Health Care Structures, Functions and Facilities Essay

Assignment Content
In the health care industry, a variety of structures, facilities, and services serve different functions. You must understand what these are and why each is important.

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Complete the Knowing Your Health Care Functions, Structures, and Facilities worksheet.Health Care Structures, Functions and Facilities Essay

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Knowing Your Health Care Structures, Functions and Facilities

Part 1 – Health Care Structure
Complete the table below.
• Describe 5 health care structures. Include structures from the Federal, State, and Local level.
• Explain the function of each structure.

Health Care Structure Describe the health care structure. Explain the function of each health care structure.
Private Structure
For-Profit Structure
Voluntary Structure

Part 2 – Health Care Facilities and Services
Complete the table below.
• Describe 5 health care facilities.
• Explain the function of each facility.
• Describe services offered at the facilities.

Facility Describe the facility. Explain the function of each facility. Describe the services offered at this facility.
1. Hospital
2. Ambulatory care
3. Rehabilitation
4. Retail health clinic
5. Long-term care

Part 3 – Lifespan Health care Needs
Explain how an individual may need different structures, Health Care Structures, Functions and Facilities Essay facilities, or services in their lifeti

Hospital’s Organizational Structure Hospitals have organizational structures that allows them to carry out their duties efficiently and successfully. What separates the organizational structure of a healthcare organization from a business, essentially that the hospital ‘s organization is chiefly founded on the amalgamation of medical and administrative staff (Carayon, et al., 2014). The organizational structure of the twenty-first century solutions in health care hospitals involves, both divisional and hierarchical structure. In the of the chain of command hierarchy, there are various levels of professional’s that fall under other levels within the facility, and each staff member is organized in regards to departments that are related to their (KSA’s) skills, attributes and job duties (Carayon, et al., 2014). Hospital organization philosophies is based on development of values and ethics, with the understanding on moral principles relating to human conduct. These systems are comprised with the processes in decision making and determining the best actions to consider between the difficult alternatives when pertaining to patient care. Administrative staff remains at the top- level of the organizational structure, formulated of individual’s that have ownership (stakeholders) with the functions of operations in the healthcare facility. These important individuals are accountable for the enforcement on policies and regulations, with ensuring the implementation for public Health Care Structures, Functions and Facilities Essay

For Americans to enjoy optimal health—as individuals and as a population—they must have the benefit of high-quality health care services that are effectively coordinated within a strong public health system. In considering the role of the health care sector in assuring the nation’s health, the committee took as its starting point one of the recommendations of the Institute of Medicine (IOM) report Crossing the Quality Chasm (2001b: 6): “All health care organizations, professional groups, and private and public purchasers should adopt as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.”Health Care Structures, Functions and Facilities Essay

This chapter addresses the issues of access, managing chronic disease, neglected health care services (i.e., clinical preventive services, oral, and mental health care and substance abuse services), and the capacity of the health care delivery system to better serve the population in terms of cultural competence, quality, the workforce, financing, information technology, and emergency preparedness. In addition, the chapter discusses the responsibility of the health care system to recognize and play its appropriate role within the intersectoral public health system, particularly as it collaborates with the governmental public health agencies.Health Care Structures, Functions and Facilities Essay

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. Some are based in the public sector; others operate in the private sector as either for-profit or not-for-Health Care Structures, Functions and Facilities Essay

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Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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profit entities. The health care sector also includes regulators, some voluntary and others governmental. Although these various individuals and organizations are generally referred to collectively as “the health care delivery system,” the phrase suggests an order, integration, and accountability that do not exist. Communication, collaboration, or systems planning among these various entities is limited and is almost incidental to their operations. For convenience, however, the committee uses the common terminology of health care delivery system.Health Care Structures, Functions and Facilities Essay

As described in Crossing the Quality Chasm (IOM, 2001b) and other literature, this health care system is faced with serious quality and cost challenges. 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). In the aggregate, these per capita expenditures account for 13.2 percent of the U.S. gross domestic product, about $1.3 trillion (Levit et al., 2002). 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. Yet the nation’s substantial health-related spending has not produced superlative health outcomes for its people. Fundamental flaws in the systems that finance, organize, and deliver health care work to undermine the organizational structure necessary to ensure the effective translation of scientific discoveries into routine patient care, and many parts of the health care delivery system are economically vulnerable. Insurance plans and providers scramble to adapt and survive in a rapidly evolving and highly competitive market; and the variations among health insurance plans—whether public or private—in eligibility, benefits, cost sharing, plan restrictions, reimbursement policies, and other attributes create confusion, inequity, and excessive administrative burdens for both providers of care and consumers.Health Care Structures, Functions and Facilities Essay

Because of its history, structure, and particularly the highly competitive market in health services that has evolved since the collapse of health care reform efforts in the early 1990s, the health care delivery system often does not interact effectively with other components of the public health system described in this report, in particular, the governmental public health agencies. Health care’s structure and incentives are technology and procedure driven and do not support time for the inquiry and reflection, communication, and external relationship building typically needed for effective disease prevention and health promotion. State health departments often have legal authority to regulate the entry of providers and purchasers of health care into the market and to set insurance reimbursement rates for public and, less often, private providers and purchasers.Health Care Structures, Functions and Facilities Essay They may control the ability of providers to acquire desired technology and perform complex, costly procedures that are important to the hospital but increase demands on state revenues. Health Care Structures, Functions and Facilities Essay

Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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monitor the quality of health services provided in the public and private sectors. Many health care providers argue that such regulation adds to their costs, and high-profile problems can create additional tensions that impede collaboration between the state public health agency and the health care delivery system.Health Care Structures, Functions and Facilities Essay

Furthermore, when the delivery of health care through the private sector falters, the responsibility for providing some level of basic health care services to the poor and other special populations falls to governmental public health agencies as one of their essential public health services, as discussed in Chapter 1. In many jurisdictions, this default is already occurring, consuming resources and impairing the ability of governmental public health agencies to perform other essential tasks.

Although this committee was not constituted to investigate or make recommendations regarding the serious economic and structural problems confronting the health care system in the United States, it concluded that it must examine certain issues having serious implications for the public health system’s effectiveness in promoting the nation’s health. Drawing heavily on the work of other IOM committees, this chapter examines the influence that health insurance exerts on access to health care and on the range of care available, as well as the shortcomings in the quality of services provided, some of the constraints on the capacity of the health care system to provide high-quality care, and the need for better collaboration within the public health system, especially among governmental public health agencies and the organizations in the personal health care delivery system.Health Care Structures, Functions and Facilities Essay

ACCESS TO HEALTH CARE
Health care is not the only, or even the strongest, determinant of health, but it is very important. For most Americans, having health insurance— under a private plan or through a publicly financed program—is a threshold requirement for routine access to health care. “Health insurance coverage is associated with better health outcomes for adults. It is also associated with having a regular source of care and with greater and more appropriate use of health services. These factors, in turn, improve the likelihood of disease screening and early detection, the management of chronic illness, and the effective treatment of acute conditions,” IOM notes in a recent report (IOM, 2002a: 6).Health Care Structures, Functions and Facilities Essay

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Private insurance is predominantly purchased through employment-based groups and to a lesser extent through individual policies (Mills, 2002). Publicly funded insurance is provided primarily through seven government programs (see Table 5–1). Medicare provides coverage to 13.5 percent of the population, whereas Medicaid covers 11.2 percent of the population (Mills, 2002). Additionally, public funding supports directly

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Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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TABLE 5–1 Government Health Programs Health Care Structures, Functions and Facilities Essay

Program

Year

Enrollment

Expenditures

Medicare

2001

40 million aged and disabled individualsa

$242.4 billionh

Medicaid

2002

47 million low-income individualsb

$247 billion (federal, $147 billion; state, $100 billion)b

SCHIP

2001

4.6 million low-income childrenc

$4.6 billionc

VHA

2001

4.3 million veteransd

$21 billiond

IHS

2001

1.5 million American Indians and Alaska Nativese

$3.2 billione

DOD TRICARE

2001

8.4 million active-duty members of the militaryf Health Care Structures, Functions and Facilities Essay

$14.2 billionf

FEHBP

2000

9 million federal employees, dependents, and retireesg

$20 billiong

NOTE: VHA = Veterans Health Administration; IHS = Indian Health Service; DOD = Department of Defense; FEHBP = Federal Employees Health Benefits Program.

SOURCES: aBoards of Trustees (2002). bSmith et al. (2002); CMS (2002a); CMS (2002c). cCMS (2002a); CMS (2002a); CMS (2002c). dGAO (2001b). eIHS (2002a, 2002b). fDepartment of Defense (2002). gOPM (2001); Office of the President (2001). hDHHS (2002).Health Care Structures, Functions and Facilities Essay

delivered health care (through community health centers and other health centers qualified for Medicaid reimbursement) accessed by 11 percent of the nation’s uninsured, who constitute 41 percent of patients at such health centers (Markus et al., 2002). 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. 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).

Being uninsured, although not the only barrier to obtaining health care, is by all indications the most significant one. The fact that more than 41 million people—more than 80 percent of whom are members of working families—are uninsured is the strongest possible indictment of the nation’s health care delivery system. Those without health insurance or without insurance for particular types of services face serious, sometimes insurmountable barriers to necessary and appropriate care.Health Care Structures, Functions and Facilities Essay

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Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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Adults without health insurance are far more likely to go without health care that they believe they need than are adults with health insurance of any kind (Lurie et al., 1984, 1986; Berk and Schur, 1998; Burstin et al., 1998; Baker et al., 2000; Kasper et al., 2000; Schoen and DesRoches, 2000). Children without health insurance may be compromised in ways that will diminish their health and productivity throughout their lives.Health Care Structures, Functions and Facilities Essay

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. Safety-net providers are also more likely to offer outreach and enabling services (e.g., transportation and child care) to help overcome barriers that may not be directly related to the health care system itself.

In this section, the committee reviews concerns about the barriers to health care that are raised by the lack of health insurance and by threats to the nation’s safety-net providers.

The Uninsured and the Underinsured
The persistently large proportion of the American population that is uninsured—about one in five working-age adults and one in seven children— is the most visible and troubling sign of the nation’s failure to assure access to health care. 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., 2001). 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, 2002a).Health Care Structures, Functions and Facilities Essay

Because insurance status affects access to secure and continuous care, it also affects health, leading to an estimated 18,000 premature deaths annually (IOM, 2002a). 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.

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Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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BOX 5–1 Findings from Coverage Matters Health Care Structures, Functions and Facilities Essay

In its report Coverage Matters, the IOM Committee on the Consequences of Uninsurance (IOM, 2001a) found the following:

Forty-two million people in the United States lacked health insurance coverage in 1999 (Mills, 2000). 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).

Nearly 3 out of every 10 Americans, more than 70 million people, lacked health insurance for at least a month over a 36-month period. These numbers are greater than the combined populations of Texas, California, and Connecticut.Health Care Structures, Functions and Facilities Essay

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.Health Care Structures, Functions and Facilities Essay

However, even when the uninsured receive care, they fare less well than the insured. The IOM Committee on the Consequences of Uninsurance found that “[u]ninsured adults receive health services that are less adequate and appropriate than those received by patients who have either public or private health insurance, and they have poorer clinical outcomes and poorer overall health than do adults with private health insurance” (IOM, 2002a: 87). For example, Hadley and colleagues (1991) 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,

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Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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received fewer services when admitted, and were more likely to die than insured trauma victims (Hadley et al., 1991).Health Care Structures, Functions and Facilities Essay

For children, too, being uninsured tends to reduce access to health care and is associated with poorer health. The 1998 IOM report America’s Children: Health Insurance and Access to Care found that uninsured children “are more likely to be sick as newborns, less likely to be immunized as preschoolers, less likely to receive medical treatment when they are injured, and less likely to receive treatment for illness such as acute or recurrent ear infections, asthma and tooth decay” (IOM, 1998:3). That report emphasized that untreated health problems can affect children’s physical and emotional growth, development, and overall health and well-being. Untreated ear infections, for example, can have permanent consequences of hearing loss or deafness.

Even when insured, limitations on coverage may still impede people’s access to care. 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, 2000). Cost-sharing requirements for these services may also be higher than those for other commonly covered services. (Additional discussion of these and other “neglected” forms of care appears later in this chapter.)Health Care Structures, Functions and Facilities Essay

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., 2000). The same effects have been shown for the use of behavioral health care services (Wells et al., 2000).Health Care Structures, Functions and Facilities Essay

As a result of the nation’s increased awareness of bioterrorist threats, there are concerns about the implications of copayments and other financial barriers to health care. 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. The issues are complex, and the failures of health Health Care Structures, Functions and Facilities Essay

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Suggested Citation:”5. The Health Care Delivery System.” Institute of Medicine. 2003. The Future of the Public’s Health in the 21st Century. Washington, DC: The National Academies Press. doi: 10.17226/10548.×
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care reform efforts over the past 30 years testify to the difficulty of crafting a solution. 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.Health Care Structures, Functions and Facilities Essay