Sunday, October 31, 2010

peak oil and the healthcare industry


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Bureau of Labor Statistics | Industry organization. About 595,800 establishments make up the healthcare industry; they vary greatly in terms of size, staffing patterns, and organizational structures. About 76 percent of healthcare establishments are offices of physicians, dentists, or other health practitioners. Although hospitals constitute only 1 percent of all healthcare establishments, they employ 35 percent of all workers (table 1).

Table 1. Percent distribution of employment and establishments in health services by detailed industry sector, 2008

Industry segment

Employment

Establishments

Total

100.0

100.0


Ambulatory healthcare services

42.6

87.3

Offices of physicians

17.0

36.0

Home healthcare services

7.2

3.7

Offices of dentists

6.2

20.4

Offices of other health practitioners

4.7

19.6

Outpatient care centers

4.0

3.6

Other ambulatory healthcare services

1.8

1.4

Medical and diagnostic laboratories

1.6

2.4


Hospitals

34.6

1.3

General medical and surgical hospitals

32.5

1.0

Other specialty hospitals

1.4

0.2

Psychiatric and substance abuse hospitals

0.7

0.1


Nursing and residential care facilities

22.8

11.4

Nursing care facilities

12.2

2.8

Community care facilities for the elderly

5.2

3.5

Residential mental health facilities

4.1

4.0

Other residential care facilities

1.3

1.1

SOURCE: BLS Quarterly Census of Employment and Wages, 2008.

The healthcare industry includes establishments ranging from small-town private practices of physicians who employ only one medical assistant to busy inner-city hospitals that provide thousands of diverse jobs. In 2008, around 48 percent of non-hospital healthcare establishments employed fewer than five workers. In contrast, 72 percent of hospital employees were in establishments with more than 1,000 workers.

The healthcare industry consists of the following segments:

Hospitals. Hospitals provide complete medical care, ranging from diagnostic services, to surgery, to continuous nursing care. Some hospitals specialize in treatment of the mentally ill, cancer patients, or children. Hospital-based care may be on an inpatient (overnight) or outpatient basis. The mix of workers needed varies, depending on the size, geographic location, goals, philosophy, funding, organization, and management style of the institution. As hospitals work to improve efficiency, care continues to shift from an inpatient to outpatient basis whenever possible.

Nursing and residential care facilities. Nursing care facilities provide inpatient nursing, rehabilitation, and health-related personal care to those who need continuous nursing care, but do not require hospital services. Nursing aides provide the vast majority of direct care. Other facilities, such as convalescent homes, help patients who need less assistance. Residential care facilities provide around-the-clock social and personal care to children, the elderly, and others who have limited ability to care for themselves. Workers care for residents of assisted-living facilities, alcohol and drug rehabilitation centers, group homes, and halfway houses. Nursing and medical care, however, are not the main functions of establishments providing residential care, as they are in nursing care facilities.

Offices of physicians. About 36 percent of all healthcare establishments fall into this industry segment. Physicians and surgeons practice privately or in groups of practitioners who have the same or different specialties. Many physicians and surgeons prefer to join group practices because they afford backup coverage, reduce overhead expenses, and facilitate consultation with peers. Physicians and surgeons are increasingly working as salaried employees of group medical practices, clinics, or integrated health systems.

Offices of dentists. About 20 percent of healthcare establishments are dentist's offices. Most employ only a few workers, who provide preventative, cosmetic, or emergency care. Some offices specialize in a single field of dentistry, such as orthodontics or periodontics.

Home healthcare services.
Skilled nursing or medical care is sometimes provided in the home, under a physician's supervision. Home healthcare services are provided mainly to the elderly. The development of in-home medical technologies, substantial cost savings, and patients' preference for care in the home have helped change this once-small segment of the industry into one of the fastest growing healthcare services.

Offices of other health practitioners.
This segment of the industry includes the offices of chiropractors, optometrists, podiatrists, occupational and physical therapists, psychologists, audiologists, speech-language pathologists, dietitians, and other health practitioners. Demand for the services of this segment is related to the ability of patients to pay, either directly or through health insurance. Hospitals and nursing facilities may contract out for these services. This segment also includes the offices of practitioners of alternative medicine, such as acupuncturists, homeopaths, hypnotherapists, and naturopaths.

Ambulatory healthcare services. This segment includes outpatient care center and medical and diagnostic laboratories. These establishments are diverse including kidney dialysis centers, outpatient mental health and substance abuse centers, blood and organ banks, and medical labs that analyze blood, do diagnostic imaging, and perform other clinical tests.

Recent developments. In the rapidly changing healthcare industry, technological advances have made many new procedures and methods of diagnosis and treatment possible. Clinical developments, such as infection control, less invasive surgical techniques, advances in reproductive technology, and gene therapy for cancer treatment, continue to increase the longevity and improve the quality of life of many Americans. Advances in medical technology also have improved the survival rates of trauma victims and the severely ill, who need extensive care from therapists and social workers as well as other support personnel.

In addition, advances in information technology have a perceived improvement on patient care and worker efficiency. Devices such as hand-held computers are used record a patient’s medical history. Information on vital signs and orders for tests are transferred electronically to a main database; this process eliminates the need for paper and reduces recordkeeping errors. Adoption of electronic health records is, however, relatively low presently.

Cost containment also is shaping the healthcare industry, as shown by the growing emphasis on providing services on an outpatient, ambulatory basis; limiting unnecessary or low-priority services; and stressing preventive care, which reduces the potential cost of undiagnosed, untreated medical conditions. Enrollment in managed care programs—predominantly preferred provider organizations, health maintenance organizations, and hybrid plans such as point-of-service programs—continues to grow. These prepaid plans provide comprehensive coverage to members and control health insurance costs by emphasizing preventive care. Cost effectiveness also is improved with the increased use of integrated delivery systems, which combine two or more segments of the industry to increase efficiency through the streamlining of functions, primarily financial and managerial. These changes will continue to reshape not only the nature of the healthcare workforce, but also the manner in which healthcare is provided.

Various healthcare reforms are presently under consideration. These reforms may affect the number of people covered by some form of health insurance, the number of people being treated by healthcare providers, and the number and type of healthcare procedures that will be performed.

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