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Health Care Systems

Allocation of Resources / Resource Utilization
by

Patty Averre

on 24 August 2016

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Transcript of Health Care Systems

Theories of Justice
Resource Utilization
NUR 212
Ms. Averre
Historically health care was the best quality, whatever the cost.
Since 1980, U.S. health care spending has tripled!!!
Spending continues to increase without transparent cause!
Factors Increasing Health Care Cost
What can nurses do?
What can nurses do?
Expanding resources in one area requires reducing services in another.

Health Care Resources
Care coordination:
Decrease wasted health care resources.
Case management:
Ensure effective treatment across the health care continuum.
Disease management:
Manage and improve the health of various populations over the course of their disease.
Outcomes management:
Demonstrate efficient care with measurable outcomes.
Resource Management: Ensuring adequate personnel, time and supplies are provided for patient care and operation of the organization.
Dynamics of national economy
Inflation
Aging population
Technology
Growth of third party payments
Employer-provided health insurance
Increased costs of labor
Malpractice
Illegal populations
Health Care Systems
Allocation of Resources
and
The analysis of how scarce resources are supplied by producers and distributed to consumers
The allocation of resources based on anticipated need for those resources
Federal Budget
When resources are scarce:
-services to offer?
-how to produce?
-how to distribute?
Macroallocation VS.
Microallocation
1. Government Regulation
Medicare Prospective Payment System (PPS)
Hospital: Diagnosis Related Groups (DRGs)
LTC: Minimum Data Set (MDS) and Resource Utilization Group (RUG) score
Home Health: Outcome and Assessment Information Set (OASIS) and Resource Utilization Group (RUG) score
Controlling Costs
2. Competition - Market supply and demand forces driving costs of health care
3. Cost Sharing - Employers require employees to share costs
4. Managed Care - Provider contracts
5. Medical Savings/Flex-spending Accounts
6. Hospital initiatives
7. Resource-based relative value scale (RBRVS) assigns a value to a procedure

Controlling Costs
4. Managed Care
Combines financing and delivery of health services into a single entity...
75% of people with insurance participate in managed care...
Control cost through controlling resources and provider contracts...
Controlling Costs
Ethical Dilemmas
Right to health care?
Each person entitled to the same health care?
Ability to pay?
Is gate-keeping ethical?
Does the cheapest care compromise quality?
Ethical Dilemmas
Who?
What?
When?
How much?
Why?
Utilitarian:
the greatest good for the greatest number
Libertarian:
allows citizens to improve their circumstances by their own efforts
Communitarian:
places the community at the center of the value system
Theories of Justice
Theories of Justice
Egalitarian: relates to equality, where people who are similarly situated should be treated similarly; promotes the idea of equal distribution.
Controlling Costs

 

Labor:
nurses, doctors, technicians, etc.
Capital:
facilities, equipment, and supplies
Land:
property for facilities
Entrepreneurship:
vision and skill to develop and manage the healthcare business
Egalitarian:
promotes the concept of equality

and equal distribution
Keeping an open mind in these controversial dilemmas is difficult, but reflecting on personal values prepares nurses to make decisions based on patient welfare.
6. Single Payer / National Health Coverage
7. Federal economic stabilization program
8. Hospital initiatives
9. Resource-based relative value scale (RBRVS) assigns a value to a procedure
Controlling Costs
5. Medical Savings Accounts (MSA)
Account set up for health care use usually automatically deducted and tax deferred!

Controlling Costs
Primary Factors Driving HC Cost:
1. Prices
2. Waste
IOM(2011)
Full transcript