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  • Abraham Lincoln Quote Health People 2010 Who makes up this initiative? 2 goals Increase quality and years of healthy life Eliminate health disparities Underlying premise is that the health of the individual is almost inseparable from the health o f the larger community and that the health of every community in every state and territory determines the overall health of the Nation. Strategic Planning Is it a good thing to increase life span?
  • There are many different views of health care Each of these views goes a step further. WHO - See notes Holistic view - Ex) Our Lady of the Lake College. Ex) Priest coming to visit in the hospital The key to th e WHO and Holistic View’s is the balance among these dimensions.
  • There are many different views of health care Each of these views goes a step further. WHO - See notes Holistic view - Ex) Our Lady of the Lake College. Ex) Priest coming to visit in the hospital The key to th e WHO and Holistic View’s is the balance among these dimensions.
  • There are many different views of health care Each of these views goes a step further. WHO - See notes Holistic view - Ex) Our Lady of the Lake College. Ex) Priest coming to visit in the hospital The key to th e WHO and Holistic View’s is the balance among these dimensions.
  • These are not the same. 1) A person can feel ill, but not have disease Can someone give me an example? Ex) Jamie - could not attend school - feel well now so can go back to school, but probably does not have a disease 2) Vice Versa - you can have a disease and not feel ill Can someone give me an example?
  • Risk Factors Give examples of each: 1) Genetic makeup - Cancer, diabetes, heart condition 2) Individual behaviors - Smoking, exercising, eating, red meat 3) Medical Practice - Prevention? Yearly check-ups, ect. I don’t. I only go when I have a problem 4) Environment - - Shaw chemical site (living near Travis’s plant) - Rural area = no high tech equipment to find diseases, et.c.
  • Listed in order of importance Environment - Ex) relationship of socioeconomic status - Better education = higher incomes = better locations =less exposure to environmental risks (Shaw Group) =better access to health care. - The greater the economic gap between rich and poor, the worse the health status of population. -less social cohesion -greater psychological stress Lifestyles- Ex) Diet and exercise
  • The idea that capitalism and free markets has been extended to health care. The role of distributing economic goods is assigned to the market. Lincoln - would argue that free market implies that giving people something they have not earned would be morally and economically wrong. - Don’t punish those on “top”. Libertarians view
  • Assumptions: 1) 2) When individuals achieve, society is better served 3) People are willing to purchase health care services Some see health care as an investment = Reduces the number of sick days, therefore, more productive.
  • 1) People trust their physician 2) The market is more efficient that the government Who can’t agree with that statement?
  • 1) 2) Thus, Price and ability to pay ration the quality and type of health care services people would consume. 3)
  • *** The idea of collectivism and restraining of markets has been extended to health care. The role of distributing social (collective) goods is assigned to the government.
  • Utilitarian (not libertarian) - Society’s goal is to achieve the greatest good for the greatest number of people. See Moral Issues
  • Deliberate attempt by the government to limit the supply of health care services = beyond basic care = How high tech should be dispersed, etc. ____________________________________________________________ Elements of both Market and Social Justice exist in U.S. Give examples? -private insurance -pay out of pocket -Medicare and Medicaid Interesting: In 90’s, U.S. economy did very well, yet # of uninsured climbed. Conclusion: Some argue that we need to try social justice Discuss meeting with Davidge.
  • Deliberate attempt by the government to limit the supply of health care services = beyond basic care = How high tech should be dispersed, etc. ____________________________________________________________ Elements of both Market and Social Justice exist in U.S. Give examples? -private insurance -pay out of pocket -Medicare and Medicaid Interesting: In 90’s, U.S. economy did very well, yet # of uninsured climbed. Conclusion: Some argue that we need to try social justice Discuss meeting with Davidge.

US health care system overview 2 Presentation Transcript

  • 1. Foundation of US Health Care Delivery Chapter 2
  • 2.
    • Curative medicine has
      • decreasing returns in health improvement with increased health care expenditures
    • There is recognition of the benefits to society from the promotion of health and prevention
    Beliefs, Values and Health
  • 3. Beliefs, Values and Health
    • Beliefs and values in US
      • have remained mostly private,
        • not a tax-financed national health care program
      • are strong forces against
        • fundamental changes in the financing and delivery of health care
    • Social norms explain
      • how we view illness and expectations
  • 4. What Is Health ?
    • U.S. health care has followed a
    • medical/biomedical model
      • It presupposes the existence of illness or disease
      • It emphasizes
        • clinical diagnosis and medical interventions to:
          • treat disease or its symptoms
          • have a clinical diagnosis and medical interventions
  • 5.
    • Absence of illness and disease
    • O ptimum health exists when
      • a person is free of symptoms and
      • does not require medical treatment
    What Is Health ?
  • 6.
    • “ A state of physical and mental well-being that facilitates the achievements of individual and societal goals”
      • Society for Academic Medicine
    • “ A complete state of physical, mental and social well being, not merely the absence of disease
      • WHO
        • referred to as the biopsychosocial model of health
        • WHO defined a health care system as
          • all the activities whose primary purpose is to promote, restore, or maintain health
    What Is Health ?
  • 7. Holistic Health
    • Holistic medicine
      • treats the whole person
      • incorporates alternative therapies
    • Holistic health incorporates
      • physical, mental, social and spiritual aspects
    • Literature shows that:
      • religious & spiritual belief has a positive impact on overall well-being
      • it affects the incidence, experience, and outcomes of common medical problems
  • 8. Illness vs. Disease
    • Illness
      • identified by a person’s perception and evaluation of how he/she is feeling
      • people are ill when they
        • infer a diminished capacity to perform tasks and roles expected by society
    • Disease
      • based on a professional evaluation
      • requires therapeutic intervention
  • 9. Disease Classifications
      • A) acute
        • relatively severe,
        • episodic (of short duration) and
        • often treatable
          • (i.e., myocardial infarct, lack of kidney function)
      • B) subacute
        • some acute features
        • postacute treatment after discharge
          • (i.e., head trauma, ventilator)
      • C) chronic
        • less severe, but long and continuous
        • can be controlled, but can lead to serious complications
          • (i.e., asthma, diabetes, hypertension)
  • 10. Quality of Life
      • Overall satisfaction with life during and following a person’s encounter with the health care delivery system
      • An indicator of how satisfied a person was with the experiences while receiving health care
        • comfort, respect, privacy, security, autonomy
      • A person’s overall satisfaction with life and self-perceptions of health, especially after a medical intervention
      • Goal:
        • have a positive effect on an individual’s ability to function, meet obligations, feeling of self-worth
  • 11. Determinants of Health
    • Factors that influence an individual and a population’s health:
      • A person’s genetic make up
        • 20% of premature deaths
      • Individual Behaviors
        • 50% of premature deaths
      • Medical Practice
        • 10%
      • Social and Environmental Factors
        • 20%
        • See Figure 2-1
  • 12. Determinants of Health
      • Environment
        • Physical, social, cultural, and economic factors
      • Behavior/Lifestyle
        • Diet and foods play a major role in most significant health problems
      • Heredity
        • Predisposes individuals to certain diseases
        • Current lifestyles can impact future progeny
      • Medical care
        • Access to adequate preventive and curative health care services
  • 13. Healthy People 2010
      • 10 year plans
      • key national health objectives
      • founded on the integration of medical care and prevention, health promotion and education
      • emphasizes the role of community partners
        • (businesses, governments, civic, professional, and religious organizations)
          • as agents for improving health in their communities
      • under the US Surgeon General’s direction
        • Look at Figure 2-2
  • 14. Healthy People 2010
    • Designed to achieve two goals:
      • Increase Quality and Years of Healthy Life
      • Eliminate Health Disparities
  • 15. Social and Market Justice Approaches
    • The production, distribution, and, consumption of health care must be perceived as equitable.
    • No society
      • has a perfectly equitable method to distribute limited resources
    • Any method of resource distribution leaves some inequalities
  • 16. Social and Market Justice Approaches
    • A theory of justice is
      • needed to resolve the allocation of health care
    • Equitable access to health services is addressed by
      • the theories of market and social justice.
    • These two contrasting theories govern
      • the production and distribution of health care services.
  • 17. Market Justice “The Economic Good”
    • Fair distribution of health care to the market forces in a free economy
      • Medical services distributed on the basis of people’s willingness and ability to pay.
  • 18. Principles of Market Justice
    • Health care is
      • an economic good
        • governed by free market forces
    • Individuals are
      • responsible for their own achievements
    • People make rational choices
      • in their decision to buy health care products and services
  • 19.
    • People consult with their physicians, who know what is best for them
    • The market works best without interference from government
    Principles of Market Justice
  • 20. Market Justice
    • The production of health care is determined by
      • how much the consumers are willing and able to buy at the prevailing price.
    • Those not able to pay have barriers to health care
      • “ rationing by ability to pay”
    • Focus on individual rather than a collective responsibility for health
        • Look at Table 2-1
  • 21. Social Justice “The Good Society”
    • Theory is at odds with capitalism and market justice
    • The equitable distribution of health care is society’s responsibility
      • Best when a central agency is responsible for the production and distribution of health care
    • Health care is a social good
      • Should be collectively financed and available to every citizen.
  • 22. Principles of Social Justice
    • Health care should be based on need rather than cost
    • There is a shared responsibility for health
      • Factors outside a person’s control might have brought on the condition
    • There is an obligation to the collective good
      • The well-being of the community is superior to that of the individual
  • 23.
    • Government, rather than the market, can better decide, through planning,
      • how much health care to provide and how to distribute among all citizens
    Principles of Social Justice
  • 24.
    • Planned rationing, supply-side rationing, or nonprice rationing is where
      • government limits the supply of health care services, particularly those beyond the basic level of care
        • Look at Table 2-1
    Social Justice
  • 25. Limitations of Market Justice
    • Fails to rectify human concerns such as
      • crime, illiteracy, and homelessness, which can significantly weaken the fabric of a society.
    • Does not always protect the society.
    • Individual health issues can have negative consequences for society
    • Does not work well in health care delivery
  • 26. Focusing on Determinants
    • To improve the nation's health and
    • resolve disparities among its
    • vulnerable populations,
        • a framework embodying the social and medical determinants is warranted.
      • Look at Figure 2.3
  • 27. Social Determinants of Health
    • The framework includes:
      • demographics, personal behaviors, and community-level inequalities and their defining influence on health.
    • Personal demographics
      • (e.g., race/ethnicity or age)
        • directly contribute to vulnerability levels  
    • Social and income inequalities
      • have shown to contribute to disparities in health
  • 28. Medical Care Determinants
    • The medical care system focuses primarily on treating illness or poor health
    • This framework includes:
      • a broad spectrum of medical care services and interventions to improve health,
        • though preventive and primary care
        • contributes to the general health status
          • others are more influential in end-of-life mortality
            • (specialty and long-term care)
  • 29. Social and Medical Points of Intervention
    • Reductions in health disparities are obtainable through interventions
    • Interventions are grouped according to four strategies:
      • 1) social or medical care policy
      • 2) community-based interventions
      • 3) health care interventions
      • 4) individual interventions 
  • 30. 1. Social and Medical Points of Intervention
    • Policy Interventions
      • Social or public policy affects the health of the population
      • Guards the welfare of the nation
  • 31. 1. Social and Medical Points of Intervention
    • Vulnerable populations
      • are uniquely dependent upon social and public policy to
        • develop and implement programs that address basic nutritional, safety, social, and health care needs
    • Policy initiatives can be
      • prevention strategies to alter the dynamics linking social factors to poor health
  • 32. 2. Community-Based Interventions
    • Many health disparities may be addressed at the community or local levels. 
    • Neighborhood poverty, the presence of local health and social welfare resources, and societal cohesion and support contribute to the level of inequalities in a community
  • 33. 2. Community-Based Interventions
    • Community partnerships
      • reflect the priorities of a local population
      • are often managed by members of the community
      • minimize cultural barriers
      • improve community buy-in to the program
    • Mobilizing resources at the local level to address problems
  • 34. 2. Community-Based Interventions
    • Community resources can be applied directly to community members
      • businesses have greater incentive to contribute to local health causes. 
    • Community solutions benefit from participatory decision making
  • 35. 3. Health Care Interventions
    • Designed to
      • improve the quality and efficiency of services provided, and
      • reduce disparities across groups
    • Examples include:
      • integrated electronic medical record systems to coordinate care for populations with multiple chronic and acute conditions
      • continuing education for pediatricians to target developmental services to children
      • educating pregnant mothers to receive regular prenatal care
  • 36. 4. Individual-level Interventions
    • Attempts to intervene and minimize the effects of negative social determinants on health status. 
    • Altering behaviors that influence health is often the focus of these individual-level interventions
      • (e.g., reduce smoking and encourage exercise)
  • 37. Conclusion
    • The health care delivery system in the United States is:
      • mostly private
        • many of the peculiarities of this system can be traced back to the beliefs and values underlying the American culture
      • driven by the medical model, which emphasizes illness rather than wellness
  • 38. Conclusion
    • Holistic concepts of health care, along with preventive and health promotional efforts, need to be adopted to significantly improve the health of Americans
    • It would also require
      • individual responsibility for one’s behaviors
      • community partnerships
      • initiatives such as Healthy People 2010
  • 39. Conclusion
    • To improve the nation's health and resolve disparities,
      • it is critical to address both the social and medical determinants of health.
  • 40. Slides created by:
    • Elizabeth A. Berzas, MHA, CHE
    • Chair and Program Director
    • Our Lady of the Lake College
    • Department of Health Sciences
    • 7434 Perkins Road
    • Baton Rouge, LA 70808
    • 225.768.1706
    • [email_address]
    • www.ololcollege.edu