- ANS U.S. Health Care System- Intro
Health - ANS State of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Healthcare - ANS Healthcare is the maintenance and improvement of physical and mental health, specially throu...
Health - ANS State of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity.
Healthcare - ANS Healthcare is the maintenance and improvement of physical and mental
health, specially through the provision of medical services.
Healthcare Organization - ANS Ideally we should organize healthcare so that we are
"assuring that the right patient receives the right service at the right time and in the right place"
(Rodwin, 1984)
Levels of Health Care Services - ANS Levels of Care-correspond with certain unique
patients needs:
1.Primary Health care (PHC)
2.Secondary Health Care
3.Tertiary Health Care
Healthcare Organizational Models - ANS -Regionalized Model (United Kingdom)
-Dispersed Model (United States)
Regionalized Model - ANS 1.Based on the concept of REGIONALIZATION
2.Flow of patients across levels occurs in an ORDERLY, regulated fashion.
3.Emphasis on
-PRIMARY Care**
-Population Health
US Healthcare System is a Dispersed Model - ANS 1.Fluid roles and increased
AUTONOMY for personnel.
2.Flow of patients is FREE-FLOWING across all levels of care.
3Emphasis on
-TERTIARY care**
-Individual Health
US Model-Pros - ANS -Flexible system
-Convenient for patients
-Competition for care
-Emphasis on specialization and technology which promotes innovations
,US Model-Cons - ANS 1."Top-heavy", and "too specialized"
2.Fragmented and uncoordinated care
3.Uncontrolled growth and costs.
4.Poor quality of care and higher mortality
US National Health Expenditures (NHE) - ANS National Health Expenditures (NHE) as %
of GDP increased from 1960 to 2010 (5.2%-17.6%)
Life Expectancy 2014 - ANS US ranks 34th in life expectancy at birth.
Medical Errors - ANS 1.Result in 44,000 to 98,000 deaths/yr
-More deaths than AIDs, breast cancer or car accidents.
-8th leading cause of death in the US
2.Billions of dollars spent annually on drug related problems, many of which are preventable.
PARADOXES of the US System - ANS 1.Health Care Expenditures (high expenditure/low
quality)
2.Health standards (high standards/no good access, many errors)
3.Health Outcomes (high expenditures & standards/no healthier state)
Why is the US Healthcare System organized this way? - ANS Major Forces:
1.Cultural beliefs & Values
2.Social changes
3.Technological advances
4.Economic Constraints
5.Politics
Treatment - ANS -Person is already ill
-Requires medical treatment
Prevention - ANS -Person is not yet ill
-Goal is to prevent exposure to the cause of illness
-May require very different actions than the medical treatment.
Forces Driving the US System - ANS -Patient, patient's family members
-Nurse, physician,
-Health care delivery system
-Private and governmental insurance agencies
,-Allied health professionals
-Social workers
-Hospitals or other health care facilities.
Who provides healthcare services?
(18th - 19th centuries) - ANS -Family& Friends
-Clergy
-Midwives
-Quacks
-Medicine men
-Apothecaries
-Physicians
-Nurses
Healthcare Educational System
(Medicine) - ANS 1.Flexner Report (1910)
2.Reforms
-Abandon apprenticeship model
-Accreditation of medical schools (ACGME)
-Graduate fewer students
-Close weak schools
-Promote research and specialties.
Healthcare Educational System
(Pharmacy) - ANS 1.Acreditation of Pharmacy Schools (ACPE)
2.Pharmaceutical Care (1990)
3.All PharmD Degree (2000's)
Healthcare Educational System - ANS 1.Biomedical Model ->emphasis on organ
systems->specialization
2.Osteopathic Model (LECOM Model)- promotes a more patient-centered, holistic approach to
medicine, and emphasizes the role of the primary care physician.
Physician Power - ANS 1.Hierarchical system
2.Professional "sovereignty" (supreme power or authority)
3.Self-regulation
4.Demand for technology
, 5.Increased inpatient services.
Government Involvement in Healthcare - ANS 1.REGULATION
-Pure Food & Drug Act (1906)
-Food Drug & Cosmetic Act (1938)
-Affordable Care Act "Obamacare" (2010)
2.FUNDING
-Hill-Burton (1946)
-Medicare (1965)
Government Involment in Healthcare - ANS 1.MEDICAL HOMES
-Encouraged by the Affordable Care Act
-Provide comprehensive and continuous medical care
2.COMMUNITY HEALTH CENTERS
-Federally funded
-Provide primary care/regionalized services
-1300 centers serve 2.2 million people.
US NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM - ANS
1.Monitoring health status to identify & solve community health problems.
2.Diagnosing & investigating health problems & hazards
3.Informing & educating people about health problems & hazards
4.Mobilizing the community to solve health problems.
5.Developing policies to support individual & community health efforts.
6.Enforcing laws & regulations to support health safety.
7.Providing people with access to necessary care.
8.Assuring a competent & professional health workplace
9.Evaluating the effectiveness, accessibility, and quality of personal & population-based health
services.
10.Performing research to discover innovative solutions to health problems.
Insurance Companies
(Third Party Payers) - ANS -Also known as "Third Party Payers"
-Huge influence on US Healthcare system via FINANCIAL INCENTIVES (favor hospitals and
specialization).
What has changed with insurance? - ANS 1.Government hospitals for merchant seamen
(1798)
2.Employers, trade unions, or fraternal organizations (19th century)
3.Worker's compensation (1914)
4.State-supported health proposals (1917)
5.BLUE CROSS (1929)
6.BLUE SHIELD (1939)
7.Henry Kaiser's prepaid plan for workers on the Grand Coulee Dam (1938)
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