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- The nurse reviews a theory for applicability to a family health situation. System 2. Hypothesis 3. Propositions 4. Conceptual model 3. The nurse prepares to assess a family according to a family development theory. Which action will the nurse...
- Mesosystem 2. Exosystem 3. Microsystem 4. Macrosystem 6. The nurse reviews the bioecological system theory before discussing this approach with a group of new graduate nurses. What should the nurse explain as the blueprint for the ecology of human...
- Which actions will the nurse complete during this assessment? Complete a family ecomap 2. Determine normative and nonnormative events 3. Complete a family genogram 4. Conduct family member care-planning sessions 5. Ans: 4 Page: 29 1. Theories are designed to make sense of the world by showing how one concept is related to another and how together they make a meaningful pattern that can predict the consequences of certain clusters of characteristics or events. The major function of theory in family nursing is to provide knowledge and understanding that improves nursing services to families. Ans: 2 Page: 29 1. Feedback System is not part of a theory. A hypothesis is a way of stating an expected relationship between concepts or an expected proposition. Propositions are statements about the proposed relationship between two or more concepts. A conceptual model is a set of general propositions that integrate concepts into meaningful configurations or patterns.
- Rowe Family Health Care Nursing, 6e 1. Feedback The health of individual members is analyzed according to the impact on the entire family unit. The employment status of the parents is not a specific feature of family development theory. When conducting family assessments using the developmental model, nurses begin by determining the family structure and where this family falls in the family life cycle stages. Ans: 1 Page: 47 1. Feedback A primary criticism of family development theory is that it best describes the trajectory of intact, two-parent, heterosexual nuclear families. It does not consider same-sex couples and normalizes one type of family while ignoring others. Children leaving home to go to college would be an expected trajectory within the developmental model.
- 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. However, they are also enormously important for children. Being uninsured, although not the only barrier to obtaining health care, is by all indications the most significant one. Those without health insurance or without insurance for particular types of services face serious, sometimes insurmountable barriers to necessary and appropriate care.
- Page Share Cite Suggested Citation:"5. The Health Care Delivery System. The Future of the Public's Health in the 21st Century. Children without health insurance may be compromised in ways that will diminish their health and productivity throughout their lives. When individuals cannot access mainstream health care services, they often seek care from the so-called safety-net providers. These providers include institutions and professionals that by mandate or mission deliver a large amount of care to uninsured and other vulnerable populations. People turn to safety-net providers for a variety of reasons: some because they lack health insurance and others because there are no other providers in the area where they live or because language and cultural differences make them uncomfortable with mainstream care.
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Safety-net providers are also more likely to offer outreach and enabling services e. Yet the public and many elected officials seem almost willfully ignorant of the magnitude, persistence, and implications of this problem. Surveys conducted over the past two decades show a consistent underestimation of the number of uninsured and of trends in insurance coverage over time Blendon et al. The facts about uninsurance in America are sobering see Box 5—1. By almost any metric, uninsured adults suffer worse health status and live shorter lives than insured adults IOM, a.- Because insurance status affects access to secure and continuous care, it also affects health, leading to an estimated 18, premature deaths annually IOM, a. Having a regular source of care improves chances of receiving personal preventive care and screening services and improves the management of chronic disease. When risk factors, such as high blood pressure, can be identified and treated, the chances of developing conditions such as heart disease can be reduced. Similarly, if diseases can be detected and treated when they are still in their early stages, subsequent rates of morbidity and mortality can often be reduced. Without insurance, the chances of early detection and treatment of risk factors or disease are low. This number represented about 15 percent of the total population of 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.
- Nearly 3 out of every 10 Americans, more than 70 million people, lacked health insurance for at least a month over a month period. These numbers are greater than the combined populations of Texas, California, and Connecticut. More than 80 percent of uninsured children and adults under the age of 65 lived in working families. Contrary to popular belief, recent immigrants accounted for a relatively small proportion of the uninsured less than one in five. Insurance status is a powerful determinant of access to care: people without insurance generally have reduced access. Research consistently finds that persons without insurance are less likely to have any physician visits within a year, have fewer visits annually, and are less likely to have a regular source of care. Children without insurance are three times more likely than children with Medicaid coverage to have no regular source of care. The uninsured were less likely to receive health care services, even for serious conditions.
- Research consistently finds that persons without insurance are less likely to have any physician visits within a year, have fewer visits annually, and are less likely to have a regular source of care 15 percent of uninsured children do not have a regular provider, whereas just 5 percent of children with Medicaid do not have a regular provider , and uninsured adults are more than three times as likely to lack a regular source of care. However, even when the uninsured receive care, they fare less well than the insured. For example, Hadley and colleagues found that uninsured adult hospital inpatients had a significantly higher risk of dying in the hospital than their privately insured counterparts.
- Emergency and trauma care were also found to vary for insured and uninsured patients. Uninsured persons with traumatic injuries were less likely to be admitted to the hospital, Page Share Cite Suggested Citation:"5. For children, too, being uninsured tends to reduce access to health care and is associated with poorer health. Untreated ear infections, for example, can have permanent consequences of hearing loss or deafness. Many people who are counted as insured have very limited benefits and are exposed to high out-of-pocket expenses or service restrictions.
- Three areas in which benefits are frequently circumscribed under both public and private insurance plans are preventive services, behavioral health care treatment of mental illness and addictive disorders , and oral health care. When offered, coverage for these services often carries limits that are unrelated to treatment needs and are stricter than those for other types of care King, Cost-sharing requirements for these services may also be higher than those for other commonly covered services.
- Access to care for the insured can also be affected by requirements for cost sharing and copayments. Cost sharing is an effective means to reduce the use of health care for trivial or self-limited conditions. Numerous studies, starting with the RAND Health Insurance Experiment, show that copayments also reduce the use of preventive and primary care services by the poor, although not by higher-income groups Solanki et al.
- The same effects have been shown for the use of behavioral health care services Wells et al. Cost sharing may discourage early care seeking, impeding infectious disease surveillance, delaying timely diagnosis and treatment, and posing a threat to the health of the public. The committee encourages health care policy makers in the public and private sectors to reexamine these issues in light of the concerns about bioterrorism. This committee was not constituted to make specific recommendations about health insurance. However, the committee finds that both the scale of the problem and the strong evidence of adverse health effects from being uninsured or underinsured make a compelling case that the health of the American people as a whole is compromised by the absence of insurance coverage for so many.
- Assuring the health of the population in the twenty-first century requires finding a means to guarantee insurance coverage for every person living in this country. Adequate population health cannot be achieved without making comprehensive and affordable health care available to every person residing in the United States. It is the responsibility of the federal government to lead a national effort to examine the options available to achieve stable health care coverage of individuals and families and to assure the implementation of plans to achieve that result. Safety-Net Providers Absent the availability of health insurance, the role of the safety-net provider is critically important. Increasing their numbers and assuring their viability can, to some degree, improve the availability of care. The organization and delivery of safety-net services vary widely from state to state and community to community Baxter and Mechanic, The safety net consists of public hospital systems; academic health centers; community health centers or clinics funded by federal, state, and local governmental public health agencies see Chapter 3 ; and local health departments themselves although systematic data on the extent of health department services are lacking IOM, a.
- A recent study of changes in the capacities and roles of local health departments as safety-net providers found, however, that more than a quarter of the health departments surveyed were the sole safety-net providers in their jurisdictions and that this was more likely to be the case in smaller jurisdictions Keane et al. Safety-net service providers, which include local and state governmen Page Share Cite Suggested Citation:"5. Services provided by state and local governments often include mental health hospitals and outpatient clinics, substance abuse treatment programs, maternal and child health services, and clinics for the homeless. In addition, an estimated 1, public hospitals nationwide Legnini et al. These demands can overwhelm the traditional population-oriented mission of the governmental public health agencies.
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Furthermore, changes in the funding streams or reimbursement policies for any of these programs or increases in demand for free or subsidized care that inevitably occur in periods of economic downturn create crises for safety-net providers, including those operated by state and local governments see the section Collaboration with Governmental Public Health Agencies later in this chapter for additional discussion. 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.- Although safety net providers have proven to be both resilient and resourceful, the committee believes that many providers may be unable to survive the current environment. Taken alone, the growth in Medicaid managed care enrollment; the retrenchment or elimination of key direct and indirect subsidies that providers have relied upon to help finance uncompensated care; and the continued growth in the number of uninsured people would make it difficult for many safety net providers to survive.
- Taken together, these trends are beginning to place unparalleled strain on the health care safety net in many parts of the country. The committee believes that the effects of these combined forces and dynamics demand the immediate attention of public policy officials. All federal programs and policies targeted to support the safety net and the populations it serves should be reviewed for their effectiveness in meeting the needs of the uninsured. Given the growing number of uninsured people, the adverse effects of Medicaid managed care on safety-net provider revenues, and the absence of concerted public policies directed at increasing the rate of insurance coverage, the committee believes that a new targeted federal initiative should be established to help support core safety-net providers that care for a disproportionate number of uninsured and other vulnerable people. NEGLECTED CARE The committee is concerned that the specific types of care that are important for population health—clinical preventive services, mental health care, treatment for substance abuse, and oral health care—are less available because of the current organization and financing of health care services.
- Many forms of publicly or privately purchased health insurance provide limited coverage, and sometimes no coverage, for these services. Clinical Preventive Services The evidence that insurance makes a difference in health outcomes is well documented for preventive, screening, and chronic disease care IOM, b. Such services include immunizations and screening tests, as well as counseling aimed at changing the personal health behaviors of patients long before Page Share Cite Suggested Citation:"5. The importance of counseling and behavioral interventions is evident, given the influence on health of factors such as tobacco, alcohol, and illicit drug use; unsafe sexual behavior; and lack of exercise and poor diets.
- 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, Coverage of clinical preventive services has increased steadily over the past decade. In , about three-quarters of adults with employment-based health insurance had a benefit package that included adult physical examinations. Two years later, the proportion had risen to 90 percent Rice et al. The type of health plan is the most important predictor of coverage RWJF, 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. The U. Public Health Service, has endorsed a core set of clinical preventive services for asymptomatic individuals with no known risk factors. However, the USPSTF recommendations have had relatively little influence on the design of insurance benefits, and recommended counseling and screening services are often not covered and, consequently, not used Partnership for Prevention, see Box 5—3.
- As might be expected, though, adults without health insurance are the least likely to receive recommended preventive and screening services or to receive them at the recommended frequencies Ayanian et al. Having any health insurance, even without coverage for any preventive services, increases the probability that an individual will receive appropriate preventive care Hayward et al.
- Studies of the use of preventive services by Hispanics and African Americans find that health insurance is strongly associated with the increased receipt of preventive services Solis et al. However, the higher rates of uninsurance among racial and ethnic minorities contribute significantly Page Share Cite Suggested Citation:"5. Yet about half of all pregnancies and nearly a third of all births each year are unintended. One out of five employer-sponsored plans does not cover childhood immunizations, and one out of four does not cover adolescent immunizations although these are among the most cost-effective preventive services. For example, African Americans and members of other minority groups who are diagnosed with cancer are more likely to be diagnosed at advanced stages of disease than are whites Farley and Flannery, ; Mandelblatt et al. Medicare Coverage of Preventive Services Preventive services are important for older adults, for whom they can reduce premature morbidity and mortality, help preserve function, and enhance quality of life.
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Unfortunately, the Medicare program was not designed with a focus on prevention, and the process for adding preventive services to the Medicare benefit package is complex and difficult. Unlike forms of treatment that are incorporated into the payment system on a relatively routine basis as they come into general use, preventive services are subject to a greater degree of scrutiny and a demand for a higher level of effectiveness, and there is no routine process for making such assessments. Box 5—4 lists the preventive services currently covered by Medicare. The level of use of preventive services among older adults has been relatively low CDC,UNIT 1 Health Care Systems Test Review Flashcards - 1medicoguia.com
Corresponding author: Goran Ridic, PhD. Fall, Ilinois, USA. E-mail: moc. This article has been cited by other articles in PMC. Abstract The purpose of this research paper is to compare health care systems in three highly advanced industrialized countries: The United States of America, Canada and Germany. The first part of the research paper will focus on the description of health care systems in the above-mentioned countries while the second part will analyze, evaluate and compare the three systems regarding equity and efficiency.- Finally, an overview of recent changes and proposed future reforms in these countries will be provided as well. We start by providing a general description and comparison of the structure of health care systems in Canada, Germany and the United States. Health insurance coverage is universal. General taxes finance NHI through a single payer system only one third-party payer is responsible for paying health care providers for medical services. Consumer co-payments are negligible and physician choice is unlimited. Production of health care services is private; physicians receive payments on a negotiated fee for service and hospitals receive global budget payments Method used by third party payers to control medical care costs by establishing total expenditure limits for medical services over a specified period of time. Most of the population lives within miles of the United States border. From the American point of view, Canada provides a good comparison and contrast in terms of the structure of its health care systems.
Comparisons Of Health Care Systems In The United States, Germany And Canada
The Canadian health care system began to take on its current form when the province of Saskatchewan set up a hospitalization plan immediately after WWII. The rural, low—income province was plagued by shortages of both hospital beds and medical practitioners. The main feature of this plan was the creation of the regional system of hospitals: local hospitals for primary care, district hospitals for more complex cases, and base hospitals for the most difficult cases. In , the federal parliament enacted the Hospital and Diagnostic Services Act laying the groundwork for a nationwide system of hospital insurance.- By all ten provinces and the two territories had hospital insurance plans of their own with the federal government paying one half of the costs. Since the health care system has moved in different directions. While Canada has had publicly funded national health insurance, the United States has relied largely on private financing and delivery. During this period, spending in the United States has grown much more rapidly despite large groups that either uninsured or minimally insured. The provisions of the Canada Health Act define the health care delivery system as it currently operates. Under the Act, each provincial health plan is administered at the provincial level and provides comprehensive first dollar coverage of all medically necessary services.
- With minor exceptions, health coverage is available to all residents with no out of pocket charges. Most physicians are paid on a fee for service basis and enjoy a great deal of practice autonomy. Private health insurance for covered services is illegal. Most Canadians have supplemental private insurance for uncovered services, such as prescription drugs and dental services. As a result, virtually all physicians are forced to participate and each health plan effectively serves all residents in the province Henderson Patients do not participate in the reimbursement process, and reimbursement exclusively takes place between the public insurer the government and the health care provider.
- The monetary exchange is practically non-existent between patient and health care provider. The ministry of health in each province is responsible for controlling medical costs. Cost control is attempted primarily through fixed global budgets and predetermined fees for physicians. Specifically, the operating budgets of hospitals are approved and funded entirely by the ministry in each province and an annual global budget is negotiated between the ministry and each individual hospital. Capital expenditures must also be approved by the ministry, which funds the bulk of the spending. Physician fees are determined by periodic negotiations between the ministry and provincial medical associations the Canadian version of the American Medical Association.
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With the passage of the Canada Health Act of , the right to extra billing was removed in all provinces. Extra billing or balance billing refers to a situation in which the physician bills the patient some dollar amount above the predominated fee set by third party payer. For the profession as a whole, negotiated fee increases are implemented in steps, conditional on the rate of increase in the volume of services. If volume per physician arises faster than a predetermined percentage, subsequent fee increases are scaled down or eliminated to cap gross billings — the product of the fee and the volume of each service — at some predetermined target.
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