Health Care Delivery Chapter 1 PDF

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CHAPTER 1: HEALTHCARE DELIVERY IN AMERICA: HISTORICAL AND POLICY PERSPECTIVES 1.

PARADOXES OF THE US HEALTHCARE SYSTEM A. US has most advanced tech. however still has an extremely high rate of medical errors. B. Large percentage of Americans don’t have health insurance C. Large expenditure=Extremely expensive healthcare system D. Fragmented in terms of how the healthcare services are delivered and organized

2. TECHNOLOGY A. Technological advances have caused Americans to expect only the best technical care, which leads to overuse of technological advances i.

New technology is updated so frequently without examination of cost effectiveness and patient safety

B. Use of Electronic health records is cost saving, reduce medical error, and improve patient access and outcomes, but lose focus of the physician and patient relationship i.

Doctors are diagnosing without care and deeply thinking about the patient

C. Technology isn’t equally distributed among patients, b/ of insurance status, income, and race

3. HEALTH EXPENDITURES A. US is spending more money on healthcare than other developed nations, however millions of citizens still lack adequate acess to health care

4. HEALTH INSURANCE A. 46.3 million Americans were without health insurance (2009) B. Those insured, often are underinsured (insurance don’t cover important care)

5. HEALTH STANDARDS A. US underperforms in aspects of patient access, patient safety, coordination, efficient, and equity, often due to lack of workers B. 44,000-98,000 people die each year from medical errors

6. AN EXAMPLE: HEALTHCARE-ASSOCIATED INFECTIONS A. 1.7 million healthcare associated infections and 99000 associated deaths B. HCAI is one of the top-10 leading causes of death in the US C. Hand Washing Guidelines need to be implemented more rigorously than they have been in the past and have actually increased

7. HEALTH OUTCOMES A. Racial, ethnic, and socioeconomic disparities have increased in the US, often due ot lack of access to quality care, insurance, and underinsurance B. Obesity is a rising problem in the US and when trying to reduce diabetes prevalence, the US’s diabetes cases actually increased

8. HEALTH DISEASE, AND HEALTH PRACTITIONERS IN COLONIAL AMERICA A. Native Americans have high mortality rates, but as colonists arrived, they brought diseases B. In the past, family and neighbors would diagnose and make medicines

9. AMERICA IN THE 19 TH CENTURY: THE HEALCARE ENVIRONMENT A. Rural and urban health 2

i.

Farmers and travelers relied on themselves and family/midwives would be the social healers for the rural community 1. Services were paid through cash or kind

ii.

Most major cities offered services like writing prescriptions, surgeries, and vaccinations

10. THE RISE AND TRANSFORMATION OF THE HOSPITAL: 19 TH -20 TH CENTURIES A. Earliest hospitals were mostly charitable(for the poor) and welfare functions, and was a place for people to die B. Often located in urban, new, immigrant neighborhoods and provided prescribing medication therapies, dental work, and minor surgery C. Over a 50 yr period after the Civil War, the number of US hospitals grew from 200-6000. D. In the 20th century, hospitals started using aseptic and antiseptic techniques E. The growth of the modern hospital as an indispensable element was ensured in 1946, which led to an overabundance of hospital beds with funds disproportionately going to middle-income communities F. Medicare and Medicaid began in the 1960’s, when emphasis was placed on pursuing cost-cutting and efficiency measures G. 21st century focused on patient centered care, and being respectful and responsive to individual patient preferences and help prevent fragmented healthcare experience

11. CONTINUITY AND CHANGE IN HEALTH INSTITUTIONS AND PROFESSIONS A. MEDICINE i.

The Flexner report focused on having medical schools be accredited under the control of the American Medical Association and so many lower class, women, and minorities did not pursue their studies around the 1900’s-1960’s

ii.

The 20th century was the golden age, b/ physicians were coined as prestigious and admired for their work

iii.

During the 1970’s social inequities were addressed and women and minorities began being admitted to schools

iv.

Patient centered medical home model help expand primary care

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12.

PHARMACY

A. The 1960’s were a yrs of revolution in pharmacy, b/ they pushed for a new identity in clinical pharmacy, where the pharmacist is the durg expert and is responsible for being a therapeutic advisor for patients and other health professionals B. Pharmaceutical care was implemented in communities and hospitals

13.

HEALTH POLICY OVERVIEW: 1900-1950

A. New Legislation in the Early 20th Century i.

Gov’t got more involved with health care (FOOD, DRUG, COSMETIC ACT

B. Public Private Health Insurance i.

14.

b/ of the large drop of physicians and hospital income after the Great Depression, hospitals reconsidered insurance plans

POST-WORD WAR II HEALTHCARE CHANGES

A. Prepaid Health Care, Health Maintenance Organizations, and managed care i.

Medicare initially only part Aor hospital and Part B for medical care insurance (physicians and various medical services)

ii.

Medicaid was established as a joint federal and state program to provide health care for low income elderly, disabled, and families with children

B. Renewed Efforts for National Health Insurance i.

Clinton’s health security was turned down

C. Incremental Policy Proposals i.

Children’s Health Insurance Program

ii.

The Medicare Prescription Drug, Improvement, and Modernization Act (2003)

HEALTHCARE REFORM: A CONTINUING PARADOX

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