NUR 4150 - Community
Exam 2 Study Guide.
,Chapter 3
The Changing US Health and Public Health Care Systems
Objectives
● Describe the events and trends that influence the status of the health care system.
● Discuss key aspects of the private health care system.
● Define public health and the nurse’s role.
● Compare and contrast the current public health system with the model of
primary health care.
● Assess the effects of health care and insurance reform on population health care
Introduction
● This chapter describes a health care system in transition as it struggles to meet
evolving global and domestic challenges.
● Nurses play a pivotal role in meeting these needs.
Forces Stimulating
Change in US Health Care
System
● Demographic trends
● Social and economic trends
● Health workforce trends
● Technological trends
Forces Stimulating Change in US Health Care System (Cont.)
Demographic trends
● Population growth of the world
● Aging Baby Boom generation
● Change in largest minority group
● Changing composition of the US household
● Declining mortality for both genders in all age groups
Demographic trends:
• Increased fertility and decreased mortality.
• “Baby Boom” & Baby Bust”
• Increasing average age
• Change in largest minority group (African American to Hispanic).
• Hispanic persons now outnumber African Americans as the
largest minority group.
• Whites predicted to make up only 50.1% of the US population in 2050.
• Growing foreign-born population
• Change in household composition (more single-parent homes).
, • Mortality for both genders in all age-groups declined.
• Leading deaths changed from infectious diseases to chronic
and degenerative diseases.
Forces Stimulating Change in US Health Care System (Cont.)
Social and economic trends
● Changing lifestyles
● to be healthy one must take care of one’s self
● Growing appreciation of the quality of life
● Shift in values changing the importance of financial success
● Changing composition of families and living patterns
● Changing household incomes
● Average per-person income is increasing
● Gap between the richest 25% and the poorest 25% is widening
● Revised definition of quality health care
● Economic downturn of 2008
● Affordable Care Act
Forces Stimulating Change in US Health Care System (Cont.)
Health workforce trends
● Not enough primary-care providers
➢ Advanced-practice nursing (APN) specialties
● Move to contain costs and move to community-based care
● Current nursing shortage
➢ By 2016, expecting 587,000 new nursing positions
➢ 55% of surveyed nurses intend to retire between 2011 and 2020
● Need to increase number of minority nurses to help decrease health disparities
➢ In 2008, minority nurses represented about 22% of the RN population.
Forces Stimulating Change in US Health Care System (Cont.)
Technological trends
• Positive effects
o Improve health care services
o Reduce costs (efficient means of delivering care; replacing people with machines)
o More convenience (time & travel)
• Negative effects
o Can also increase costs
▪ High-tech. equipment is expensive, quickly becomes out-dated,
often requires highly trained personnel
, o Legal liability
o Potential for decreased privacy
o Too much reliance on machines
• Digital divide
• Electronic medical records
note Generation Y very comfortable with technology and expect health care
providers to be as well
Technological disparity, “digital divide”
Current Health Care System in the United States
● Cost
➢ The “Great Recession”
➢ Aging Baby Boom generation
➢ Affordable Care Act
● Access
➢ Two-class system: private and public
➢ Rising number of uninsured
➢ Private = Those with insurance or who can pay for health care are viewed
as receiving superior care.
➢ Public = Those who depend on public funds.
➢ Uninsured = working poor who do not qualify for public funds (either make
too much money or are illegal immigrants).
● Quality
➢ Institute of Medicine (IOM) reports
➢ Hospital compare
• To Err Is Human: Building a Safer Health System (IOM, 2000)
To Err Is Human: Building a Safer Health System (IOM,
2000). As indicated in this groundbreaking report, as many as
98,000 deaths per year could be attributed to preventable
medical errors. Some of the untoward events categorized in
this report included adverse drug events and improper
transfusions, surgical injuries and wrong-site surgery,
suicides, restraint- related injuries or death, falls, burns,
pressure ulcers, and mistaken client identities
• Keeping Patients Safe: Transforming the Work Environment of
Nurses (2003)
Stated that nurses’ long work hours pose a serious threat to
patient safety, because fatigue slows reaction time, saps
energy, and diminishes attention to detail. The group called
for state regulators to pass laws barring nurses from
working
Exam 2 Study Guide.
,Chapter 3
The Changing US Health and Public Health Care Systems
Objectives
● Describe the events and trends that influence the status of the health care system.
● Discuss key aspects of the private health care system.
● Define public health and the nurse’s role.
● Compare and contrast the current public health system with the model of
primary health care.
● Assess the effects of health care and insurance reform on population health care
Introduction
● This chapter describes a health care system in transition as it struggles to meet
evolving global and domestic challenges.
● Nurses play a pivotal role in meeting these needs.
Forces Stimulating
Change in US Health Care
System
● Demographic trends
● Social and economic trends
● Health workforce trends
● Technological trends
Forces Stimulating Change in US Health Care System (Cont.)
Demographic trends
● Population growth of the world
● Aging Baby Boom generation
● Change in largest minority group
● Changing composition of the US household
● Declining mortality for both genders in all age groups
Demographic trends:
• Increased fertility and decreased mortality.
• “Baby Boom” & Baby Bust”
• Increasing average age
• Change in largest minority group (African American to Hispanic).
• Hispanic persons now outnumber African Americans as the
largest minority group.
• Whites predicted to make up only 50.1% of the US population in 2050.
• Growing foreign-born population
• Change in household composition (more single-parent homes).
, • Mortality for both genders in all age-groups declined.
• Leading deaths changed from infectious diseases to chronic
and degenerative diseases.
Forces Stimulating Change in US Health Care System (Cont.)
Social and economic trends
● Changing lifestyles
● to be healthy one must take care of one’s self
● Growing appreciation of the quality of life
● Shift in values changing the importance of financial success
● Changing composition of families and living patterns
● Changing household incomes
● Average per-person income is increasing
● Gap between the richest 25% and the poorest 25% is widening
● Revised definition of quality health care
● Economic downturn of 2008
● Affordable Care Act
Forces Stimulating Change in US Health Care System (Cont.)
Health workforce trends
● Not enough primary-care providers
➢ Advanced-practice nursing (APN) specialties
● Move to contain costs and move to community-based care
● Current nursing shortage
➢ By 2016, expecting 587,000 new nursing positions
➢ 55% of surveyed nurses intend to retire between 2011 and 2020
● Need to increase number of minority nurses to help decrease health disparities
➢ In 2008, minority nurses represented about 22% of the RN population.
Forces Stimulating Change in US Health Care System (Cont.)
Technological trends
• Positive effects
o Improve health care services
o Reduce costs (efficient means of delivering care; replacing people with machines)
o More convenience (time & travel)
• Negative effects
o Can also increase costs
▪ High-tech. equipment is expensive, quickly becomes out-dated,
often requires highly trained personnel
, o Legal liability
o Potential for decreased privacy
o Too much reliance on machines
• Digital divide
• Electronic medical records
note Generation Y very comfortable with technology and expect health care
providers to be as well
Technological disparity, “digital divide”
Current Health Care System in the United States
● Cost
➢ The “Great Recession”
➢ Aging Baby Boom generation
➢ Affordable Care Act
● Access
➢ Two-class system: private and public
➢ Rising number of uninsured
➢ Private = Those with insurance or who can pay for health care are viewed
as receiving superior care.
➢ Public = Those who depend on public funds.
➢ Uninsured = working poor who do not qualify for public funds (either make
too much money or are illegal immigrants).
● Quality
➢ Institute of Medicine (IOM) reports
➢ Hospital compare
• To Err Is Human: Building a Safer Health System (IOM, 2000)
To Err Is Human: Building a Safer Health System (IOM,
2000). As indicated in this groundbreaking report, as many as
98,000 deaths per year could be attributed to preventable
medical errors. Some of the untoward events categorized in
this report included adverse drug events and improper
transfusions, surgical injuries and wrong-site surgery,
suicides, restraint- related injuries or death, falls, burns,
pressure ulcers, and mistaken client identities
• Keeping Patients Safe: Transforming the Work Environment of
Nurses (2003)
Stated that nurses’ long work hours pose a serious threat to
patient safety, because fatigue slows reaction time, saps
energy, and diminishes attention to detail. The group called
for state regulators to pass laws barring nurses from
working
