Upload
eleanore-dickerson
View
216
Download
0
Tags:
Embed Size (px)
Citation preview
Introduction
• What is Meant by Primary, Secondary and Tertiary Care?
• How Are Clinical Health Professionals Rewarded and Compensated for Their Services?
• How Can We Ensure the System Has the Right Number of Health Professionals?
ScenariosHealth Professionals and the Health Workforce
In the hospital the nurse specialist examines you and consults with the radiologists, the gastroenterologist, and the general surgeon. Your medication is reviewed by the PharmD, and your meals by the clinical nutritionist. Throughout your hospitalization you are followed by a hospitalist. Once you get back home the home care team comes to see you regularly for the first two weeks and the physician assistant and registered nurse see you in the office. You realize that health care is no longer just about doctors and nurses. You ask yourself, what roles do all of these health professions play?
ScenariosHealth Professionals and the Health WorkforceJenna decides that after college she wants to become a doctor and practice medicine, thinking there was only one kind of doctor who could diagnose disease and prescribe medicine. Not so any more, says her advisor. There are allopathic and osteopathic physicians. In addition there are nurse practitioners who are often authorized to diagnose and prescribe medication as well as physician assistants who do the same under a physician’s supervision. Doctors now include doctors of nursing practice as well as others with doctoral degrees such as pharmacists and physical therapists. Understanding careers in health care can be as difficult for students as it is for patients, you think to yourself. Now she understands why her advisor asked: “What do you mean by practice? What do you mean by doctor?”
ScenariosHealth Professionals and the Health WorkforceSarah was about to begin medical school and was expecting two years of “preclinical” classroom lectures focusing on the basic sciences followed by the study of clinical diseases. Then she expected two years of clinical hospital” rotations” and electives checking out specialties like she’d heard about from her physician dad. She is surprised to find that medical school has changed. There are small group, problem-based learning sessions where she needs to be able to locate and read the research literature. There is contact with patients and their problems right from the beginning. There is increasingly a four year approach instead of a preclinical and clinical approach to medical education. She wonders: are these changes for the better? What else needs to be done to improve medical education?
ScenariosHealth Professionals and the Health Workforce
You are interested in clinical care as well as public health. “I need to make a choice you think to yourself.” “Not necessarily,” your advisor says, “there are many ways to combine clinical care with public health.” After a little investigation you find out that undergraduate public health education is increasingly seen as preparation for clinical education, and clinical prevention & population health is increasingly becoming part of clinical care. In addition many careers from health administration to health policy to clinical research combine the individual orientation of clinical care with the population perspective of public health. So what’s the best pathway to public health for you?
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Allergy and Immunology
Allergy and Immunology
American Board of Anesthesiology
Anesthesiology Critical Care MedicineHospice and Palliative Medicine1
Pain Medicine
American Board of Colon and Rectal Surgery
Colon and Rectal Surgery
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Dermatology
Dermatology Clinical and Laboratory Dermatological ImmunologyDermatopathologyPediatric Dermatology
American Board of Emergency Medicine
Emergency Medicine Hospice and Palliative Medicine1
Medical ToxicologyPediatric Emergency MedicineSports MedicineUndersea and Hyperbaric Medicine
American Board of Family Medicine
Family Medicine Adolescent MedicineGeriatric MedicineHospice and Palliative Medicine1
Sleep MedicineSports Medicine
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Internal Medicine
Internal Medicine Adolescent MedicineCardiovascular DiseaseClinical Cardiac ElectrophysiologyCritical Care MedicineEndocrinology, Diabetes and MetabolismGastroenterologyGeriatric MedicineHematologyHospice and Palliative Medicine1
Infectious DiseaseInterventional CardiologyMedical OncologyNephrologyPulmonary DiseaseRheumatologySleep MedicineSports MedicineTransplant Hepatology
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Medical Genetics
Clinical Biochemical GeneticsClinical CytogeneticsClinical Genetics (MD)Clinical Molecular GeneticsPhD Medical Genetics
Medical Biochemical Genetics4Molecular Genetic Pathology
American Board of Neurological Surgery
Neurological Surgery
American Board of Nuclear Medicine
Nuclear Medicine
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Obstetrics and Gynecology
Obstetrics and Gynecology Critical Care MedicineGynecologic OncologyHospice and Palliative Medicine1
Maternal and Fetal MedicineReproductive Endocrinology/Infertility
American Board of Ophthalmology
Ophthalmology
American Board of Orthopaedic Surgery
Orthopaedic Surgery Orthopaedic Sports MedicineSurgery of the Hand
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Otolaryngology
Otolaryngology Neurotology Pediatric OtolaryngologyPlastic Surgery Within the Head and NeckSleep Medicine
American Board of Pathology
Anatomic Pathology and Clinical PathologyPathology - AnatomicPathology - Clinical
Blood Banking/Transfusion MedicineChemical PathologyCytopathologyDermatopathologyForensic PathologyHematologyMedical MicrobiologyMolecular Genetic PathologyNeuropathologyPediatric Pathology
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Pediatrics
Pediatrics Adolescent MedicineChild Abuse Pediatrics2
Developmental-Behavioral PediatricsHospice and Palliative Medicine1
Medical ToxicologyNeonatal-Perinatal MedicineNeurodevelopmental DisabilitiesPediatric CardiologyPediatric Critical Care MedicinePediatric Emergency MedicinePediatric EndocrinologyPediatric GastroenterologyPediatric Hematology-OncologyPediatric Infectious DiseasesPediatric NephrologyPediatric PulmonologyPediatric RheumatologyPediatric Transplant HepatologySleep MedicineSports Medicine
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Physical Medicine and Rehabilitation
Physical Medicine and Rehabilitation
Hospice and Palliative Medicine1
Neuromuscular Medicine3
Pain MedicinePediatric Rehabilitation MedicineSpinal Cord Injury MedicineSports Medicine
American Board of Plastic Surgery
Plastic Surgery Plastic Surgery Within the Head and NeckSurgery of the Hand
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Preventive Medicine
Aerospace MedicineOccupational MedicinePublic Health and General Preventive Medicine
Medical ToxicologyUndersea and Hyperbaric Medicine
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Psychiatry and Neurology
PsychiatryNeurologyNeurology with Special Qualifications in Child Neurology
Addiction PsychiatryChild and Adolescent PsychiatryClinical NeurophysiologyForensic PsychiatryGeriatric PsychiatryHospice and Palliative Medicine1
Neurodevelopmental DisabilitiesNeuromuscular Medicine3
Pain MedicinePsychosomatic MedicineSleep MedicineVascular Neurology
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Radiology
Diagnostic RadiologyRadiation OncologyRadiologic Physics
Hospice and Palliative Medicine1
NeuroradiologyNuclear RadiologyPediatric RadiologyVascular and Interventional Radiology
American Board of Surgery
SurgeryVascular Surgery
Hospice and Palliative Medicine1
Pediatric SurgerySurgery of the HandSurgical Critical Care
Selected Specialties and Sub-specialties of Medicine
General Certificate(s) Subspecialty Certificates
American Board of Thoracic Surgery
Thoracic Surgery Congenital Cardiac Surgery4
American Board of Urology
Urology Pediatric Urology
Ideals and Realities of Primary Care
Primary care ideals
Realities
Contact The point of first contact with the health care system—the entry point
Patients enter the health care systems through many disconnected points including: ER, specialists, urgent care centers, nontraditional practitioners, etc.
Ideals and Realities of Primary Care
Primary care ideals
Realities
Comprehensive Primary care intends to be able to diagnose and treat the great majority of problems
Rapid increase in possible treatments and high-volume practices increase proportion of patient problems that are referred to specialists
Ideals and Realities of Primary Care
Primary care ideals
Realities
Coordinated Primary care intends to be the focal point for diagnosis and treatment with coordination through referral to specialists for consultation and feedback
Primary care physicians increasingly being replaced by "hospitalists," who are full time in the hospital and provide care for inpatients and direct patient access to specialists
Ideals and Realities of Primary Care
Primary care ideals
Realities
Continuity Patient followed over many years—continuous care provision
Patients increasingly required or encouraged to change physicians/providers for insurance purposes
Ideals and Realities of Primary Care
Primary care ideals
Realities
Caring Individualized care based on individual relationships
Primary care increasingly becoming an administrative entity without long-term individual relationship
Ideals and Realities of Primary Care
Primary care ideals
Realities
Community Primary care designed to connect the individual patient with community resources and community requirements (required examinations, reportable diseases, vaccinations, driver’s licenses, etc.)
Health care professionals and public health have long history of distant and—at times—contentious relationships
Methods of Financial Compensation to Providers of Health Services
Compensation method
Meaning Examples Advantages Disadvantages
Fee-for-service Clinician paidfor eachcovered service
Physiciansoften paid formedical visitsand procedure,but may not bepaid forcounseling forprevention
Reward linkeddirectly to workPerformed
Encouragesefficiency ofdelivery ofservices
May encouragedelivery ofunnecessary, aswell asNecessaryservices
Methods of Financial Compensation to Providers of Health Services
Compensationmethod
Meaning Examples Advantages Disadvantages
Capitation Clinician ispaid a setamount pertime period foreach patient forwhom they areresponsible,regardless oflevel of use ofservices
Primary carephysicians inhealth plansmay be paid aset amount perpatient permonth and areexpected toprovide allprimary careservices
DiscouragesUnnecessarycare, mayEncouragepreventive
care,allows forPredictablebudgeting
MayDiscouragenecessary care,may encouragereferral toSpecialistsunless specialtycare isfinanciallydiscouraged
Methods of Financial Compensation to Providers of Health Services
Compensationmethod
Meaning Examples Advantages Disadvantages
Episode ofcare
Institution orclinician is paida set amountfor providingComprehensiveservices, suchas hospitaltreatment basedon the patient’sdiagnosis
Medicare paysfor hospitalcare based onDiagnosisRelated Groups(DRGs)Allowingdefined numberof days percondition
Encouragesrapid andEfficientdelivery of care
May encouragedischarge priorto ability toprovide self-care
Methods of Financial Compensation to Providers of Health Services
Compensation method
Meaning Examples Advantages Disadvantages
Salary Set amount per time period
Governmental facilities generally pay clinicians on a seniority-based salary
May allow focus on quality
May discourage efficiency
Methods of Financial Compensation to Providers of Health Services
Compensationmethod
Meaning Examples Advantages Disadvantages
Pay forPerformance
“P4P”
Compensationadjusted basedon measures ofthe quality ofcare delivered
AdditionalCompensationfor adherenceto evidenceBasedguidelines
Links incomewith qualityProvidingStrongincentive for quality
Difficult tomeasure qualityOutcomesmaybe relatedto factorsOutsideclinician’scontrol
Health Care System
Health Professionals
Health CareInstitutions
Health Financing