TOPIC: HEALTHCARE DELIVERY SYSTEMS (PART I)

I. Types of Healthcare Services

II. Types of healthcare Agencies and Services

LEARNING OBJECTIVES:
After completing this topic, you will be able to:
 Understand health care delivery system and organization of Health Care at various levels.
 Differentiate primary, secondary, and tertiary health care services.
 Describe the functions and purposes of the health care agencies.
 Identify the roles of various health care professionals.
 To understand primary healthcare services, frameworks for care and financing healthcare.

Selected health care definitions

Health: According to WHO, health is defined as “a dynamic state of complete physical, mental and social well-
being not merely an absence of disease or infirmity.”
Health care services: It is defined as “multitude of services rendered to individuals, families or communities
by the agents of the health services or professions for the purpose of promoting, maintaining, monitoring or
restoring health.”

Definitions of health care delivery:

1. Health care delivery system refers to the totality of resources that a population or
society distributes in the organization and delivery of health population services. It also includes all
personal and public services performed by individuals or institutions for the purpose of maintaining
or restoring health.
2. Health care delivery system is a system in which the services related to healthcare delivered to the
target population.
3. Health care delivery system is an integral part of the government, responsible to central authority
and interrelated in its activities with a general conduct to governmental affairs.

I. TYPES of HEALTHCARE SERVICES

A. Health Promotion and Illness prevention (Primary Prevention)
 Health promotion and disease prevention programs focus on keeping people healthy. Health
promotion programs aim to engage and empower individuals and communities to choose healthy
behaviors, and make changes that reduce the risk of developing chronic diseases and other
morbidities.
 Defined by the World Health Organization, health promotion:
“Enables people to increase control over their own health. It covers a wide range of social and
environmental interventions that are designed to benefit and protect individual people’s health and
quality of life by addressing and preventing the root causes of ill health, not just focusing on
treatment and cure.”

Health Promotion Illness Prevention

 Policies and interventions to address  Vaccination and post-exposure
tobacco, alcohol, physical activity and prophylaxis of children, adults and the
diet. elderly
 Dietary and nutritional intervention  Provision of information on behavioural
should also appropriately tackle and medical health risks, and measures
malnutrition, defined as a condition to reduce risks at the individual and
that arises from eating a diet in which population levels.
certain nutrients are lacking, in excess  Inclusion of disease prevention
(too high in intake), or in the wrong programs at primary and specialized
proportions. health care levels, such as access to
 Intersectoral policies and health preventive services (ex. counselling).
services interventions to address Nutritional and food supplementation; and
mental health and substance abuse. Dental hygiene education and oral
 Strategies to tackle domestic violence, health services
including public awareness campaigns;
treatment and protection of victims;
and linkage with law enforcement and
social services.
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B. Diagnosis and Treatment (Secondary Prevention)
 Disease is detected and treated early, often before symptoms are present, thus minimizing serious
consequences. Hospitals and physician’s offices have been the major agencies offering these complex
services.
 Hospitals continue to focus significant resources on patients requiring emergency, intensive, and
round the clock acute care.
 Freestanding diagnostic and treatment facilities have also evolved and serve ever growing numbers
of clients.
For example, MRI (magnetic resonance imaging) and related radiological diagnostic procedures are
commonly performed at physician or corporate owned centers.

C. Rehabilitation and Health Restoration (Tertiary Prevention)

 Rehabilitation is a process of restoring ill or injured people to optimum and functional levels of
wellness.
 Rehabilitative care emphasizes the importance of assisting clients to function adequately in the
physical, mental, social, economic, and vocational areas of their lives.
 The goal of Rehabilitation is to help people move to their previous level of health or to the highest
level they are capable of given their current health status.
 Rehabilitation may begin in the Hospital, but will eventually lead clients back into the community for
further treatment and follow-up once health has been restored.
 A growing field of nursing and health care services is that of palliative care providing comfort and
treatment for symptoms. End of life care may be conducted in many settings including the home.

II. TYPES OF HEALTHCARE AGENCIES AND SERVICES

 PUBLIC HEALTH AGENCIES
 Government (official) agencies are established at the local state or provincial, and federal levels
to provide public health services.
 Their funds, generally from taxes, are administered by elected or appointed officials. Local
health departments have responsibility for developing programs to meet the health needs of
the people, providing the necessary staff and facilities to carry out these programs, continually
evaluating the effectiveness of the programs, and monitoring changing needs.
 State health organizations are responsible for assisting the local health departments. In some
remote areas, state departments also provide direct services to people. The Public Health
Service (PHS) of the U.S. Department of Health and Human Services is an official agency at the
federal level. Its functions include conducting research and providing training in the health field,
providing assistance to communities in planning and developing health facilities, and assisting
states and local communities through financing and provision of trained personnel.
e.g DOH Philippines

 PHYSICIANS’ OFFICES
 The physician's office is a primary care setting. The majority of physicians either have their own
offices or work with several other physicians in a group practice.
 Clients usually go to a physician's office for routine health screening, illness diagnosis, and
treatment.
 People often seek consultation from physicians when they are experiencing symptoms of illness
or when a significant other considers the person to be ill.
 Where there are RNs, they have a variety of roles and responsibilities including client
registration, preparing the client for an examination, obtaining health information, and
providing information.
 Other functions may include obtaining specimens, assisting with procedures, and providing
some treatments, In offices without RNs, these tasks may be performed by medical assistants.

 AMBULATORY CARE CENTERS (CLINIC CENTERS)

 Ambulatory care centers are used frequently in many communities. Most ambulatory care
centers have diagnostic and treatment facilities providing medical, nursing, laboratory, and
radiological services, and they may or may not be attached to or associated with an acute care
hospital.
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  Some ambulatory care centers provide services to people who require minor surgical
procedures that can be performed outside the hospital. After surgery, the client returns home,
often the same day.
 These centers offer two advantages: They permit the client to live at home while obtaining
necessary health care, and they free costly hospital-beds for seriously ill clients.

 OCCUPATIONAL HEALTH CLINIC

 The industrial (occupational) clinic is gaining importance as a setting for employee health care.
Employee health has long been recognized as important to productivity.
 Community health nurses in the occupational setting have a variety of roles. Worker safety has
always been a concern of occupational nurses.
 Today, nursing functions in industrial health care include work safety and health education,
annual employee health screening for tuberculosis, and maintaining immunization information.
 Other functions may include screening for such health problems as hypertension and obesity,
caring for employees following injury, and counseling.

 HOSPITALS
 Hospitals can be classified according to:
1. Ownership or Control
 Government (Public Hospital) – government owned and is fully funded by the
government and operates solely off the money that is collected from taxpayers to
fund healthcare initiatives.
- Governmental hospitals are either federal, state, city, or county hospitals;
- The federal government provides hospital facilities for veterans and merchant
mariners (VA hospitals).
Military hospitals provide care to military personnel and their families.
 Nongovernment (Private Hospital) - are often operated by churches, companies,
communities, and charitable organizations. Private hospitals may be for-profit or
not-for-profit

2. The Services they provide

 General hospitals admit clients requiring a variety of services, such as medical,
surgical, obstetric, pediatric, and psychiatric services.
 Other hospitals offer only specialty services, such as psychiatric or pediatric care.

 Hospitals vary in size from the 12-bed rural hospital to the 1,500-bed metropolitan hospital.
Hospitals can be further described as acute care or chronic (long-term) care.
 An acute care hospital provides assistance to clients who are acutely ill or whose illness and
need for hospitalization are relatively short term, for example, 2 days.
 Long-term care hospitals provide services for longer periods, sometimes for years or the
remainder of the client's life.
 The variety of health care services hospitals provide usually depends on their size and location.
The large urban hospitals usually have inpatient beds, emergency services, diagnostic facilities,
ambulatory surgery centers, pharmacy services, intensive and coronary care services, and
multiple outpatient services provided by clinics.
 Some large hospitals have other specialized services such as spinal cord injury and burn units,
oncology services, and infusion and dialysis units. In addition, some hospitals have substance
abuse treatment units and health-promotion units.
 Small rural hospitals often are limited to inpatient beds, radiology and laboratory services, and
basic emergency services.
 The number of services a rural hospital provides is usually directly related to its size and its
distance from an urban center.
 Other hospitals are providing innovative outpatient services, such as fitness classes, day care
for elderly people, nutrition classes, and alternative birth centers.

 EXTENDED CARE (LONG-TERM CARE FACILITIES)

 Formerly nursing homes, are now often multilevel campuses that include independent living
quarters for seniors and assisted living facilities, skilled nursing facilities (intermediate care),
and extended care facilities (long-term care) that provide levels of personal care for those who
are chronically ill or are unable to care for themselves without assistance.
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  Traditionally, extended care facilities only provided care for elderly clients, but they now
provide care to clients of all ages who require rehabilitation or custodial care. Because clients
are being discharged earlier from acute care hospitals, some clients may still require
supplemental care in a skilled nursing or extended care facility before they return home.
 These facilities are intended for people who require not only personal services (bathing,
hygiene, assistance with daily activities, and so on) but also some regular nursing care and
occasional medical attention.
 Specific guidelines govern the admission procedures for clients admitted to an extended care
facility. Insurance criteria, treatment needs, and nursing care requirements must all be assessed
beforehand.
 Nurses in extended-care facilities assist clients with their daily activities, provide care when
necessary, and coordinate rehabilitation activities.

 RETIREMENT AND ASSISTED-LIVING CENTERS

 Retirement and assisted living centers consist of separate houses, condominiums, or
apartments for residents. Intended to meet the needs of people who are unable to remain at
home but do not require hospital or nursing home care.
 They also work collaboratively with other communities including case managers, social services,
and a hospice to meet the needs of the residents who live there.
 Nurses provide limited care to residents, usually related to the administration of medications
and minor treatments and health promotion.

 REHABILITATION CENTERS
 Rehabilitation centers usually are independent community centers or special units. However,
because rehabilitation ideally starts the moment the client enters the health care system,
nurses who are employed on pediatric, psychiatric, or surgical units of hospitals also help to
rehabilitate clients.
 Rehabilitation centers play an important role in assisting clients to restore their health and
recuperate. Drug and alcohol rehabilitation centers, for ex-ample, help free clients of drug and
alcohol dependence and assist them to reenter the community and function to the best of their
ability.
 Today, the concept of rehabilitation is applied to all illness and injury (physical and mental).
 Nurses in the rehabilitation setting coordinate client activities and ensure that clients are
complying with their treatments. This type of nursing often requires specialized skills and
knowledge.

 HOME HEALTH CARE AGENCIES

 The implementation of prospective payment and the resulting earlier discharge of clients from
hospitals have made home care an essential aspect of the health care delivery system. As
concerns about the cost of health care have escalated, the use of the home as a care delivery
site has increased. In addition, the scope of services offered in the home has broadened. Home
health care agencies offer education to clients and families and also provide comprehensive
care to acute, chronic, and terminally ill clients.

 RURAL CARE
 Rural primary care hospitals were created as a result of the 1987 Omnibus Budget
Reconciliation Act to provide emergency care to clients in rural areas.
 In 1997, the Balanced Budget Act authorized the Medicare Rural Hospital Flexibility Program in
order to continue to make available primary care access and improve emergency care for rural
residents.
 Nurses in rural settings must be generalists who are able to manage a wide variety of clients
and health care problems.

 HOSPICE SERVICES
 Interdisciplinary health care service for the dying provided in the home or another health
care setting. The hospice movement subsumes a variety of services given to the terminally ill;
their families, and support persons.
 The central concept of the hospice movement, as distinct from the acute care model, is not
saving life but improving or maintaining the quality of life until death. Hospice nurses serve
primarily as case managers and supervise the delivery of direct care by other members of the
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 team.

 CRISIS CENTERS
 Crisis centers provide emergency services to clients experiencing life crises
 These centers may operate out of a hospital or in the community, and most provide 24-hour
telephone service.
 Some also provide direct counseling to people at the center or in their homes. The primary
purpose of a crisis center is to help people cope with an immediate crisis and then provide
guidance and support for long-term therapy.

 MUTUAL SUPPORT AND SELF-HELP GROUPS

 Mutual support and self-help programs can be implemented online or in a community setting.
 Are characterized by welcoming, supportive relationships in the context of recovery and
providing continuing support during times of vulnerability to relapse
 These interventions include structured programs that have behavioral, spiritual, and a cognitive
components, such as 12-step programs like Alcoholics Anonymous (AA) and Narcotics
Anonymous (NA)

References:
Fundamentals of Nursing , concepts, process and practice 11th edition by Kozier
https://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-
prevention.html

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