Potter: Fundamentals of Nursing, 8th Edition

Chapter 02: The Health Care Delivery System Key Points - Printable Increasing costs and decreasing reimbursement are forcing health care institutions to deliver care more efficiently without sacrificing quality. In a managed care system the provider of care receives a predetermined capitated payment regardless of the services a patient uses. The Medicare prospective reimbursement system is based on payment calculated on the basis of DRG assignment. Levels of health care describe the range of services and settings in which health care is available to patients in all stages of health and illness. Health promotion occurs in home, work, and community settings. Nurses are facing the challenge of keeping populations healthy and well within their own homes and communities. Successful community-based health programs involve building relationships with the community and incorporating cultural and environmental factors. Hospitalized patients are acutely ill, requiring better coordination of services before discharge. Rehabilitation allows an individual to return to a level of normal or near-normal function after a physical or mental illness, injury, or chemical dependency. Home care agencies provide a wide variety of health care services with an emphasis on patient and family independence. Discharge planning begins at admission to a health care facility and helps in the transition of a patients care from one environment to another. Health care organizations are being evaluated on the basis of outcomes such as prevention of complications, patients functional outcomes, and patient satisfaction. Nurses need to remain knowledgeable and proactive about issues in the health care delivery system to provide quality patient care and positively affect health.