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Six main forces that will determine future changes in health care
- 1) Social and Demographic Forces
- 2) Economics Forces
- 3) Political Forces
- 4) Technological Forces
- 5) Informational Forces
- 6) Ecological Forces
Successful Historical Precedents for PPACA
- 1) Oregon Health Plan - Late 80's Medicaid expansion including prioritization and streamlining of covered procedures, Health Insurance Pool for those with pre-existing conditions, and an Employer mandate.
- 2) Massachsettss Health Plan - 2006 Individual Mandate, Employer mandate, Subsidized coverage for low-income
A person's ability to manage their own health and utilization of care.
Challenges include socioeconomic and health status. Those enrolled in Medicaid are the least active of all insured.
Recommendations for Transforming the Nursing Profession
- Nurses should practice to the full extent of their education and training.
- Nurses should achieve higher levels of education and training.
- Nurses should be full partners in redesigning health care.
- Improved data and technology should drive assessment of workforce requirements by role, skill mix and demographics.
Training of Primary Care Physicians (to become comprehensivists)
- Comprehensivists will need to be experts in:
- 1) Anticipating, preventing and managing complications of common conditions.
- 2) Managing complex pharmacology.
- 3) Understanding end-of-life issues.
- 4) Coordinating care.
- 5) Leading health care teams.
Future Long-Term Care Challenges
- 1) Financing - less than 10% of elderly have LTC insurance and midlle class is growing, strain on state and federal budgets.
- 2) Resources - shift away from insititutional care straining the system.
- 3) Infrastructure - LTC is more attractive because of new facility design.
- 4) Workforce - Aging of americans shrinks workforce as number of those who need LTC grows.
- 5) Regulation - Quality issues and inconsisten applciaiton of regulations must be addressed.
- 6) IT - technology will enable better tracking of LTC patients as they move between facilities.
What changes will technology bring to the delivery of health care?
- 1) Rational drug design allows more accurate creation and customization of drugs.
- 2) Imaging technology allows better identifiaction of disesase and delivery of treatment.
- 3) Advanced, minimally invasive surgery.
- 4) Genetic mapping has allowed identifaction of genes which cause disease and may lead to disease.
- 5) Gene therapy - inserting of genese into targeted cells to correct a defect.
- 6) Vaccines now used for therapy of noninfectious diseases (HPV/cancer) in addition to prevention. Also more advacned vaccines being developed.
- 7) Transplantation of organs
- 8) Regenerative medicine.
Globalization and International Cooperation
Globalization means that infectious disesases are no longer contained to a single geographic area. Also, large-scale devastation no longer needs to be a addressed by a single country.
International cooperation is necessary to prevent and manage the effects of disease pandemics and deliver aid after disasters.
How to improve evidence-based health care
- 1) Health care leaders must emphasize evidence-based guidelines.
- 2) Ongoing modeling of multidisciplinary caregiving to determine best practices.
- 3) Ongoing clinical trials of drugs.
- 4) Constant revision and updating of guidelines and protocols.
- 5) Incorporating economic analysis into practice guidelines.
- 6) Restructuring financial incentives to focus on outcomes rather than volume.