The expeditures in 2014 were thesame.
Unfortunately,thepublicislargelyunawareofthecontribu- tions of public health practice. After the passage of Medicare andMedicaid,federalandprivatemoniesinsupportofpublic health dwindled, public health agencies began to provide per- sonalcareservicesforpersonswhocouldnotreceivecareelse- where,andthehealthdepartmentsbenefitedbygettingMedicaid and Medicare funds. The result was a shift of resources and energy away from public healths traditional and unique prevention-oriented,population-focusedperspectivetoinclude a primary care focus (U.S. Department of Health and Human Services[USDHHS],2002).
One consequence of a successful implementation of the AffordableCareActmightactuallybethatthemajorityofthe population would be covered by insurance and public health agencieswillnotneedtoprovidedirectclinicalservicesinorder to assure that those who need them can receive them. If this occurs public health organizations can refocus their efforts on the core functions and emphasize community-oriented, population-focused health promotion and preventive strate- gies, if ways can be found to finance such efforts.An Institute ofMedicinereport,For the Publics Health: Investing in a Health- ier Future, released in 2012, began with presentation of data showingthatincomparisonwithotherwealthyWesterncoun- triestheUnitedStateslagswellbehinditspeersonhealthstatus while outspending every country in the world on health. However,akeymessagewasthathealth-relatedspendinginthe United States is primarily expended on clinical care costs for medicalandhospitalservices;verylittlespendingisforpublic healthactivities.
A central conclusion of the report was that to improve health outcomes in the United States, there will need to be a
timeforpublichealthnursing,atimeofopportunityandchal- lenge. The issue of growing costs together with the changing demography of the U.S. population, particularly the aging of the population, is expected to put increased demands on resources available for health care. In addition, the threats of bioterrorism,highlightedbytheeventsofSeptember11,2001, and the anthrax scares, will divert health care funds and resources from other health care programs to be spent for public safety. Also important to the public health community is the emergence of modern-day epidemics (such as the mosquito-borneWestNilevirus,theH1N1influenzavirus,and theemergingEbolaviruscrisis)andgloballyinducedinfectious diseasessuchasavianinfluenzaandothercausesofmortality, many of which affect the very young (see Chapters 3 and 5). Mostofthecausesoftheseepidemicsarepreventable.Whathas allofthistodowithnursing?
Understanding the importance of community-oriented, population-focusednursingpracticeanddevelopingtheknowl- edgeandskillstopracticeitwillbecriticaltoattainingaleader- ship role in health care regardless of the practice setting. The following discussion explains why those who practice community-based, prevention-oriented, population-focused nursing will be in a very strong position to affect the health of populations and decisions about how scarce resources will beused.
PUBLIC HEALTH PRACTICE: THE FOUNDATION FOR HEALTHY POPULATIONS AND COMMUNITIES Duringthelast25years,considerableattentionhasbeenfocused onproposalstoreformtheAmericanhealthcaresystem.These proposalsfocusedprimarilyoncontainingcostinmedicalcare financingandonstrategiesforprovidinghealthinsurancecov- eragetoahigherproportionofthepopulation.Inthenational healthlegislationthatpassedin2010,thePatientProtectionand AffordableCareAct,themajorityoftheprovisionsandthevast majority of the discussion of the bill focused on those issues (www.hhs.).
Because physician services and hospital care combined account for over half of the health care expenditures in the United States, it is understandable that changes in how such services would be paid for would receive much attention (kaiserEDU.org,2010).However,asstatedinthePublicHealth Functions Steering Committee Report on the Core Functions ofPublicHealth(1998),whileitwasimportanttomakereforms inthemedicalinsurancesystemthereisaclearunderstanding among those familiar with the history of public health and its impactthatsuchreformsalonewillnotbeadequatetoimprove thehealthofAmericans.
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