Lesson 1
What is health? What is health care?
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Introduction to and History of Modern Health Care and Public Health in the U.S. Lecture a Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S. Lecture a This material (Comp 1 Unit 1) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Welcome to Introduction to Health Care and Public Health in the U.S.: Introduction to and History of Modern Health Care in the U.S. This is lecture a. The component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and how services are delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S. Health IT Workforce Curriculum Version 4.0 1 Introduction to and History of Modern Health Care in the U.S. Learning Objectives - 1 Define key terms in health care and public health (Lectures a, b, c, d) Describe components of health care delivery and health care systems (Lecture a) Discuss examples of improvements in public health (Lecture b) 2 The learning objectives for Introduction to and History of Modern Health Care in the U.S. are to: Define key terms in health care and public health, Describe components of health care delivery and health care systems, Discuss examples of improvements in public health, 2 Introduction to and History of Modern Health Care in the U.S. Learning Objectives - 2 Define core values and paradigm shifts in U.S. health care (Lecture c) Describe the technology used in the delivery and administration of health care (Lecture d) 3 Define core values and paradigm shifts in U.S. health care, And describe the technology used in the delivery and administration of health care. 3 Some Definitions: Health Often thought of as the absence of disease World Health Organization (WHO) “…state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” “Illness” is a state of poor health 4 This introductory lecture will provide a high level perspective as well as some important definitions. We will begin by defining the term “health.” We often think of health as the absence of disease but this is a somewhat narrow description of the term. In 1946, representatives of 61 countries attended the International Health Conference in New York to ratify the Preamble to the Constitution of the World Health Organization, which is the specialized agency of the United Nations that deals with global health. The WHO definition of health is that health is the state of complete physical, mental, and social well being and not merely the absence of disease or infirmity. Thus, illness represents a state of poor health. 4 Health Care The prevention and treatment of illness Delivered by people from varied disciplines Medicine Dentistry Nursing Laboratory Science Pharmacy Other allied health professions Work together as interdisciplinary teams to deliver care 5 Let’s look at the term “health care.” Health care is the prevention and treatment of illness. It is delivered by people who are drawn from different and often disparate disciplines, including medicine, dentistry, nursing, laboratory science, pharmacy, and other allied health professions which may include anesthesia technologists, cardiovascular technologists, medical assistants, perfusionists or respiratory therapists. As you can see, these people have different backgrounds, and they have disparate training, but often work together as interdisciplinary teams in order to deliver care to patients. 5 Health Care Delivery Delivered in different places Inpatient facilities Hospitals Institutions for treating sick or injured people Historically places for shelter, almshouses Hospital Survey and Construction Act (also known as the Hill-Burton Act) passed in 1946 Nursing and residential care Outpatient facilities 6 Health care is delivered in different places. In this unit, we are going to define and look at in-patient facilities, including nursing and residential care, and out-patient facilities. When we think of in-patient facilities, we typically think of hospitals. Hospitals are institutions that treat patients who are sick or injured. Hospitals are physical structures that house patients during treatment and allow clinicians to conduct diagnostic tests and perform management interventions and specialized functions such as surgery or managing childbirth. Historically, hospitals were places for shelter, or alms-houses for the poor. In 1946, the Hospital Survey and Construction Act was passed – this act was known as the Hill-Burton Act, since it was sponsored by Senator Lister Hill of Alabama and Senator Harold Burton of Ohio. This law provided federal grants to improve the physical infrastructure of hospitals and led to significant augmentation of the infrastructure of facilities that provided in-patient care in the United States. 6 Health Care Delivery - Hospitals Types of hospitals: General medical and surgical Specialty (orthopedic, pediatrics, women’s services) Psychiatric Publicly or privately owned Patients can be admitted: Via emergency department Directly from physician’s office 7 There are different types of hospitals. Hospitals can provide general, medical, and surgical care. But some hospitals may provide specialty services that focus on a particular aspect of care, such as orthopedics, pediatrics, or women’s services. Some hospitals focus on mental health, or psychiatric care. Hospitals may be publicly or privately owned. Public hospitals may be administered by the city, county, state, or at a federal level. Privately owned hospitals may be not-for-profit, or may pursue profits like any other business. Patients may be admitted to a hospital one of two ways. They may go into an emergency room where they are evaluated by a team of clinicians. If the clinicians feel that the person is sick enough, they may admit the person into the hospital for care. Patients may also be directly admitted to hospitals from physician’s offices. 7 Health Care Delivery – Nursing and Residential Care Facilities - 1 Short-term or long-term facilities Long-term care classified by level of care Skilled nursing facilities (nursing homes) Proliferated after amendment of the Social Security Act Originally part of the welfare system Now part of the health care system 8 Let us now turn our attention to health care delivery in nursing and residential care facilities. These can be short-term facilities where it is anticipated that patients will stay for a brief period of time before returning home or to their residences, or long-term facilities where patients may stay for an extended or indefinite period of time. An example of a short-term facility would be a post-surgical rehabilitation center. After surgery, it may be deemed that a patient is too frail to return home and may need to spend some time in a rehabilitation center before gaining enough strength to return home. An example of a long-term facility might be an Alzheimer’s unit in a nursing home. A patient with gradually progressive dementia may need to stay indefinitely in such a facility. Long-term care is classified by the level of care. For example, a patient with relatively few health needs may reside in an assisted living facility, whereas a patient with profound and significant health needs may need the services of a nursing home. Skilled nursing facilities, also called nursing homes, initially proliferated after an amendment of the Social Security Act. They were originally part of the welfare system and gradually shifted to become a part of the current health care system. 8 Health Care Delivery – Nursing and Residential Care Facilities - 2 1969 - Medicare drastically reduced coverage for nursing homes 1970 - Miller Amendment established a new standard, “intermediate care” 1990s - “Sub-acute care” Provided care for patients discharged from hospitals who briefly need a higher level of care “than is provided to the majority of patients in a skilled nursing facility.” 9 In 1969, as the cost of Medicare increased, the then Department of Health and Human Services drastically reduced coverage for nursing homes. A year later, the Miller Amendment established a new standard called intermediate care. Intermediate care facilities didn’t require the same amount of skilled nursing or resources thus requiring reduced levels of reimbursement. In the 1990s another standard, sub-acute care, was defined to provide care for patients discharged from hospitals who briefly needed a higher level of care than was provided to a majority of patients in a skilled nursing facility. These distinct levels of care have been delineated primarily from the cost-effectiveness perspective. 9 Health Care Delivery – Outpatient Facilities – 1 Physicians offices Primary care Specialty care Single specialty or multispecialty Dental offices General dentists Specialists Orthodontists Endodontist Oral Surgeons 10 Let’s now spend some time talking about health care delivery in the outpatient setting. Outpatient facilities may be physicians’ offices, dental offices, medical and diagnostic laboratories, or other ambulatory health services. Physician’s offices may be focused on primary, family, or specialty care. Family practice typically includes family care, internal medicine, and pediatrics, but also may focus on a particular specialty. These specialty care offices may represent medical specialties, such as gastroenterology or cardiology; surgical specialties such orthopedics or neurosurgery; or may reflect mental health care in the outpatient setting. These offices are physical structures and though they may be present in close proximity to inpatient facilities, many physicians’ offices exist in the communities they serve and some of them may be quite far from hospitals. These offices may be single-specialty, where all the physicians practicing in a single office are of the same field such as family practice or internal medicine, or they may be multi-specialty offices, where an internal medicine practitioner may share space with an orthopedic surgeon. Dental offices may be those of general dentists, or specialists such as orthodontists, endodontists, or oral surgeons. 10 Health Care Delivery – Outpatient Facilities – 2 Medical and diagnostic laboratories X-rays CT Scans and MRIs Biologic Specimens Other ambulatory health services Ambulance services Home health care Hospice Visiting Nurse Services 11 When we think of laboratories, we think of medical and diagnostic laboratories. Diagnostic laboratories are typically involved with imaging: x-rays, C-T scans – also called Computerized Axial Tomography scans or CAT scans - Magnetic Resonance Imaging, or MRIs and mammograms. Ultrasound imaging centers are examples of diagnostic laboratories. Medical laboratories usually deal with biologic specimens such as blood, cytology, or bacteriologic specimens. Specialized medical laboratories include DNA testing laboratories, medical pathology laboratories, parasitology and mycology health laboratories, toxicology health testing, and facilities that deal with non-radiologic, non- x-ray testing services. Examples of other ambulatory health services include ambulance services, home health care