Home Health Care Case Study

1. Describe how some of the changes in the health services delivery system have led to a decline in hospital inpatient days and a growth in ambulatory services.
• Two of the main factors that have led to decrease in hospital inpatient days and a growth in ambulatory services are Medicare reimbursement and cost-saving efforts of managed care. Medicare instituted PPS for reimbursing hospitals in the mid 1980s. PPS repayment based on DRGs gives fixed case-based payment to hospitals. Therefore, hospitals have a strong reason to decrease the inpatient length of stay and continue in an outpatient setting. Outpatient area has fewer payment restrictions. Managed care adopted a cost-containment strategy, which also stresses lower inpatient utilization,
with a corresponding emphasis on outpatient services. For instance, these financial factors have provided a major impulse for the unprecedented growth of home health care. Also, availability of new technology has also shifted a number of inpatient surgical procedures to the outpatient setting.

4. What are the main characteristics of primary care?
• One of the main functions of primary care is to coordinate the delivery of health services between the patient and the myriad delivery components of the system.
Hence, in addition to providing basic services, primary care professionals serve the role of patient advisor, advocate. Another main characteristic is essential care. Primary health care is regarded as essential health care. As such, the goal of the health delivery system is to optimize population health, not just the health of individuals who have the means to access health services. Achievement of this goal requires that disparities across population subgroups be minimized to ensure equal
access.

13. Why is the hospital emergency department sometimes used for nonurgent conditions? What are the consequences?
• Nonurgent conditions do not require the resources of an emergency service, and the disorder is nonacute or minor in severity. Reasons for emergency department use for nonurgent care include erroneous self-perceptions of the severity of ailment or injury, the 24-hour open-door policy, convenience, and unavailability of primary care providers. Since many private physicians do not provide services to Medicaid enrollees because of low reimbursement rates, Medicaid beneficiaries often have no primary care provider. Since emergency departments are required by law to evaluate every patient regardless of ability to pay, Medicaid patients and the uninsured frequently use them for primary care treatments. Even the insured sometimes feel that they need medical attention immediately regardless of how their problem might be classified by a provider. Such patients present themselves at the emergency department because they cannot find needed care elsewhere. Since the emergency department requires sophisticated facilities and highly trained personnel and must be accessible 24 hours a day, costs are high and services are not designed for nonurgent care. Inappropriate use of the emergency department wastes precious resources.

15.
What is the basic philosophy of home health care? Describe the services provided through home health care.
• Home health is consistent with the philosophy of maintaining people in the least restrictive environment possible. Home health services typically include nursing care, such as changing dressings, monitoring medications, and providing help with bathing; short-term rehabilitation, such as physical therapy, occupational therapy, and speech therapy. Other services include homemaker services, such as meal preparation, shopping, transportation, and some specific household chores.

17. Explain the concept of hospice care and the types of services a hospice provides.
• The term hospice refers to a cluster of comprehensive services for the terminally ill with a medically determined life expectancy of 6 months or less. Hospice care provides: meeting the patient’s physical needs, with an emphasis on pain management and comfort, emotional and spiritual needs, support for the family members before and after the patient’s death and focuses on maintaining the quality of life rather than prolonging life.

21. Why do both Republican and Democrat presidents support the community health center
program?
• CHC tailors their services to family oriented primary and preventative health care and dental services. Successful at managing needs of underserved populations, takes less of a burden off of health care funds and still covers health needs for under served.