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Index - Major Sections
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Hospitals and Primary CareHospitals may be under-valued in their role in primary health care. Hospitals are made out to be more costly to operate than smaller clinical systems. However, this does not have to be the case (and is definitely not the case in well managed hospitals). Hospitals because of their economics of scale can serve the public better at less cost than smaller clinical systems. Hospitals have the resources such that a better diagnosis can be made and referrals unnecessary. Health care education can be undertaken more effectively by including larger groups of the target population. Clients see the “big hospital” as having better services and thus come to that hospital, by-passing the smaller clinics. It is this increase in volume that can make the large hospital more efficient. Preventive care and primary care can easily be integrated into hospitals. Hospitals have a “captive” market. Because clients do come to hospitals, hospitals can take advantage of this and include “education” and primary care in their regular programs. Research in Bangladesh has shown this to work very effectively. Smaller clinics are costly to build, over-head is greater, and resources go underutilized. Governments may be better off by investing their money in the transportation systems (which serves more than one purpose) in order to get the clients to the hospital rather than building clinics closer to the clients. Problem Focused and Comprehensive ExaminationThe client is receiving “problem focused” care instead of “comprehensive” care. A health care professional (HCP) may use one of four types of examinations:
In the Problem Focused examination, the HCP only concentrates on the client’s chief complaint and little else. The idea is to get her or him out of the unit as rapidly as possible. In general, this may work in developed countries because the client may understand his health condition…a big assumption. However, in countries where health is not well understood, the chief complaint that the client has may not be the “real” problem. The client may have health problems of which he is not aware. Many examples may be stated; failing eye sight-cataracts, swelling of the feet-congested heart failure, high blood pressure, diabetics…to name only a few. In order for a HCP to discover and prevent these “unknown” health problems, he must do a comprehensive examination. This implies that the HCP must gather ALL the information on the client. This requires a greater amount of time per client but InHCc feels in the end that it will more than pay for itself by increasing the health status of the client. In addition, this information will form a base line to measure all future visits to the health care organization. Preventive and Curative CareHealth care organizations are not taking advantage of the curative care setting to teach preventive care. A complete client history is seldom solicited from the client. By taking a complete history the health care professional has an opportunity to discover the health risks of the patient and is then able to assign that patient to a health education class. Education is as much a part of the management of the client as drugs or medical procedures. While some research has shown that the client has a very low demand for preventive care, the cost of this education can easily be included in the cost of the curative care and thus be more acceptable to the client. The Health Care Organization should make no attempt to separate the curative from the preventive. Both should be integrated into one homogeneous component. A very easy to use method of assigning patients to health care classes should be built into each “curative” health care visit. Big hospitals do not “only” have to offer curative care. That is a management decision. |
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