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The evolution of health care and timeline essay

For example, in 2001 and 2002, two of the largest health care systems in southeastern Michigan i. These closures result in additional strains on remaining hospitals, creating even greater stresses for an already fragile system.

While hospital closings and mergers create many issues and concerns, both the declining number of beds and the declining number of admissions is related to a significant decline in the number of in-patient surgeries. By 1995, the respective percentages of in-patient and out-patient surgeries were 42 percent and 58 percent.

While the cost savings to insurers is real, although difficult to calculate, the impact on formal and informal after-care services and in home health care is equally difficult to estimate. Now many more patients return home on the same day of their surgeries. For individuals with familial and social supports this reality may not be as challenging as for patients who live alone and have little if any family or social network on which to depend. In today's world, most of the leading causes of death are related to life style.

It is calculated by the Institute for the Future 2000 that 40 percent of sickness is related to life style and health behavior choices. Clearly education and early case finding are paramount. Prevention has proven effective for individuals or families who have made life style and health behavior changes. However, for many patients, changing to a managed care program, or switching between managed care programs, changes and limits the choices of providers to those on preferred panels. In many plans, if a patient wants to see a provider with whom he or she is familiar, but who is not included as a provider in their "new" plan, an option may exist the evolution of health care and timeline essay obtaining "out of network" services, but it almost always comes with a significantly higher out-of pocket co-pay.

Some employers are covering fewer persons. Some are passing the increases on to employees and requiring higher levels of employee contribution. And some employers are just doing away with health care benefits all together.

While reductions in the "value" of an existing plan adversely impact employees, the ability to contain insurance costs helps for more people to at least remain covered in some fashion—even if their coverage is only for very serious illnesses. The number of people in the population without health care has increased. Currently it is estimated that 42 million people, or 16 percent of the population, is without any form of health care insurance. The Institute for the Future 2000 projected that the number of uninsured will reach 48 billion by 2010.

While this statistic usually rises during times of recession and decreases in times of expansion, the number of uninsured has increased even during the expansion of the late 1990s and early 2000s. The Institute for the Future 2000 also reported that the number of non-elderly persons covered by employment related health insurance dropped from 69.

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In Michigan, for example, the Access to Health Care Coalition 2002 reported that between 1999 and 2000 the percent of residents without health insurance decreased from 10. However, given the relationship between the economy and the availability of health insurance, this decrease appears temporary.

An increase is expected in the number of uninsured, especially in light of the economic downturn of 2001. Of the uninsured in Michigan, an estimated 106,000 are children—despite programs aimed at improving children's health like Healthy Kids and MIChild. While not all eligible children have been enrolled in these programs, a considerable number are not eligible based on family income exceeding a percentage of the Federal Poverty Level FPL.

Mirroring national trends, Michigan is struggling with rising unemployment, a budget deficit, and growing demands for health services and insurance coverage. Often the underinsured and uninsured use the emergency room, the most expensive form of health care service, for any illness.

Weiss and Lonnquist 2000 reported that uninsured emergency room care visits totaled 93 million in 1996.

What Factors Are Driving the Change?

In approximately half of the cases, urgent care was not needed, nor did the individuals seeking care have a regular physician or other option for gaining access to health care services. The Institute for the Future in Health and Health Care 2010 described three tiers of coverage in today's evolving health care system and projected how individuals and families may experience this changing system based on which tier of health coverage describes their particular situation 2000.

Their observations are summarized below: The first group represents 38 percent of the population. It consists of empowered consumers with considerable discretionary income, who are well educated and use technology, including the Internet, to get information about their health.

Historical Development of Nursing Timeline Essay

Usually they are able to make choices in their plans and coverages. They are able to educate themselves about health behaviors as well as health care issues and concerns. They are likely to engage in shared decision making with physicians and other allied health professionals.

Their primary concern is benefit security and the issue of value as plans become more restrictive. People included in this group include those with unstable job security, both employers and employees, and also early retirees who are waiting for Medicare to begin. Though they have limited access to information, they are likely to focus on learning more about plans and coverages.

They are also likely to become more empowered due to some of the voluntary associations to which they belong who focus on problems in the health care system. The third group represents 28 percent of the population whose main concern is access to health care. It includes people under 65 who are uninsured as well as children who have no coverage or are covered by Medicaid.

Access to care for this tier is severely limited because the safety net has frayed. People in this tier depend on the limited resources and strained generosity of safety net funding streams and providers. While some are covered by Medicaid, this plan offers only limited choices and benefits depend on funding which often competes with prisons and schools.

Generally poor and lacking education, most people in this tier have serious trouble overcoming the information gap between patients and providers.

  • For example, nurses play a central role in health care; a complex system, and they interact with numerous elements of the system;
  • The number of people in the population without health care has increased;
  • It includes people under 65 who are uninsured as well as children who have no coverage or are covered by Medicaid;
  • While hospital closings and mergers create many issues and concerns, both the declining number of beds and the declining number of admissions is related to a significant decline in the number of in-patient surgeries;
  • National Survey of Health Insurance;
  • A time line of important events in the field of nursing which.

They may be largely ineffective in changing legislation or the structure of health care. If the problem of access is to be solved, it will need to be driven from the top two tiers.

  • Science provides an increasing flow of contributions to the nursing care delivery which enhances the professional relationship Lindberg, 2005;
  • In approximately half of the cases, urgent care was not needed, nor did the individuals seeking care have a regular physician or other option for gaining access to health care services.

Trust however is another issue. Mechanic's elements of trust cited in Dranove, 2000 are as follows: Patients trust that providers will act unselfishly, putting the patients' interest above their own Patients trust that providers have the technical competence necessary for proper diagnosis and treatment, the evolution of health care and timeline essay Patients trust that providers can control and coordinate the resources necessary to deliver quality care.

Survey results indicated that only 30 percent of patients in managed care plans trusted that their plan would do the right thing for their care, while 55 percent in traditional plans trusted their plans.

Also, fewer than 30 percent of patients trusted their HMOs to control costs without adversely affecting quality of care Dranove, 2000. Managed care has a long way to go in persuading the public that managed care is actually care management, although they frequently advertise high quality at a reasonable cost. What Can Be Done? All of this information may be overwhelming, although it represents only a brief overview of the issues and concerns related to our evolving health care system.

Nevertheless, there are several practical steps that we can take both individually and collectively: Practicing more health promotion behaviors and using preventive services; Preparing to bear a higher burden of health insurance cost if one has coverage or preparing to bear a higher burden of actual "out-of-pocket" health care costs; Being ready to provide more home care services to assist friends and family members whose surgical procedures will involve limited hospitalization; Anticipating further limitations in selecting one's own primary care provider; Knowing your own plan and any intended changes; Developing assertiveness skills in dealing with your own insurers, providers, and case managers; Keeping abreast of broader issues and concerns, such as how the entire system bears the cost of the underinsured and, especially, the uninsured; Advocating for policy changes at the legislative level, especially for those without access to even basic health care services.

What Does the Future Hold?

  1. Throughout history, nursing has shown the uniqueness of the profession. Some employers are covering fewer persons.
  2. Hire Writer 1860- Florence Nightingale. They are likely to engage in shared decision making with physicians and other allied health professionals.
  3. Retrieved March 1, 2002 from http. It includes people under 65 who are uninsured as well as children who have no coverage or are covered by Medicaid.
  4. In approximately half of the cases, urgent care was not needed, nor did the individuals seeking care have a regular physician or other option for gaining access to health care services. When met distress diminishes, adequacy increases, or enhances well-being.
  5. Blue Cross Blue Shield of Michigan. Access to care for this tier is severely limited because the safety net has frayed.

While trends can be traced and often predicted, there are a significant number of "wild cards" in the future that make the evolution of the American health care system uncertain and volatile. Some of these, according to the Institute for the Future 2000include Demographic trends and increasing numbers of elderly people in the population; Reimbursement rates for home health care services; new cost containment and cost-shifting strategies; Increasing technology; Economic recessions or expansions; legal and mandatory restrictions on managed care plans; Malpractice insurance, settlements, and jury awards; universal health insurance legislation; and Switching from a private and public insurance model to a national health insurance system.

One solution is to learn from other health care delivery models. Perhaps we could benefit both by learning more about other systems especially from countries with high levels of accessand also by beginning to advocate for needed changes in the American health care system.

Indeed, the greatest changes may come about as consumers make their concerns known to providers and to state and federal policy makers.

  • Their primary concern is benefit security and the issue of value as plans become more restrictive;
  • For more information please contact mpub-help umich;
  • Science provides an increasing flow of contributions to the nursing care delivery which enhances the professional relationship Lindberg, 2005;
  • These closures result in additional strains on remaining hospitals, creating even greater stresses for an already fragile system;
  • Also, fewer than 30 percent of patients trusted their HMOs to control costs without adversely affecting quality of care Dranove, 2000.

It would also make strategic and tactical sense for providers to partner with consumers and policy makers to bring about needed changes. Given our current reality, the focus of change will need to address both access and affordability. References Access to Health Care Coalition 2001.

Improving access to health care in Michigan. Blue Cross Blue Shield of Michigan. Retrieved March 1, 2002 from http: A comprehensive summary of U. A clinical approach 2nd ed. The evolution of American health care. Employer-Sponsored Health Benefits 1997. Institute for the Future 2000. Health and health care 2010: The forecast, the challenge. National Survey of Health Insurance. National health spending trends in 1996. Health Affairs, 17, 35-51.

The sociology of health, healing, and illness 3rd ed. Upper Saddle River, NJ: For more information please contact mpub-help umich.