Health care competent

The cardiovascular health care marketplace is highly competitive. This works to the advantage of medical device companies. Hospitals are engaged in intense competition for those who might be candidates for cardiovascular therapies. Therefore, hospitals are anxious to offer the best treatment possible, having the newest devices. Medical specialties are also competing for their share of the same patient population. 

The simplest economic theories assume— somewhat unrealistically—that markets work sufficiendy well to ensure that society s scarce resources are allocated efficiendy. Of course, few markets are as well-behaved as in the elementary textbook, but nevertheless market forces can often be relied upon to allocate goods and services reasonably well between competing demands. If this is the case, then the need for economic evaluation of the costs and outcomes flowing from alternative uses of scarce resources is lessened. Mental health-care services in Britain are purchased and provided within internal markets (quasi-markets) within the state sector (mainly), and these muted market forces have clearly had some influence over allocations. Market forces have a more overt role in countries such as the USA, strongly influencing who obtains what service and at what cost to different parties. However, it is difficult to imagine circumstances in which techniques such as... 

This determination requires an examination of both an old and a new line of cases. In the new line of cases, plaintiffs have argued—in the therapeutic context—that health care providers have a duty to provide comparative data about the effectiveness not only of various treatment alternatives, but also about the qualifications, competence, and experience of the provider. In the one case in which plaintiffs have so far succeeded in surviving a motion to dismiss, the Wisconsin Supreme Court held that a neurosurgeon had a duty to disclose his level of experience with a procedure and the morbidity and mortality differences between himself and more experienced neurosurgeons (Johnson v. Kokemoor, 1996). The Wisconsin court s ruling has been labeled the "second revolution" of the informed consent doctrine (Twerski and Cohen, 1999 Ketler, 2001). 

When new technologies are not available to all members of a society, they can exacerbate existing inequalities in the system of medical care. Currently the structure of the U.S. health care system is fundamentally flawed. Racial and ethnic disparities in health status and health care, more than 40 million uninsured, spiraling health care costs, and inadequate levels of culturally competent medical care are all evidence of this problem. 

Campinha-Bacote, J., The Process of Cultural Competence in the Delivery of Health Care Services, Transcultural C.A.R.E. Associates, Ohio (1998 and 1999). 

This high attrition rate, particularly during late preclinical and clinical development, carries a large price tag for the pharmaceutical and biotechnology industry, which is carried over to health care providers. In addition, compounds which qualify for clinical use but fail due to safety matters raise serious ethical issues and questions concerning the responsibility and competence of the industry and registration authorities. 

General support for science and technology remains strong in the United States (19,20), hut actual financial support for scientific research remains under increased pressure from competing critical needs, including health care, crime prevention, education, pollution control, and national defense. 

In health care, our definition of competitors sometimes has to be broadened beyond that which is most obvious. For example, in the hospital environment, a new pharmacy program actually may compete with other professions within the hospital. Many of the advanced clinical services that pharmacists provide replace functions of other health care professionals, especially physicians. This is true even in the outpatient environment. For example, a pharmacy-run immunization clinic may compete with physician offices that also administer vaccines. 

While health care accreditation organizations have existed for quite a while, quality data were not readily available to the general public until recendy. These quality measurements (sometimes called report cards ) make health care quality indicators readily available to the public. This encourages health care organizations to compete on the basis of quality and creates markets where quality, not just cost containment, is rewarded (Blumenthal and Kilo, 1998 O Malley, 1997). 

Helminth infections of humans are rarely immediately life-threatening. Competing health care demands in poor countries, including basic nutrition, sanitation, HIV infection and tuberculosis, dwarf the demand for better control of worms. 

Communication of information and coordination of the response are major challenges due to the current structure of the EHS and health care systems. Unlike those found in other countries, the U.S. health care system is splintered (Lee, Chiu, Ng, Chen, 2002). Competing health care systems are reluctant to share information and resources because it could place them at a... 

Information and health care technologies—Use computer technology competently to communicate health information. 

To achieve these goals, nurses must have a solid understanding of the basic principles of environmental health, methods of health promotion, and disease prevention strategies. They must also maintain competencies in such relevant skills in order to collaborate with other members of the team who provide health care. 

Ensure a Competent Public and Personal Health Care Workforce. This service includes education and training for personnel to meet the needs for public and personal health services efficient processes for licensure... 

The nursing fundamentals practiced in normal daily situations and during smaller crises will be applicable during a special event or mass casualty situation. All nurses providing health care at mass gatherings must be competent in the basic principles of first aid, including cardiopulmonary resuscitation and the use of the automated external defibrillator. In addition, the nurse should possess the following minimum core competencies ... 

To deal with the health care dimensions of LEP, hospitals, clinics, and physician s offices must plan for and undertake a culturally competent response. The Rural Action Center, an initiative of the Department of Health and Human Services, defines cultural competence as... 

The presence of competent mosquito vectors [Ae. aegypti and Anopheles quadrimacalatus) and of recent immigrants from the Caribbean Islands and Latin America raised the possibility of dengue and malaria transmission in Florida. Because mosquito-based surveillance for St. Louis encephalitis (SLE) is unable to detect these diseases, fliers with information on identification and reporting of dengue and malaria were distributed to health care workers in the area. No dengue or malaria cases were reported to the Florida Department of Health and Rehabilitative Services. 

Nationai Organization of Nurse Practitioner Faculties, American Association of Coiieges of Nursing. (2002). Nurse practitioner primary care competencies in specialty areas Adult, family, gerontological, pediatric, and women s health. Rockville, MD Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. 

Finally, there is an opportunity to explore the impact of the provider-client relationship at the community level. In many communities, providers are known— particularly nurses—as neighbors and friends. One example of a community-level research intervention may be to explore ways to use nurses (as providers) in communities as resource persons with linkages to hospitals and other health care delivery agencies in disaster drills. Of course, this again would require some agreement and standards of practice defining the level (s) of competencies in disaster preparedness (which may be the first research question that needs to be explored). 

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