Health Care Delivery Model

Health Care Delivery Model:

Childhood Asthma

Sara

October 22, 2005

University of Portland

School of Nursing

Abstract

Childhood asthma affected an estimated 5 million children under the age of 15 during the year of 1995. The diagnosis of this disease is on a continual rise in the United States, and it is the responsibility of all health care providers to busy themselves in providing the proper patient education, treatment, and preventative measures available to prevent unnecessary suffering caused by asthma (Improving Childhood Asthma, n.d.). Throughout the next few pages the following essential issues will be: defining more closely this patient population, identifying organizations that provide care for this population, discussing methods in which this care is financed, and finally suggesting mechanisms in which nursing can impact this health care delivery model. Addressing the aforementioned essential issues concerning childhood asthma will provide the necessary knowledge to health care providers treating this monster childhood disease.

Identification of the patient population being served

The patient population focus for this paper will be children with asthma. This chronic lung disease, grouped into the COPD class of diseases, affects an estimated 5 million children every year (Improving Childhood Asthma, n.d.). "Asthma is a growing health problem in the United States, particularly in inner-city African-American and Latino populations" (Asthma: A Concern for Minority, 2001). The death rate for these inner-city patients is three times that of whites. Noted as contributing factors to the increase in death rates are: low socioeconomic status, lack of access to medical care, substandard housing that increases exposure to certain indoor allergens, lack of education, and the failure to take prescription medicine appropriately (Asthma: A Concern for Minority, 2001). Health care providers involved in the care of this specific patient population must focus on the contributing factors yielding vulnerability to this group.

A focused approach to the treatment of childhood asthma should not exclude from the affected patient population but instead be used as a guide to provide appropriate and effective care to any noted high risk patient. Specific symptoms of an asthmatic attack can include chest tightness, wheezing, coughing, and a sensation of shortness of breath. These symptoms are often precipitated by various triggers; including but not limited to viral respiratory infections, exposure to allergens (such as house dust mites and cockroaches), exposure to airway irritants, and exercise. Under normal circumstances environmental modifications along with the proper use of inhalers asthma sufferers can control, if not prevent, attacks (Asthma: A Concern for Minority, 2001).

Organizations that comprise the health care delivery system

"Childhood asthma is a national public health problem that challenges not only the entire health system but also school systems and the many public and private organizations that track the effects of this illness, provide education and other community-based programs, and fund research into the causes of asthma" (Improving Childhood Asthma, n.d.). Considering the multi-faceted health care delivery system for the childhood asthma patient, improvement of care will require resources, research, time, and implementation from all of these various organizations. The national government contributes resources that are more monetarily focused and will be discussed in more detail later. Despite the many resources the national government provides, the majority of the health care delivery system for the child with asthma falls on the backs of state and local governments. Under Federal Law, hospitals can not turn away basic care to any patient regardless of the ability to pay for services provided.

Hospitals funded by the state, privately owned hospitals, and local [county owned] hospitals all provide emergency and in-house care to the childhood asthma patient (Buescher & Jones-Vessey, 1999). Ideal delivery systems also include a primary care clinic, or physicians office who provide continuous managed care for these vulnerable individual. Unfortunately, due to the socioeconomic factors surrounding childhood asthma many patients' caregivers find only one main deliverer of care, the emergency department. Remembering that this disease affects more inner-city low-income black and Latino children; these very families have little or no health insurance leading to more emergency room visits than whites with the same disease process (Summer, 2001).

Mechanisms for financing care

For the 1996 year $4,604,534,917 were spent on health care for children with asthma. "Almost one third of children with asthma are covered under Medicaid. Medicaid beneficiaries use health services differently than individuals covered under commercial insurance. Children covered under Medicaid are more likely to use hospital-based health services, while children with private insurance tend to make more office-based visits and use more prescribed drugs to treat their asthma" (Summer, 2001). Despite this huge contribution by the national and state governments provided by the Medicare program, more than one fifth of the health care provided to children with asthma is paid out-of-pocket. Private insurance companies provide the most financial expenditure concerning childhood asthma at fifty percent (Summer, 2001). Pharmaceutical companies, such as GlaxoSmithKline, provide free samples, or discounted rates for individuals based on a need basis (Sign up for the Breathe, n.d.) Private organizations and the aforementioned pharmaceuticals provide a mere three percent of the overall costs associated with the health care provided to asthmatic children.

With changes in health care, namely the evolution of managed care, Medicare will eventually provide more efficient health care to its constituents. Future reports by the Center for Health Care Strategies on childhood asthma will hopefully reflect this shift to managed care with less emergency room visits and increased primary

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