Lesson 7 Discussion
What are the major differences between Medicare, Medicaid, and CHIP? What is Medicare? Does the government fund it completely? How is the funding for Medicaid and CHIP different from the funding for Medicare? What are the four parts of Medicare and what do they cover, in general? Most Americans pay no premiums for Part A - why? What is meant by the “prospective payment system,” and what part of Medicare does it affect?
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Component 1, Unit 7: Lecture c: Introduction to Health Care and Public Health in the U.S. Introduction to Health Care and Public Health in the U.S. Public Health, Part 1 Lecture c This material (Comp 1 Unit 7) 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 90WY0001. 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.: Public Health, Part 1. This is lecture c. 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 services are delivered in the U.S. Health IT Workforce Curriculum Version 4.0 1 Public Health, Part 1 Learning Objectives - 1 Discern the main differences and similarities between public and private health (Lecture a) Delineate the historic timeline and achievements of public health in the U.S. (Lecture a) Define and discuss key terminology of public health (Lecture b) 2 The learning objectives for Public Health, Part 1 are: Discern the main differences and similarities between public and private health Delineate the historic timeline and achievements of public health in the U.S. Define and discuss key terminology of public health Public Health, Part 1 Learning Objectives - 2 Illustrate the general organization of public health agencies and public health data flow (Lecture b) Evaluate and explain the effect and value of public health (Lecture c) 3 Illustrate the general organization of public health agencies and public health data flow Evaluate and explain the impact and value of public health Public Health Progress - 1 In the 20th century, Public Health: Significantly increased life expectancy Reduced infant and child mortality Reduced communicable diseases 4 This lecture discusses the value and effect of Public Health. In the 20th century, public health made radical improvements to population health. The achievements include a significant increase in life expectancy, and similarly significant reductions in both infant and child mortality and in communicable diseases. Public Health Progress - 2 Daily life examples of Public Health: Food safety Restaurant inspections Fluoridated water Seatbelt use Unleaded gasoline Influenza vaccine programs Trans-fats and other nutritional information Public health response to the most recent disaster 5 The improvements made by public health have become such a normal part of everyday life in the U.S. that we are often not even aware of them. However, it is nearly impossible to spend a single day unaffected by public health. This slide lists some examples of these public health achievements, including improvements in food safety, restaurant inspections, water quality and fluoridation, seatbelt use, removal of lead from gasoline, etc. Public health has a long and diverse record of working in the public interest, and that record is almost entirely positive. A Terrible Injustice - 1932 Public Health Service’s Tuskegee Study Recorded effects of syphilis on African American men Even after penicillin became the recommended drug treatment in 1947, the men did not receive adequate treatment. In 1972, an advisory panel found the study "ethically unjustified” and it was immediately halted 6 The record of public health does have two sad and serious stains on it, which are its involvement as a partner in two syphilis studies which veered into unethical behavior. These first of these is the infamous Tuskegee Study which began in 1932 and concluded in 1972. What started as an experiment to study the effects of syphilis on African American men, became unethical when a new treatment, penicillin, was deliberately withheld from subjects after it became the recommended treatment in 1947. The study was not halted until 1972, after an advisory panel found it to be ethically unjustified. A Terrible Injustice – 1932 Results Public Health Service’s Tuskegee Study Resulted in 128 men dying, 40 wives being infected, and 19 children being born with congenital syphilis 7 As a result of this experiment, 128 men died, 40 wives were infected, and 19 children were born with congenital syphilis. A Terrible Injustice - 1946 Guatemalan National Penitentiary U.S.-backed experiment deliberately infected inmates with syphilis Studied the effects of early penicillin treatment Resulted in at least 83 deaths 8 The second stain on the public health record is a U.S.-backed study that involved the deliberate infection with syphilis of prisoners in a Guatemalan prison in 1946. The study was done to investigate the effects of early penicillin treatment. At least 83 people died as a result of this experiment. Terrible Injustices The injustice of these studies must be noted and remembered Also remember the enormous benefits that Public Health has conferred 9 The injustice of these two studies must be both noted and remembered. It is important to also remember the enormous benefits that have come from public health. Top Ten Public Health Achievements in the 20th Century Vaccination Motor-vehicle safety Safer workplaces Control of infectious diseases Decrease in coronary heart disease/stroke deaths Safer and healthier foods Healthier mothers and babies Family planning Fluoridation of drinking water Recognition of tobacco as health hazard (CDC, 1999) 10 The CDC constructed a list of the top ten public health achievements in the 20th century. From family services - improvements in hygiene, nutrition, and health care have reduced infant mortality 90% from the 1900 level, and reduced maternal mortality 99% - to safer workplaces - reduction in both diseases such as silicosis, and workplace injuries - and motor vehicle safety - think seat belts, child seats, motorcycle helmets - the U.S. population has reaped enormous benefits from investment in public health. Public Health Highlights - 1 Since 1900, the average life expectancy for Americans has increased about 30 years; 25 of those years are attributed to public health initiatives 1950s – In anti-tuberculosis efforts, more than 20 million X-ray examinations were made by the Public Health Service 11 A few more highlights of public health. As mentioned earlier in this unit, public health has significantly increased life expectancy. In fact, since 1900, the average life expectancy in the U.S. has increased 30 years, and a startling 25 of those years are attributed to public health initiatives. Congress passed the Public Health Services Act in 1944 which resulted in the establishment of the “Division of Tuberculosis Control”. By 1950, more than 20 million X-ray examinations were made by the Public Health Service. Public Health Highlights - 2 1977 – Worldwide eradication of smallpox (as recently as 1958, two million people a year die from smallpox) 1990s – only 4.4% of U.S. children have elevated blood lead levels (in the 1970s, 88.2% had elevated blood lead levels) 12 As recently as 1958, two million people died annually from smallpox. In 1977, a dedicated public health initiative brought about worldwide eradication of this disease. And in the 1970s, a huge majority, 88%, of U.S. children had elevated levels of lead in their blood, but by the 1990s public health had reduced that percentage to only 4.4%. Public Health Highlights - 3 A near elimination of deaths from childhood diseases such as: Measles Diphtheria Scarlet fever Whooping cough In 2014, of the top 10 causes of mortality, only one is NOT related to chronic disease or injury 13 Childhood illnesses used to be devastating to the population, but both medical progress and public health efforts have nearly eliminated deaths from illnesses such as measles, diphtheria, scarlet fever, and whooping cough. In fact, the long-standing battle against infectious diseases has been so successful that of the current leading causes of mortality, only one factor is NOT a chronic disease-related or injury-related factor. 2014 Top 10 Causes of Mortality in the U.S. Heart disease: 614,348 Cancer: 591,699 Chronic lower respiratory diseases: 147,101 Accidents (unintentional injuries): 136,053 Stroke (cerebrovascular diseases): 133,103 Alzheimer's disease: 93,541 Diabetes: 76,488 Influenza and pneumonia: 55,227 Nephritis, nephrotic syndrome, and nephrosis: 48,146 Intentional self-harm (suicide): 42,773 (CDC, 2014) 14 Of the top ten causes of mortality in the United States, only #8, influenza and pneumonia, is caused, at least, to our current accepted knowledge, by infectious disease agents. Public Health, Part 1 Summary – Lecture c The radical yet often overlooked improvements which public health has made to population health are discussed. Included are some examples of amazing successes in communicable disease countermeasures. 15 This concludes lecture c of Public Health, Part 1. In summary, the radical yet often overlooked improvements which public health has made to population health are discussed. Included are some examples of amazing successes in communicable disease countermeasures. Public Health, Part 1 Summary - 1 Similarities and differences between public and private health were discussed. Criteria for assigning public health importance were explained. The history of public health in the U.S. was reviewed with the help of some important historical highlights, including the creation of the Centers for Disease Control and Prevention (CDC). 16 This also concludes the unit: Public Health, Part 1. In summary, the similarities and differences between public and private health were discussed. Criteria for assigning public health importance were explained. The history of public health in the U.S. was reviewed with the help of some important historical highlights, including the creation of the Centers for Disease Control and Prevention. Health IT Workforce Curriculum Version 4.0 16 Public Health, Part 1 Summary - 2 Some key terminology of public health was defined. The organization and funding of public health in the U.S. was discussed. The roles of public health were discussed, and disease reporting and surveillance was used as an example. 17 Some key terminology of public health was defined. The organization and funding of public health in the U.S. was discussed. The roles of public health were discussed, and one of these roles, disease reporting and surveillance, was described in detail. Health IT Workforce Curriculum Version 4.0 17 Public Health, Part 1 Summary - 3 The radical yet often overlooked improvements which public health has made to population health were discussed. Included were some examples of amazing successes in communicable disease countermeasures 18 The radical yet often overlooked improvements which public health has made to population health were discussed. Included were some examples of amazing successes in communicable disease countermeasures. Health IT Workforce Curriculum Version 4.0 18 Public Health, Part 1 References – Lecture c References Brown, R. H., Harris, J. L., Hiltner, S., Sinkford, J. C., Speaker, F., & Weeks, B. H. (n.d.). Tuskegee Syphilis Study Ad