factors such as income, type of insurance coverage, gender, race or ethnicity, geographical proximity, and system characteristics affect a person's ability to have access to health care.
The 2010 passage of The Patient Protection and Affordable Care Act and the HCERA has made changes in the U.S. health care system.
The elderly have a form of UHC coverage through Medicare.
Because the United States does not have national/UHC insurance, public health care programs are intended to fill the gap.
Health care spending continues to increase faster than the overall U.S. economy.
There are many contributing factors to the rising costs of health care. The key factors include the aging of the population with growth in the demand for health care, increased utilization of pharmaceuticals, expensive new technologies, rising hospital care costs, practitioner behavior, cost shifting, and administrative costs.
Because rising health care costs are based on utilization, it is important to understand other factors that can both increase and decrease utilization.
Capitation and prospective payment have had some of the most significant impacts on cost containment.
The report To Err Is Human, confronted health care clinicians and managers with concerns about the poor quality of health care attributable to misuse, overuse, and underuse of resources and procedures, which was responsible for thousands of deaths (IOM, 1999).
The report, Crossing the Quality Chasm (IOM, 2001) and several large studies (McGlynn et al., 2003; Thomas et al., 2000) have shown that the quality of health care in the United States is at an unexpected low level and needs improvement in many dimensions, given the amount of money the United States spends on health care.
Groundbreaking research, beginning in the mid‐1980s and continuing in the 1990s, demonstrated that there was significant variation in utilization of specific health care services associated with geographical location, provider preferences and training, type of health insurance, and patient‐specific factors such as age and gender.
Recent research findings illustrate the need for significant improvements in the process of health care delivery.
Health care performance and quality are measured to determine resource allocation, organize care delivery, assess clinician competency, and improve health care delivery processes.
Public reporting of organizational performance and quality information is being driven by several forces.
Several key national public quality reports of interest for health care and nursing leaders and managers for purposes of performance measurement and benchmarking are available.
A key challenge for health care is the numerous deficiencies in the delivery of care of patients with chronic conditions.
Evidence‐based practice involves supplementing clinical expertise with the judicious and conscientious implementation of the most current and best evidence along with patient values and preferences to guide health care decision making.
Health care accreditation is a mechanism used to ensure that organizations meet certain national standards.
There is a need to focus on retooling the health care workforce with new knowledge and requisite skills to function in better, redesigned health care systems.
Health professionals' education to transform current skills and knowledge includes training clinicians to effectively work in interdisciplinary teams; have an educational foundation in informatics; and deliver patient‐centered care, fully exploiting evidence‐based practice, quality improvement approaches, and informatics.
The IOM's 2004 Report on Patient Safety was the first in a series of reports published since the year 2000 to emphasize the connections among nursing, patient safety, and quality of care.
KEY TERMS
Balanced scorecards
Co‐payments
Cost shifting
Deductibles
Disease management
Gross domestic product (GDP)
Health care transparency
Outcome component of health
Outcome measurements
Primary care
Process component of health
Structure component of health
REVIEW QUESTIONS
1 The national organization that accredits health care organizations is known as which of the following?American Nurses AssociationHealth Professions CommissionAgency for Health Care Research and QualityJoint Commission
2 The largest purchaser of health care in America is which of the following?Private individualsPrivate insurance companiesHealth Maintenance OrganizationsMedicare, Medicaid, and other governmental programs
3 Who identified a structure, process, and outcome framework for quality?NightingaleDonabedianStarrLohr
4 What is the top underlying cause of health care disparity in the United States?Socioeconomic statusAgeGeographical locationChronic illness
5 Payment for health care services as a fixed dollar amount per member over a period of time is referred to as which of the following?Traditional fee for servicesProspective payment systemCapitationDiagnosis‐related groupings
6 The Patient Protection and Affordable Care Act provides comprehensive health care reform through a number of initiatives, including which of the following? Select all that apply.Restricting in‐patient hospital staysExpanding health insurance coverageTargeting fraud, abuse, and waste in health careIncreasing access to primary care servicesPromoting preventive health strategies
7 Key factors contributing to rising health care costs in the United States include which of the following? Select all that apply.An aging populationAdvancements in technologyIncreased utilization of pharmaceuticalsRising costs of primary careAdministrative costs
8 The competencies for the education of health care professionals recommended by the Institute of Medicine to improve the quality of health care include all but which of the following?Primary care settingsA patient‐centered approachUse of health information technologyEvidence‐based practice
9 The link between adverse patient outcomes and cleanliness was discovered by:W. Edwards DemingFlorence NightingaleIsabel Hampton RobbDorothea Dix
10 Three components of health care systems are:strategy, outcome, and performanceprocess, strategy, and opportunitystructure, process, and outcomeoutcome, procedure, and structure
REVIEW QUESTION ANSWERS
