Health Care Delivery System Webquest

INTRODUCTION

Rising health care costs

Uninsured Patients

Insufficient healthcare coverage

The US healthcare system is considered by many to be the best in the worls...Or is it? Complex and unpredictable, it is often a topic of great debate among practiioners, patients, policymakers, and administrators alike. Federal, state, and corporate-level policies influence which patients are seen by various types of providers, what services are reimbursed, and what and how providers are paid. States define the scope of practice for each profession, but helath care is increasingly being delivered across states, and telehealth is on the rise. So, is US healthcare really even a system? Does the United States really prvode the best healthcare in the world? How would you describe the structure and organization of the US healthcare system? As patients, providers, policymakers, and administrators, we are integral components of this system. Understanding its structure and organization is the first step toward making an impact. 

Select Task to learn more about your quest. 

TASK

The recently-deceased Heiress, Hope T.G. Wells, has left her entire multi-billion dollar estate to the United States government with the sole purpose of improving its healthcare system. In her will, the heiress explicitly requested that the majority of her estate be left to whichever area of the healthcare system is in greatest need.

You have been elected to participate in a study that will examine the structure, organization, and components of the US healthcare system. As a select member of this distinguished research team, you must examine its strengths and weaknesses and identify areas where the heiress' philanthropy will have the greatest impact on the quality of our nation’s healthcare.

What is your passion? Which part of our healthcare system do you feel would benefit most from financial support? In this WebQuest, you and your team members will look at the overall workings of the U.S. healthcare system, and then focus in on an area that interests you. Your quest is to prepare a short presentation that makes a convincing case for where and how the money should be spent, and why it should receive the bulk of this inheritance.

Select Process to begin your work.

PROCESS
Overview 
You are on your way to conducting some intense research. Remember, the only way to make an informed decision is to have a complete understanding of the overall system. First, use the provided links, along with other Internet search tools, to find answers to the general questions below. Once you have a general understanding of the country's healthcare structure, your “subcommittee” will examine one area that has a direct impact upon a specific population. From the menu on the left, choose a focus area about which you want to learn more. Your research now will become more finely-tuned.

When you have finished your research, use your choice of media (Power Point, web page, video ,etc.) to create a short presentation. Use the results of your research to convince the executors that this particular component of our healthcare system should receive the money.

Examine the Overall Healthcare System
As you are working through the questions below, think about what trends you are seeing 
in the healthcare system today.What strengths and weaknesses appear across the board? 
Using the Websites listed below, work with your teammates to answer the following 
questions:

1. What percentage of the Gross National Product is spent on healthcare in the U.S.?
2. Identify the key drivers of healthcare costs and which costs are most responsible for 
   the high U.S. healthcare expenditures.
3. What are the ways that healthcare insurance is financed, in both the public and private sectors? 
4. What are the benefits, eligibility criteria, and financing structure of Medicare, Medicaid, 
   and S-chip programs? Who is responsible for administering these programs?
5. How do market forces influence health-care delivery? 
6. For most Americans, how is their healthcare insurance financed, and what are the inherent strengths and weaknesses of this system? 
7. How does the U.S. fair in terms of health-quality indicators (e.g. infant mortality), compared with other nations, and what percentage of their GDP is spent on healthcare?
8. How are hospitals, laboratories, and radiological centers regulated? 
9. The backlash against managed care has much to do with restrictive benefit packages and an over emphasis on costs. Provide examples of how managed care organizations have responded to this backlash.
10. What is ERISA, and which entities are subject to ERISA regulation? 
11. What trends do you see in the structure and organization of the U.S. healthcare system?
12. If it continues this way, which areas might be most affected?

Useful Web Sites
Congressional Budget Office Testimony on Health Care Spending:
http://www.cbo.gov/showdoc.cfm?index=4989&sequence=0

Rand’s Overview of the Structure of the U.S. Health Care system:
http://www.rand.org/publications/MR/MR1255/MR1255.ch3.pdf

Agency for Healthcare Research and Quality: Health Insurance Choices 
http://www.ahrq.gov/consumer/insuranc.htm

New York Times: Health Spending Rises to Record 15% of Economy by Robert Pear
http://www.nytimes.com/2004/01/09/politics/09HEAL.html?ex=1083297600&en=
3486668f2e1a7218&ei=5070 (Note this link requires registration)

Centers for Medicare and Medicaid Services: 
http://www.cms.hhs.gov/statistics/nhe/default.asp?

Medicare: http://www.cms.hhs.gov/medicare/

Medicaid: http://www.cms.hhs.gov/medicaid/

S-CHIP: http://www.cms.hhs.gov/schip/

Kaiser Family Foundation: Health Care Costs and Spending 
http://www.kff.org/insurance/7031/ti2004-1-1.cfm

The World Health Organization: The World Health Report Chapter 1 
http://www.who.int/whr/2003/chapter1/en/

Core U.S. Health Indicators: http://www3.who.int/whosis/country/indicators.cfm?country=usa

Core Health Indicator from other countries:
http://www.who.int/country/en/

The New York Times: Study: U.S. Health Care Not Always Tops by the Associated Press
http://www.nytimes.com/aponline/health/AP-Health-Care-Quality.html 
(Note this link requires registration)

The National Committee for Quality Assurance: 
http://www.ncqa.org/sohc2003/

ERISA Overview: 
http://www.healthassistancepartnership.org/site/PageServer?
pagename=privateerisaoverview

Department of Labor ERISA FAQs:
http://www.dol.gov/ebsa/FAQs/faq_hipaa_ND.html

 

PROCESS
Investigate a Focus Area

Veteran's Administration

1. How are health services delivered to veterans, and what is covered?
2. How does one become eligible for VA healthcare? 
3. Which branch of the federal government is responsible for oversight of the healthcare of veterans? and the VA? 
4. What are the major demographics and health epidemics among veterans? 
5. How would you characterize the VA’s healthcare quality initiatives? 
6. Describe the strengths, weaknesses, and unique characteristics of the VA healthcare delivery system.

Useful Web Sites 

Veteran’s Benefits Association: 
http://www.vba.va.gov/

Department of Veterans Affairs:
http://www.va.gov/

House Committee on Veterans Affairs:
http://veterans.house.gov/about/index.html

Senate Committee on Veterans Affairs: 
http://veterans.senate.gov/

The Institute of Medicine: Health of Veteran’s and Deployed Forces:
http://veterans.iom.edu/

PROCESS
Investigate a Focus Area

Mental Health and Substance Abuse Treatment and Prevention

1. Describe the epidemiology of mental health and substance abuse for children, adults, 
   and older adults, and their cost implications. 
2. Discuss the legislative history of mental health parity and why mental health services 
   are covered differently than physical illness.
3. Briefly describe the public, private, and volunteer structures for mental healthcare 
   delivery in the U.S. 
4. Which branch(es) of the federal government are responsible for mental health? Substance abuse research and policy? Substance abuse prevention? 
5. Describe the strengths, weaknesses, and unique characteristics of U.S. mental health and substance abuse treatment and prevention programs.

Useful Web Sites

Mental Health: A Report of the Surgeon General
http://www.surgeongeneral.gov/library/mentalhealth/toc.html

Substance Abuse and Services Administration:
http://www.samhsa.gov/

National Institute of Mental Health:
http://www.nimh.nih.gov/

DHHS: Disease Index
http://www.dhhs.gov/diseases/index.shtml#substance

PROCESS
Investigate a Focus Area

Women's Health/Family Planning

1. What services are included in women’s health?
2. How/where do women receive healthcare in the U.S.?
3. How are women’s health services financed? 
4. Briefly describe the public, private, and volunteer structures for women’s healthcare delivery in the U.S.
5. What percentage of the federal budget is allocated for women’s health programs? 
6. What are the strengths, weaknesses and unique characteristics of women's health issues?

Useful Web Sites

DHHS Office of Women’s Health: National Women’s Health Information Center:
http://www.4woman.gov/

DHHS Women’s Health Index:
http://www.hhs.gov/specificpopulations/index.shtml#women

Centers for Disease Control and Prevention:
http://www.cdc.gov/reproductivehealth/index.htm

Kaiser Family Foundation:
http://www.kff.org/womenshealth/index.cfm

The Women’s and Children’s Health Policy Center:
http://www.jhsph.edu/WCHPC

PROCESS
Investigate a Focus Area

Health Promotion/Disease Prevention

1. What are prevention services and how are they delivered in the U.S. healthcare system?
2. Who finances prevention services? 
3. How are preventive services assessed for effectiveness, and how are they recommended for widespread clinical use with the general population?
4. What is "translation research" and how do clinicians become aware of new prevention guidelines? (See "Putting Prevention into Practice" program.)
5. What is being done to reduce the racial and ethnic disparities in preventable deaths? 
6. What are HEDIS measures, and why were they developed (from a policy perspective)?

Useful Web Sites

DHHS Office of Health Promotion/Disease Prevention:
http://odphp.osophs.dhhs.gov/

University of North Dakota Rural Health Center: 
http://www.med.und.nodak.edu/depts/rural/chptr/overview.html

National Committee on Quality Assurance: HEDIS Program
http://www.ncqa.org/Programs/HEDIS/

Healthy People 2010:
http://www.healthypeople.gov/

Agency for Health Care Research and Quality: Putting Prevention into Practice
http://www.ahrq.gov/clinic/ppipix.htm

Centers for Medicare and Medicaid Services:
http://www.cms.hhs.gov/preventiveservices/

DHHS - Office of Minority Health:
http://www.omhrc.gov/

PROCESS
Investigate a Focus Area

Long-Term Care

1. What are the forms of long-term care? 
2. How do private and federal long-term care insurance programs work, and what percentage is purchased by the senior population? 
3. How is long-term care regulated and financed in the U.S.?
4. Describe the hospice benefit and eligibility.
5. How does a policy maker know if long-term care facilities are delivering quality-of-care? 
6. Who delivers care to the elderly, and what are the future projections for the long-term 
   care workforce?
7. What is OSCAR, why is it important in long-term care? Which entity has the 
   focus of responsibility for data collection? 
8. What are the strengths, weaknesses, and unique characteristics of the U.S. long-term care system?

Useful Web Sites

Long-Term Care Overview:
http://www.efmoody.com/longterm/longtermoverview.html

Agency for Health Care Research and Quality: 
http://www.ahrq.gov/research/futureltc/summary2.htm

DHHS: Administration on Aging
http://www.aoa.gov/

DHHS: Aging Index
http://www.hhs.gov/aging/index.shtml

Federal Interagency Forum on Age Related Statistics:
http://www.agingstats.gov/

National Center for Health Statistics: Aging 
http://www.cdc.gov/nchs/agingact.htm

U.S Census Bureau: Aging
http://www.census.gov/ipc/www/idbnew.html

AARP:
http://www.aarp.org/

PROCESS
Investigate a Focus Area

Public Health

1. How is the US public health system organized across the country?
2. What are safety net providers, and how are they financed?
3. Describe critical access hospitals and why a community would want to seek eligibility. 
4. Describe the Public Health Service Commissioned Corps and other members of the public health workforce.
5. What is a FQHC, whom does it serve, and why would a facility be interested in 
   applying for that designation?

Useful Web Sites

National Health Service Corps:
http://nhsc.bhpr.hrsa.gov/

Urgent Matters: Safety Nets:
http://www.urgentmatters.org/

America's Health Care Safety Net: Intact but Endangered (2000) 
Institute of Medicine
http://books.nap.edu/books/030906497X/html/1.html#pagetop

DHHS - Critical Access Webpage:
http://www.cms.hhs.gov/providers/cah/default.asp

National Conference of State Legislatures: Federally Qualified Health Centers
http://www.ncsl.org/programs/health/fqhc.htm

American Hospital Association:
http://www.hospitalconnect.com/aha/member_relations/cah/

National Rural Health Association:
http://www.nrharural.org/

EVALUATION

Developing (1)	Developing (1)	Accomplished (5)	Exemplary (10)	Score
Knowledge  of Issues	Partially answers  research questions. Does not identify  and describe trends  in the healthcare system.	Answers  research  questions. Identifies and describes some trends in the healthcare system.	Thoroughly  answers and  expands upon research  questions. Thoroughly  identifies and  describes trends in the healthcare system.
Knowledge of  Specific  Components	Partially answers  research questions.	Answers  research  questions.	Thoroughly  answers and  expands upon research  questions.
Persuasive  Argument	Demonstrates some understanding of  a specific component. Attempts at  persuasive  argument. Uses some visuals to present and  support argument.	Demonstrates understanding of  a specific component. Makes a  persuasive  argument. Uses visuals to present and support argument.	Demonstrates a thorough  understanding of a specific component. Makes a realistic, appropriate, and persuasive  argument. Uses a variety of visuals to present  and support  argument.

CONCLUSION

Before we can consider steps toward improving our healthcare system, we must understand it. Because it spans so many areas, there is no doubt that one (or more) of them will hit close to home. As patients, providers policymakers, and administrators we are directly impacted by various strengths and limitations, and we must use our knowledge and best collaborative thinking to make educated choices.

Undoubtedly, we all have at least one area that touches our lives, but it is important to realize how interconnected all of the components really are. Mentors, role models, faculty and others will be instrumental in helping you to make these connections, providing new opportunities, and encouraging you along the way. The more you understand the U.S. Healthcare system, the more you are likely to accommodate its limitations and make its strengths work for you, your patients, and the communities you serve.