure that people can access health care services; public health departments may become providers of last resort in areas where no other services are available for low-income, uninsured populations and when managed care services to Medicaid and uninsured populations are discontinued. According to the American Hospital Association (2001a), the demand for emergency department care increased by 15 percent between 1990 and 1999. a Baxter R, Rubin R, Steinberg C, Carroll C, Shapiro J, Yang A. Typically subspecialty care focused on a particular organ system or disease process. For example, admission rates for asthma were 6.4 percent higher in low-income areas than in higher-income areas, with more than 70 percent of the variation explained by household income (Billings et al., 1993). Health professions education is not currently organized to produce these results. Insurance policies held by many individuals constrain the use of substance abuse services by the exclusion of benefits for such services and by the use of annual and lifetime limits on benefits and other controls on service utilization. Children without health insurance may be compromised in ways that will diminish their health and productivity throughout their lives. A strong clinical information infrastructure is a prerequisite to reengineering processes of care; coordinating patient care across providers, plans, and settings and over time; supporting the operation of multidisciplinary teams and the application of clinical support tools; and facilitating the use of performance and outcome measures for quality improvement and accountability. Recent surveys have found that less than half of U.S. patients with hypertension, depression, diabetes, and asthma are receiving appropriate treatments (Wagner et al., 2001). A number of major insurance plans have announced that they will begin to offer defined-contribution options.2 This may be attractive to employers, whose liability will be defined by a specific premium amount rather than by a specified set of benefits. There is a significant . 4 Components of the United State health care delivery system. 1993. (Ed.). At present, nine states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee) act as a national resource for the surveillance, prevention, and control of emerging infectious diseases (CDC, 2002). Communication, collaboration, or systems planning among these various entities is limited and is almost incidental to their operations. States are largely . With these chronic . Because the largest public programs are directed to the aged, disabled, and low-income populations, they cover a disproportionate share of the chronically ill and disabled. Burstin HR, Swartz K, O'Neill AC, Orav EJ, Brennan TA. Every country irrespective of its private, public or mixed health care system faces challenges with regard to quality, delivery and cost of services. According to the Department of Health and Human Services (DHHS) Office of Health Promotion and Disease Prevention, more than 150 million Americans have limited or no dental insurance, nearly four times the number who lack insurance for medical care (cited by Allukian, 1999). The health care sector also includes regulators, some voluntary and others governmental. The health care sector in the United States consists of an array of clinicians, hospitals and other health care facilities, insurance plans, and purchasers of health care services, all operating in various configurations of groups, networks, and independent practices.