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.
  • US health care system overview 2

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

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