trends in health care where are we going?????. cost containment reasons for high health care costs
TRANSCRIPT
Trends in Health Care Trends in Health Care
Where are we going?????Where are we going?????
Cost containmentCost containment
Reasons for High Health Care CostsReasons for High Health Care Costs
Cost ContainmentCost Containment
Cost ContainmentCost Containment• means trying to control the rising cost of means trying to control the rising cost of
health care and maximizing every dollar health care and maximizing every dollar spentspent
Cost ContainmentCost Containment
Reasons for High Health Care CostsReasons for High Health Care Costs Technological advancesTechnological advances
• heart, lung, kidney, and liver transplantsheart, lung, kidney, and liver transplants• artificial heartsartificial hearts• Computers & equipment to examine Computers & equipment to examine
internal body partsinternal body parts
Cost containmentCost containment
Reasons for High Health Care CostsReasons for High Health Care Costs Technological advancesTechnological advances
Cost containmentCost containment
Reasons for High Health Care CostsReasons for High Health Care Costs Aging populationAging population
• people are surviving illnesses that used people are surviving illnesses that used to be fatal, and are then requiring to be fatal, and are then requiring expensive and life long care…expensive and life long care…
• increased use of pharmaceutical agents, increased use of pharmaceutical agents, more chronic diseases, need frequent more chronic diseases, need frequent health care serviceshealth care services
Cost containmentCost containment
Reasons for High Health Care CostsReasons for High Health Care Costs Health-related lawsuitsHealth-related lawsuits
• Malpractice insurance is expensive!Malpractice insurance is expensive!• Doctors order diagnostic tests even Doctors order diagnostic tests even
though they might not be necessarythough they might not be necessary• Doctors make every effort to avoid Doctors make every effort to avoid
lawsuits by practicing “defensive” lawsuits by practicing “defensive” medicinemedicine
Methods of cost containmentMethods of cost containment Diagnostic related groups (DRG) Diagnostic related groups (DRG)
• Payment is for the disease, not the treatmentPayment is for the disease, not the treatment• Attempts by Congress to control costs for Attempts by Congress to control costs for
Medicare and MedicaidMedicare and Medicaid• Payment is based on diagnosisPayment is based on diagnosis• Certain amount paid for each disease conditionCertain amount paid for each disease condition• Agencies providing care for less can KEEP the Agencies providing care for less can KEEP the
extra moneyextra money• Agencies accept loss if care costs more than Agencies accept loss if care costs more than
payment allowed.payment allowed.
Methods of cost containmentMethods of cost containment
Combination of services Combination of services • Health care agencies share servicesHealth care agencies share services• Care can be provided to a larger number Care can be provided to a larger number
of people at a decrease in cost per of people at a decrease in cost per personperson
• Example??Example?? Lab CorpLab Corp
Methods of cost containmentMethods of cost containment Out Patient ServicesOut Patient Services
• Patients receive care without being admitted to hospitals Patients receive care without being admitted to hospitals or other care facilitiesor other care facilities
• Hospital care is EXPENSIVEHospital care is EXPENSIVE• Reducing the length of stay or decreasing the need for Reducing the length of stay or decreasing the need for
hospital admission lowers the cost.hospital admission lowers the cost.• Example: Open heart surgery patients used to spend Example: Open heart surgery patients used to spend
several weeks in the hospital and now stay on average 5-several weeks in the hospital and now stay on average 5-7 days7 days
• Less expensive home care or transfer to a skilled care Less expensive home care or transfer to a skilled care facility is used for those who require additional assistancefacility is used for those who require additional assistance
• Examples of outpatient services are surgery, x-rays, Examples of outpatient services are surgery, x-rays, diagnostic testsdiagnostic tests
Methods of cost containmentMethods of cost containment Mass/Bulk PurchasingMass/Bulk Purchasing
• Buying equipment and supplies in larger Buying equipment and supplies in larger quantities at reduced prices- Ex: Sam’s Clubquantities at reduced prices- Ex: Sam’s Club
• Combine purchases of different departments in Combine purchases of different departments in an agencyan agency
• Combine purchases of several different agenciesCombine purchases of several different agencies• Major health care system purchasing medical Major health care system purchasing medical
supplies for hundreds or thousands of health care supplies for hundreds or thousands of health care agencies can obtain much lower prices than an agencies can obtain much lower prices than an individual agencyindividual agency
• Computerized inventory can be used to Computerized inventory can be used to determine when supplies are needed and to determine when supplies are needed and to prevent overstock and waste.prevent overstock and waste.
Methods of cost containmentMethods of cost containment Early intervention and preventive servicesEarly intervention and preventive services
• Providing care before acute or chronic illness occursProviding care before acute or chronic illness occurs• Preventing illness is ALWAYS cheaper than treating Preventing illness is ALWAYS cheaper than treating
illnessillness• Methods to prevent illness includeMethods to prevent illness include
Patient educationPatient education ImmunizationsImmunizations Regular physical examinations to detect problems earlyRegular physical examinations to detect problems early Easy access for all individuals to preventive health care Easy access for all individuals to preventive health care
servicesservices People with limited access to health services and restricted People with limited access to health services and restricted
finances use expensive emergency rooms and acute care finances use expensive emergency rooms and acute care facilities much more frequentlyfacilities much more frequently
Providing early intervention and care to these individuals is Providing early intervention and care to these individuals is much more cost effective. much more cost effective.
Methods of cost containmentMethods of cost containment Energy ConservationEnergy Conservation
• Monitoring the use of energy to control costs and conserve Monitoring the use of energy to control costs and conserve resourcesresources
• Major expenses for every health care industry/agency are Major expenses for every health care industry/agency are electricity, water, and/or gaselectricity, water, and/or gas
• Most large health care facilities perform energy audits to Most large health care facilities perform energy audits to determine how resources are being used and to calculate ways determine how resources are being used and to calculate ways to conserve energyto conserve energy
• Methods used include designing and building new energy Methods used include designing and building new energy efficient facilities, constantly monitoring and maintaining efficient facilities, constantly monitoring and maintaining heating/cooling systems, using insulation and thermopane heating/cooling systems, using insulation and thermopane windows to prevent hot/cool air loss, repairing plumbing fixtures windows to prevent hot/cool air loss, repairing plumbing fixtures immediately to stop water loss, replacing energy consuming immediately to stop water loss, replacing energy consuming light bulbs with fluorescent or energy efficient bulbs, installing light bulbs with fluorescent or energy efficient bulbs, installing infrared sensors to turn water faucets on and off, and using infrared sensors to turn water faucets on and off, and using alternative forms of energy such as solar power. alternative forms of energy such as solar power.
• Recycling is a form of energy conservation and most health care Recycling is a form of energy conservation and most health care facilities recycle many different materials.facilities recycle many different materials.
Home Health CareHome Health Care Rapidly growing Field due Rapidly growing Field due
to shorter hospital staysto shorter hospital stays• DRG’s result in shorter hospital DRG’s result in shorter hospital
stays so patients need care at homestays so patients need care at home• Home Health Care is less expensive Home Health Care is less expensive
to provide and can include:to provide and can include: Nursing careNursing care Physical and occupational therapyPhysical and occupational therapy Respiratory therapyRespiratory therapy Social servicesSocial services Nutritional and food servicesNutritional and food services Homemaking servicesHomemaking services
Hospice-care for the Hospice-care for the terminally illterminally ill
Geriatric careGeriatric care““Care of the elderlyCare of the elderly””
1.1. Types of facilitiesTypes of facilities1.1. Long Term CareLong Term Care
2.2. Extended Care FacilityExtended Care Facility
3.3. Geriatric Care Geriatric Care
4.4. Adult DaycareAdult Daycare
2.2. Omnibus Budget Reconciliation Act Omnibus Budget Reconciliation Act (OBRA)(OBRA)
1.1. Requires certification for Health Care Requires certification for Health Care Providers caring for ElderlyProviders caring for Elderly
2.2. Pt/Residents Bill of RightsPt/Residents Bill of Rights
TelemedicineTelemedicine
TelemedicineTelemedicine As consumers become more computer literate, more health care As consumers become more computer literate, more health care
services will be provided electronically.services will be provided electronically. Telemedicine machines, operating over telephone lines, are “user Telemedicine machines, operating over telephone lines, are “user
friendly”, compact, and less expensive than when they were friendly”, compact, and less expensive than when they were developed.developed.
People with chronic illnesses or disabilities can receive care in the People with chronic illnesses or disabilities can receive care in the comfort of their homes:comfort of their homes:• Decreases the need for trips to medical care facilitiesDecreases the need for trips to medical care facilities
• Can test blood sugar levels, oxygen levels, blood pressure Can test blood sugar levels, oxygen levels, blood pressure measurements, and other vital signs, transmitting results to measurements, and other vital signs, transmitting results to
nurse or nurse or physicianphysician..• Can use online courses to learn to manage illnessCan use online courses to learn to manage illness• Can schedule an “appointment” and talk “face to face” with Can schedule an “appointment” and talk “face to face” with
health care provider using video conferencinghealth care provider using video conferencing• Electronic reminders to take medicine or perform diagnostic testsElectronic reminders to take medicine or perform diagnostic tests• Receive answers to health related questionsReceive answers to health related questions• Provides access to specialists thousands of miles away.Provides access to specialists thousands of miles away.
WellnessWellness “ “The state of being of optimal health”The state of being of optimal health”
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
Most common Heath care system in the Most common Heath care system in the US is the “Western” systemUS is the “Western” system
Current trend in US is an increasing use of Current trend in US is an increasing use of the following:the following:• Alternative –methods of treatment used in Alternative –methods of treatment used in
place of biomedical therapiesplace of biomedical therapies• Complementary- methods of treatment used Complementary- methods of treatment used
along with conventional medicinealong with conventional medicine• Holistic Care-Caring for the whole personHolistic Care-Caring for the whole person
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
Ayurvedic practitionersAyurvedic practitioners• Developed in IndiaDeveloped in India• Looks at body type (Dosha)Looks at body type (Dosha)
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
Chinese Medicine PractitionersChinese Medicine Practitioners• Believe in holistic care Believe in holistic care • Chi or energy flow effects wellness Chi or energy flow effects wellness
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
Chiropractors Chiropractors • Believe that the Believe that the
spine and spine and nerves must be nerves must be in alignment for in alignment for the body to the body to function function properlyproperly
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
HomeopathsHomeopaths• Believe that the body can heal itself Believe that the body can heal itself
though the immune systemthough the immune system
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
Hypnotists Hypnotists • Believe that in a Believe that in a
trance like state trance like state the body can the body can promote healing promote healing and changes in and changes in behaviorbehavior
Alternative and Complementary Alternative and Complementary Methods of Health CareMethods of Health Care
Naturopaths • Believe in using only
“natural” therapies, like fasting, special diets, herbs, etc
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