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Week 1 health and health care system


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The introduction to the course and an introduction to the U.S. Health Care System

The introduction to the course and an introduction to the U.S. Health Care System

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  • 1. Health and the Health Care System Week 1
    BNURS 323
    Healthcare Politics and Policy
    Summer 2009
  • 2. Health
    Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
    Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
  • 3.
  • 4. Retrieved Nov/2008 from
  • 5. Jean Watson’s 10 carative factors
    The formation of a humanistic-altruistic system of values
    The instillation of faith-hope
    The cultivation of sensitivity to one’s self and to others
    The development of a helping-trusting relationship
    The promotion and acceptance of the expression of positive and negative feelings
  • 6. Jean Watson’s 10 carative factors cont’d
    The systematic use of the scientific problem-solving method for decision making
    The promotion of interpersonal teaching-learning
    The provision for a supportive, protective, and (or) corrective mental, physical, sociocultural, and spiritual environment
    Assistance with the gratification of human needs
    The allowance for existential-phenomenological forces (Watson, 1985, p. 9-10)
  • 7. Non-caring
    1986 study by Riemen found three themes emerging from patients descriptions of non-caring nurse behaviors:
    Physically present—emotionally distant
    Belittling and inhumane actions
    Devaluation of the patient as a unique individual
  • 8. Patient satisfaction
    Care is the human service quality that makes health consumers either satisfied or dissatisfied with health services and it is the care not the cure that consumers really value.
    Question for Class: Do we value (health care provider) professional satisfaction? Where does it come in?
  • 9. Health Services versus Health Care
    Service: Work done by one person or group that benefits another (Retrieved 6/22/09 from
    Health care: Implies enactment of caring theory, patient satisfaction
    Health care services: implies combination of services and caring
  • 10. Health care system
    Illness industry: a capitalist institution
    Focus on illness and injury versus prevention of problems and maintenance and promotion of health
    Care versus service versus profit
    Non-profit out-of-date term, now not-for-profit because business management same as for-profit
  • 11. Health Maintenance
    =Health Protection
    Activities that preserve present health
    Primary prevention
    Health supervision
    Monitoring and surveillance
  • 12. Health Promotion
    Risk Reduction
    Health Education: nutrition, physical activity, injury prevention, sleep, OTC medications, when to call MD and use of health care system, immunizations
    Anticipatory Guidance
    Physical G&D
    Psychological and emotional G&D
    Socialization, interactions, behavior
  • 13. Public Health
    (One) Definition of public health: effort organized by society as a whole to protect, promote, and restore health
    Focus is on what requires group effort to accomplish as opposed to individual effort
    In U.S., mixed knowledge, attitudes, and beliefs about government, role of society in individual life
  • 14. Economics, Politics, and Policy
    Economics: Study of distribution of scarce resources
    Politics: Study of power over the distribution of scarce resources; social relations involving authority or power
    Policy: A policy is typically described as a deliberate plan of action to guide decisions and achieve rational outcome(s). Retrieved 6/22/09 from
  • 15. Public Health Policy
    Policy Development as one of the Core Functions of Public Health: Assessment, Policy Development, Assurance
  • 16. Public Health Core and Essential Functions (from webpage previous slide)
    Monitor environmental and health status to identify community environmental health problems
    Diagnose and investigate environmental health problems and health hazards in the community
    Policy Development
    Inform, educate and empower people about environmental health issues
    Mobilize community partnerships to identify and solve environmental health problems
    Develop policies and plans that support individual and community environmental health efforts
    Enforce laws and regulations that protect health and ensure safety
    Link people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable
    Assure a competent environmental health workforce
    Evaluate the effectiveness, accessibility and quality of personal and population-based environmental health services
    Conduct research for new insights and innovative solutions to environmental health problems and issues
  • 17. Questions for Class
    Given the definitions of politics and policy, what is the relationship between them?
  • 18. Health Care System
    Providers: Hospitals, physicians (those who can bill third party payers directly for their services)
    In-patient/Out-patient: Hospital as basis of orientation; where does ED fall?
    Clinic, out-patient surgery, free-standing birth center
    Urgent care center, doc-in-the-box
  • 19. Hospitals
    Public: Federal, state, county, city
    Proprietary=for profit
  • 20. Questions for Class
    What is missing from this consideration of the health care system? (hint—who are we?)
    What/who makes the decision for in-patient care/admission to the hospital?
  • 21. Medical therapeutics
    MDs: Diagnose and treat. How treat?
    Prescription of medications: Drugs and herbs
    Drug categories: Legend (scheduled and non-scheduled); OTC
    Surgery: historically done by barbers until discoveries of anesthesia and antisepsis
    Counseling: lifestyle advice and recommendations
  • 22. Prevention
    Primary Prevention: prevention of occurrence of disease or injury. Code word—prevention.
    Secondary Prevention: prevention of progression of disease to symptoms. Code word—screening. Also early diagnosis and treatment.
    Tertiary Prevention: prevention of sequelae or severe consequences of disease. Prevent disability and death. Code word—rehab.
  • 23. Public Health Allegory
    A man, walking along a riverbank, suddenly sees a person flailing his arms and hears him pleading for help as he bobs in the water while being pushed downstream. The man on the bank dives into the water, swims to the victim and rescues him by pulling him ashore. When the man turns toward the river, once again he hears someone screaming for help. Then another. And another. One after the other, the man pulls victims from the river.Exhausted, and pulling yet another victim to shore, he notices a woman walking by. “Help me!” he pleads. “All these people are drowning and I have to do something to save them. More people are falling in and need help. Look!” he says, pointing to the river where more victims are in the water and needing help.
  • 24. Allegory cont’d
    Immediately, the woman starts to run upstream along the bank.“Where are you going?” he screams at the woman. “I need help now!”“I am helping right now,” says the woman. “I’m going upstream to find out how they’re falling into the river and to prevent that!” (Retrieved 6/22/09 from
  • 25. Health and Health Care
    Given the definitions of health care and health, how are they connected?
    What does the research show is the connection between health care and health?
    Social and economic determinants of health: standard of living
  • 26. Example: Tuberculosis
  • 27. Historical Trends in Mortality
    From infectious disease and injury
    To chronic diseases
    Length of life has increased, quality of life now a concern for the old-old (> 85 y. o.)
    Premature death now more of a concern
  • 28. Primary causes of death in U.S.
    0-28 days: congenital anomalies
    29-365 days: SIDS
    1 year – 45 years: unintentional injuries, esp MVA (MVC)
    45-65 years: 1. Cancer 2. unintentional injuries
    65+: 1. cardiovascular disease 2. cancer