II. The Health Care Delivery System (15%)
A. Factors influencing the current system
1. Social
a. Changing roles (e.g., family roles, single-parent family, working parents, adolescent parents, female-male roles)
b. Changing demographic patterns (e.g., increase in the aging population, shift from rural to suburban to urban, shift in immigration populations, increase in low-income groups)
c. Health problems related to changing lifestyles (e.g., substance abuse, acquired immune deficiency syndrome [AIDS], sexually transmitted diseases [STDs], persons who are homeless pr displaced)
2. Cultural
a. Communication processes (e.g., language barriers, body language)
b. Health practices (e.g., perception of illness, cultural healers, use of traditional remedies, religious sanctions and restrictions, nutritional restrictions)
c. Valued behaviors (e.g., territoriality, privacy, stoicism)
d. Spirituality
3. Economic
a. Cost-containment (e.g., focus on wellness, prospective payment systems, shifts to community-based care, diagnostic-related groups [DRGs])
b. Health insurance (e.g., lack of coverage, individual payment, government insurance, private insurance, worker's compensation, national health care plan)
4. Political
a. Role of the individual (e.g., voting, contacting congressional leaders)
b. Role of professional organizations (e.g., lobbying, proposing legislation)
c. Special interest groups (e.g., the tobacco industry, labor unions, right-to-life groups, ANA-PAC)
5. Educational
a. Consumerism (e.g., participation in self-care, health promotion, growing awareness of the individual's role as a consumer, expectations for accountability)
b. Diversity in the educational background of the consumer (e.g., persons who are illiterate, persons who are highly educated)
c. Increased specialization among health care providers
6. Technological (e.g., computerization, lasers, imaging)
B. Current practices and trends in delivery of services
1. Organization and administration
a. Types of health care delivery
(1) Health promotion (primary)
(2) Illness prevention (secondary)
(3) Rehabilitation (tertiary)
b. Regulatory agencies
(1) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
(2) State health departments
(3) Accreditation of home health agencies
2. Types of facilities
a. Ambulatory care facilities (e.g., community health centers, health maintenance organizations [HMOs], clinics, emergency care centers)
b. Hospitals (e.g., government, nonprofit, proprietary)
c. Long-term facilities (e.g., skilled nursing, intermediate, personal care)
d. Home health care agencies (e.g., visiting nurses association, public health agencies)
e. Other types of facilities/service (e.g., hospice, rehabilitation centers, respite, day care)
3. The health team
a. Composition
b. Functions of each member
c. Responsibility of each member
d. Interdependence and communication among members