Chapter 3

The U.S. Health and Public Health

Care Systems

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 Objectives
 Describe the events and trends that influence the
status of the health care system.
 Discuss key aspects of the private health care
system.
 Define public health care and explain the role
nurses play in this care.
 Compare and contrast the current public health
care system in the United States and the
responsibilities of the federal, state, and local public
health systems.
 Examine nursing roles in selected government
agencies.

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 Introduction
 This chapter describes a health care system in
transition as it struggles to meet evolving global
and domestic challenges.
 Nurses play a pivotal role in meeting these
needs.

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 Forces Stimulating Change
in U.S. Health Care System
 Demographic Trends
 Social and Economic Trends
 Health Workforce Trends
 Technological Trends

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Forces Stimulating Change in
U.S. Health Care System (Cont.)
Demographic Trends

 Population growth of the world

 Aging Baby Boomer generation
 Change in largest minority group
 Changing composition of the U.S. household
 Declining mortality for both genders in all age
groups

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Forces Stimulating Change in U.S.
Health Care System (Cont.)
Social and Economic Trends
 Changing lifestyles
 Growing appreciation of the quality of life
 Changing composition of families and living
patterns
 Changing household incomes
 Revised definition of quality health care
 Economic downturn of 2008
 Affordable Care Act

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Forces Stimulating Change in U.S.
Health Care System (Cont.)
Health Workforce Trends
 Not enough primary care providers
 Advanced practice nursing (APN) specialties
 Move to contain costs and move to community-
based care
 Current nursing shortage
 Need to increase number of minority nurses to
help decrease health disparities

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Forces Stimulating Change in U.S.
Health Care System (Cont.)
Technological Trends
 Positive effects
 Negative effects
 Digital divide
 Electronic medical records

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 Current Health Care System in
U.S.
 Cost
 The “Great Recession”
 Aging Baby Boomer generation
 Affordable Care Act
 Access
 Two-class system: private and public
 Rising number of uninsured
 Quality
 Institute of Medicine (IOM) reports
 Hospital compare

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 Organization of the Health Care
System
 An enormous variety of facilities and providers
make up the health care system
 In general, the American health care system is
divided into two components
 1. Private or personal care
 Primary care system: community health center
 2. Public health
 Public health system

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 Primary Care versus Primary
Health Care
 Primary health care (PHC) is broader than
primary care
 The setting for PHC is within all communities of
a country and involves all aspects of society
(World Health Organization, 1978)

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 Primary Health Care (PHC)
Defined
 Includes a comprehensive range of services
 Care made universally accessible to individuals
and families in a community
 Encourages self-care and self-management in
health and the social welfare of daily life
 Declaration of Alma Alta
 Healthy People 2020

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 Primary Care Defined
 Refers to personal health care that provides first
contact and continuous, comprehensive, and
coordinated care
 Managed care (HMOs and PPOs)
 Medicare and Medicaid

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 Public Health System
 Seeks to ensure that the health of the
community is protected, promoted, and ensured
 Overlaps with the primary care system
 Is mandated through laws that are developed at
the national, state, or local level
 Is organized into multiple levels comprising the
federal, state, and local systems

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Federal, State, and Local Systems
 Federal
 U.S. Department of Health and Human Services
• National Health Service Corps
• U.S. Public Health Service: Health Resources and Services
Administration (HRSA): Bureau of Health Professionals; National
Institutes of Health (NIH); Agency for Healthcare Research and
Quality (AHCRQ); Food and Drug Administration (FDA); Centers for
Disease Control and Prevention (CDC)
• Centers for Medicare and Medicaid Services (CMS)
• Department of Homeland Security (DHS)
 Department of Agriculture
 Department of Justice
 Department of Commerce
 Department of Defense
 Department of Labor

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Federal, State, and Local Systems
 State
 State board of nursing
• Nurse practice acts
 State health departments
 Local
 Local health departments

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Forces Influencing the Health Care
System of the Future
 Consumers
 Employers (purchasers)
 Health care systems
 Legislation

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 Improving Health Care
 American Nurses Association 2005 Healthcare
Agenda
 Would require a cultural change
 Change in funding priorities
 Shift from primary/specialty care to public health

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