Frequently Asked Questions
Chapter 2: The Health Care Delivery System

How is health care delivered in the United States?

Health care is delivered on three levels: primary, secondary, and tertiary. Primary health care includes health promotion and illness prevention. Secondary health care is early detection and intervention for a specific disease. Tertiary health care includes activities to minimize the effects of a disease and prevent permanent disability.

Who provides health care in the United States?

Health care is provided by both public and private agencies. Governmental, voluntary, and nonprofit institutions fund public sector agencies. These institutions may exist on the federal, state, or local level. The United States Department of Health and Human Services provides funding for health education, research, and programs on the federal level. Funding varies widely on the state and local levels. The private sector of health care includes outpatient clinics, hospitals, extended care facilities, industrial clinics, and home health care agencies.

Who staffs the health care system?

Nurses, physicians, physician assistants, advanced practice registered nurses, pharmacists, dentists, dental hygienists, dietitians, social workers, respiratory therapists, physical therapists, occupational therapists, chaplains, and unlicensed assistivepersonnel provide care.

What are the roles of the nurse in the health care system?

Nurses assume any or all of the roles of caregiver, teacher, advocate, manager, expert, case manager, and team member.

What are the types of health insurance?

Employers typically provide private health insurance at some cost to employees. The federal government provides public health insurance through Medicare and Medicaid. Medicare provides funding for health care for the elderly, those who are permanently disabled, and people with end-stage renal disease. Medicaid provides health care for the indigent. Medicaid is administered through state governments. Health insurance funds health care in the United States.

What is “managed care?”

Managed care is a system of providing and monitoring care in which access, cost, and quality are controlled before or during delivery of services. Managed care plans provide health care services at a capitated rate, which is a preset flat fee, and are administered through health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs use their own clinics and employ their own providers. Access to care is offered through the primary care provider. PPOs are contracts between a hospital, providers, employers, and insurance companies, providing care for individuals at a preset cost.

What are the major influences on health care?

Costs, access issues, and quality have all influenced health care. Costs have risen since World War II due to an over supply of medical specialists, a surplus of hospital beds, the passive role assumed by most consumers, inequitable financing of services, and the introduction of high-technology medical care.
Access to care as been adversely affected by cost-cutting measures. Fewer people can afford their share of health insurance premiums. Those who have health insurance, Medicare, or Medicaid stay fewer days in the hospital. The unemployed, the underemployed, children, elders, and the disabled receive crisis-oriented and fragmented care. Fewer health promotion and disease prevention services are available. Quality of care has declined due to these cost-cutting measures and to a shortage of nurses and other health professionals.

What are the causes of the nursing shortage?

Fewer people are entering the profession because other professions offer better hours and pay. The present cohort of nurses is aging and will retire in 10 to 15 years. At the same time, there is a greater demand for nurses due to an aging population.

What has been the nursing response to these health care challenges?

The nursing profession has responded with an Agenda for the Future, developed by the American Nurses Association. The Agenda for the Future proposes universal access to care, consumer-oriented care, increased responsibility for consumers, and an emphasis on health promotion. Nurses have participated in the development of standards of care and evidence-based practice. Nurses have also expanded into advanced practice nursing roles such as nurse practitioner, clinical nurse specialist, nurse midwife, and nurse anesthetist. Nursing practice has moved from the hospital to multiple clinical settings.