Escolar Documentos
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Cultura Documentos
Chapter Objectives
Summarize directions and trends in
the health care delivery system
discussed in prior chapters
Present expert data and
interpretations to projections for
future delivery system changes
Draw some tentative conclusions
about the future American healthcare
system
Introduction
Predictions are highly risky as system
moves into uncharted territory
Trend extrapolation most reliable under
stable conditions; reform scope and
complexity will produce much instability
National changes to cost, quality, access
historically produced many unanticipated,
sometimes adverse effects
Institutions adaptations may produce
unintended consequences
Hopeful signs:
Purchasers (employers & government) more
cost, quality conscious
Technology
MRIs: coercive power of glamorous,
expensive technology over cost-benefits;
extensive research demonstrates no patient
benefits in therapeutic choices or outcomes
Technologys mixed blessings: imposes
barriers between consumers &
practitioners; technology investments
contribute nothing to solutions for access
barriers, health disparities, other major
health determinants
Changing Population
Composition (1)
Older population size & diversity
increasing & surviving to very old age
Intact families to care for older adults
decreases with divorce, single-parenthood,
adult child out-migration
Changing racial & ethnic composition
w/minority groups, esp. Hispanics a growing
proportion; differences from whites in e.g.
mortality rates, chronic conditions, service
preferences, attitudes toward medical care
Changing Population
Composition (2)
Older population, contd
Inadequate supply of culturally
competent providers at all levels in
acute & long-term care for home &
institutional care; difficult to recruit &
retain; most long-term care facilities
now proprietary with uneven quality
track records
Systems chronic care focused on acute
interventions w/ little attraction to
maintenance services that will be
Changing Population
Composition (3)
Older population, contd
Effective chronic illness care will require
major shifts in health service priorities;
more geriatric services in an acute care
system is not a solution
Health professionals must change
entrenched acute care mindsets, values,
clinical behaviors
ACOs care continuums may help, but
widespread movements from fee-forservice to holistic approaches will not
Future of Employer-Sponsored
Health Insurance
For 5 decades, employer-sponsored health
insurance protected workers
Industrys predominant role in ACA
parameters reaffirmed influential policy
role
Under ACA, may opt to drop health
coverage and endure penalties
Significant, uncertain speculations on
employer decisions as market changes &
reform proceeds
Health Information
Technology (1)
Ideal future: providers & health plans
will replace voluminous, disorganized
medical records with standardized,
reliable, clinically relevant
electronically delivered information
New EHRS will minimize transcription &
misinterpretation errors & interoperable
systems will allow easy information
transfer among care providers, reduce
costs & improve quality
Health Information
Technology (2)
Obstacles & Solutions
Complex confidentiality, compatibility,
transferability, organization cultural issues
and complexities of patients service receipt
at multiple sites
Academic medical researchers & developers
with private HIT corporations will combine
resources to build workable infrastructures to
create a new era in HIT, a giant step forward
in advancing safety, efficacy, efficiency of
medical care
Summary of Predictions
and Future Challenges (1)
Publics prevailing belief in privatelysupplied U.S. health care as a good
despite high costs, redundancies, access
& quality problems countered by belief
in scientific, technological superiority
ACA represents beliefs that U.S. required
socially responsible system to end
distinction as only Western democracy with
sizeable population lacking health insurance
coverage