Term
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Definition
- Many challenges faced in the US also exist in other countries but it is important to also learn how other countries are responding to those challenges
- Most countries desire to improve their health
- Content will review health systems, structures, and processes of health care delivery across countries
- Content will also review population health (health status of a group of people or nation)
- Public health: Is often used to improve the health of populations through interventions
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Term
| International health care chart |
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Definition
- Table 13-1, pg 231
- US (last)
- UK= highest, Switzerland= #2 |
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Term
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Definition
- Publicly funded single payer system legislated in 1966, fully operated in 1971
- Through this system Canada provides universal access to health care
- The Canadian Health Act – sets policies for provinces receive funding
o Administration of the provincial insurance must be carried out by an accountable public authority
o All necessary services, including physicians & hospital services must be insured
o All insured residents must be able to receive same level of care
o Residents who move to diff provinces must retain their home province insurance for a minimum grade period
o There must be reasonable access to health care services
- Funding comes from federal & provincial taxes on both personal & corporate income
- Canada spends $4,000 per capita on health expenditure or 10.9% of the GDP (gross domestic product)
- One issue is the federal involvement in health care when provinces administer & deliver the services
- Some feel health care workers are not adequately compensated leading to a shortage of med workers
- US tends relatively high compensation w some arguments over certain services being too low
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Term
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Definition
- The National Health Service (NHS) in the UK was established in 1948
- NHS is a centralized, single payer system funded by general revenue from national taxes
- Cover preventative services, physician services, hospital care, prescription meds, and some long-term rehab
- Pt can purchase private insurance that allows them to “hop” over the lines
- NHS employs general practitioners, nurses, ambulance staff, & other health care workers to provide covered services
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Term
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Definition
- 1883 first nation to enact compulsory health insurance
- req employers & employees to pay into sickness funds designed to pay for med expenses of employees
o the revised Statutory Health Insurance (SHI): covers 85% of pop, 10% by private insurance; covers when make <$6,000
- SHI covers: preventative services, mental health, hospital services, physicians, prescriptions, rehab, more
- SHI has 150 funds that are autonomous, non profit & non governmental entities regulated by law
- Sickness funds
- Payment of services
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Term
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Definition
- Universal coverage system that covers all residents publicly finances through the Statutory Health Insurance (SHI)
- Covers limited services
- Cost sharing that includes co-insurance, co-payments, and extra billing
- SHI is financed primarily through employee & employee payroll taxes & national income tax
o Funds managed by a board that has representatives from employers and employees
o Strong push in recent years to have a gatekeeper & more than 85% of the pop has registered w primary care physician
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Term
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Definition
- Fragmented health care system funded by a mix of private & public sources
- The system has a large # of uninsured & many underinsured
- Covered benefits: vary by type of insurance; often include physician & hospital services, preventative services, physiotherapy, mental health & prescription drugs
- Finances: by individuals or tax-free premium contributions shared by employers
o Medicare: disabled or 65+
o Medicaid: poverty
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Term
| Comparing performance of health care sys: |
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Definition
- Rationale for comparing health care systems is to evaluate the value & performance of the system based on the time, resources, and money spent on that health care system
- Issues to consider: access to care, level of health care expenditures, satisfaction of pt, overall quality of care
- Opportunity to learn from others
- The Commonwealth Fund:
o Doc referred to in textbook Mirror, Mirror, on the wall (2014)
o Mirror, mirror 2017
- US spends more on health care than other high-income nations but has lower life expectancy & worse health
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Term
| Result: Access & level of expenditure |
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Definition
- Lack of universal coverage in US impacts access to health care
- US fundamentally funded by private insurance
- The Commonwealth Fund reported 54% of US citizens report probs w access to health care
- Although US has financial barriers to access, they receive relatively timely access to services
o UK has short waiting periods for basic health care but longer wait times for specialist care & elective surgeries
o Canada also ranks low in wait times
o Universal health care is often associated w longer wait times
- Table 13-2 pg234
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Term
| Results: Quality & Efficiency |
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Definition
- Quality: 4 categories of quality dimensions
o Effective care
o Safe care
o Coordinated care
o Patient-centered care
- US has positive findings for providing prevention & patient centered care but had lower scores for safe & coordinated care
- Efficiency: a health care system that maximize the quality of care & outcomes given the committed resources as well as ensuring that additional investments yield a net value
o US was last on overall efficiency: measures of timely access to records and test results, duplicative services, rehospitalization, and physicians use of health info technologies
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Term
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Definition
- Hard to measure across countries due to cultural norms
o Waiting may be acceptable in one country, but not another
o Refer to table 13-2 pg 234
> 29% of US said system works well compared to 38% in Canada & Germany
> 27% of US felt health care system needed complete rebuild
o Refer to table 13-3 pg 235
> US invests large amount into health care yet does not have outcomes
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Term
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Definition
- Possible revised ACOTE standard B.1.3: Demonstrate knowledge of the social determinants of health for persons, groups, and pops with or at risk for disabilitieis & chronic health conditions – must include an analysis of the epidemiological factors that impact public health & welfare of disadvantaged populations
- Moves from viewing health care as 1 individual to examining the pop as a whole
- Many major achievements in health care can be traced back to public health practice (Table 13-4 pg 236)
- 25 of the 30 year increase in longevity in the US can be attributed to public health
- Public health is able to identify illness, injuries, morbidity & disability that results from conditions: uses a system of surveillance (Table 13-5, pg 236)
- Health as a product of many factors: social, economic, & env
- This approach to healthcare can not only save lives but also $ |
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Term
| The factors that influence health... |
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Definition
AKA determinants of health:
1. Policy making
2. health services
3. individual behaviors |
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Term
| World Health Organization (WHO): |
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Definition
- focused on population health
o Created in 1948 in what is essentially the public health branch of the United Nations
o Core functions of the WHO listed in table 13-6 pg 237
o Major accomplishments: eradication of smallpox & near-eradication of poliomyelitis & leprosy through immunizations
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Term
| Public health use epidemiology: |
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Definition
o Purpose: identify threats to a pop & device a control strategy
o Done through routine surveillance w collection of data, analysis of the env, investigation of disease outbreaks, & determination of the incidence of disablement
o Determine the cause of the prob then treat & prvent
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Term
| Surveillance also used to create policies... |
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Definition
o The Healthy People Initiative
> Example of using analyzing data to determine health care trends & dev goals and objectives to improve pop health
Leading indicators for Healthy People 2020 (Table 13-7 pg 238)
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Term
| Population Health Improving Health |
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Definition
- Pop health examines the distribution of health outcomes along w determinants
- Goal: preserve health & minimize impact of morbidity
o Accomplished through prevention, lifestyle changes, reducing errors/waste, closing disparity gaps, & improving accountability and coordination of care
- Accountable Health Care Organization (ACOs)
- Pop health seeks to understand & address reasons for morbidity
- Using a pop approach comm can have favorable cultural, social, economic & env conditions that will enable healthier lives
- OTs may adderss Healthy People 2020 indicators
- Therapists can influence pop health by addressing & advocating for health promotion
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Term
| Article: Population Health & OT |
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Definition
- One of the pillars of the triple aim is to improve the overall health of the pop
- Population health: the health outcomes of a group of individuals including the distribution of such outcomes within the group
- The Official Doc of AOTA: define clients as persons, groups, pops
o pop is defined as collectives of groups of individuals w similar locale or sharing the same or like characteristics or concerns
o Framework: specifically states that organization or system level practice is valid
- Basic pop health principles
- Pop health can be approached in 2 ways:
1. Starting from the comm & thinking about the needs of the pop & integrating w clinical care
2. Starting from the individual needs of patients & learning about the social or comm factors that are impacting health & addressing needs through policy & system change
- Examples of OT w Pop Health:
o Needs of the pop of ppl living with HIV/AIDS
o The role that env plays in facilitating/limiting health disability, and rehab for those w disabilities
o OTs collaborated w CMS to measure pop health indicators for this w disabilities served under Medicaid programs
o OTs advocate for mental health initiative to support the mental health pop
- Growing opportunities to address pop health
- Recommendations & future directions:
o We should clearly articulate OTs address pop health to promote ^ recognition & consideration of the profession in policy arenas
o Ensure the wording within the framework includes pop health & provides examples
o We as profession actively support, recognize, reward & value OTs who assume roles in which direct care is not their primary function
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Term
| National Center Complementary & Integrative Health (NCCIH) |
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Definition
- The mission of NCCIH is to define, through rigorous scientific investigation, the usefulness & safety of complementary & integrative health interventions and their roles in improving health and health care
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Term
| Official Doc: OT & complementary health approaches & integrative health (CHAIH) |
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Definition
- AOTA believes that numerous complementary health approaches & integrative health (CHAIH) products & practices are within scope of competent OTs
- CHAIH replaces complementary & alternative medicine (CAM)
- Generally falls into 2 categories:
1. Natural products
2. Mind & body practices
- Commonly used to avert symptoms or manage clinical conditions to ^ quality of life
- CHAIH may include prepatory methods and tasks, occupations, and activities
- Ensure client centered practice & respect client’s values, beliefs, experience & contexts
- CHAIH must be done in the context of the overall OT process & plan of care
- Ethical Considerations:
o OTs must have continued competency in OT & CHAIH
o Req to practice in accordance w federal & state laws, relevant statutes, regulations & payer policies
o Any risks of CHAIH must be disclosed to the client
o Additional training, credentials or licensure is necessary when CHAIH fall outside the scope of OT practice
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Term
| Article: CAM (complementary & alternative medicine) use of Canadian OTs |
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Definition
- Results: 31.2% have used at least 1 for of CAM
- 5.5% using more than 1 CAM
- Massage & reflexology
- Tai Chi
- Acupuncture/Acupressure
- Magnetic Therapy
- Therapeutic touch & Reiki
- Reasons not use: lack of training (82.4%), lack of interest (23%), lack of support/evidence (22.3%)
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Term
| Article: Barriers & facilitators to cultural competence |
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Definition
- Barriers: as reported by therapists/practitioners
o Effects of language barriers
o Influence of cultural diff on service delivery
o Limited resources to facilitate culturally competent care
- Facilitators: (as reported by therapists/practitioners)
o ^ cultural awareness
o Fostering culturally competent work env
o Explaining healthcare to minority patients
- Barriers (as reported by pt/caregivers):
o Effects of language & cultural barriers
o Effects of limited resources in services
- Facilitators (as reported by pt/caregivers):
o Cultural awareness amongst practitioners
o Cultural awareness in services
o Explanations of the healthcare system
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Term
| Article: Challenges of cultural competency: A guide to OT practice |
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Definition
- Process of awareness or cultural shock
o Process of becoming aware of one’s own culture in comparison to others
- The process of cultural competency (6 stages)
o Cultural awareness
o Cultural preparedness
o Cultural pic of person
o Cultural responsiveness
o Cultural readiness
o Cultural competence
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