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US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
US health care system  overview 2
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US health care system overview 2

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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.
  • 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

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