3. • Get to know each other
better1
• Familiarize yourself with
the Syllabus and future
assignments
2
• Set the stage for
healthcare adventure3
Today’s Overview
4. Chapter 1: Introduction
• Every health system is unique
• Organized to provide the diagnosis and
treatment of individuals’ health problems
• Major Components: HC workforce, practice
setting, suppliers of therapeutics, workforce
training departments, research and system
oversight
• Health conditions, social positions, training of
physicians, organization of systems and expected
outcomes may differ
5. Chapter 1: Introduction
• Fundamental differences in beliefs based on
cultural differences
• EX: Yin and Yang-Chinese Medicine
• Set of beliefs about health and healthcare
which is referred to as “Western Medicine”-
originated over time in Western Europe
• Also know as allopathic medicine
6. Chapter 1: Introduction
• Allopathic: biologically based approach to healing, focus is on the specific
ailment using pharmaceuticals or surgery (MD’s)
• Osteopathic: licensed to practice full scope of medicine, focus on holistic
philosophy and a system of hands-on diagnosis and treatment known as
“osteopathic manipulative medicine”, emphasis on heath education and
injury and disease prevention (DO’s)
• A lot of similarities among western medicine countries in how medicine
is practiced, basic structure and organization in how healthcare is
delivered, similar economies and abilities to finance healthcare
• Major differences: paying for healthcare, equity and efficiency of
healthcare provided and population heath outcomes
7. Chapter 1: Introduction
• What is healthcare? P. 3 (WHO)
• Central focus of healthcare is to restore health or prevent exacerbation
of health problems
• Health is the product of multiple factors: genetic inheritance, physical
environment, social environment and response to these factors
• Healthcare has an impact late in the game-determinants of health have
already made an impact for better or for worse-need for healthcare is
seen as a failure to prevent those determinants of health from adversely
affecting the patient
• Healthcare is primarily associated with secondary & tertiary prevention
8. Chapter 1: Introduction
5 Components of Healthcare Systems:
• Facility where healthcare is provided
• Workforce that provides the healthcare
• Providers of healthcare therapeutics
• Educational and research institutions
• Financing mechanism
9. Chapter 1: Introduction
Organization of Healthcare System in U.S.:
• Gov’t Healthcare agencies
• Private, non-profit healthcare sector
• Private, profit-making , or commercial sector
11. Chapter 1: Introduction
U.S. Compared to Other Industrialized Countries:
Uniqueness
• No central trunk, no national ministry of health
(decentralized)
• Care provided for and paid for –fee for service
system since the end of WWII
• Physician income higher
• Since mid-1980s, has become a major venue for
the generation of corporate profits from the
direct provision of healthcare services
17. Chapter 1: Introduction
Organization of Healthcare Services:
• Gov’t Sector: Federal, state & local
• Examples: Federal-VA, State Mental Hospitals,
local gov’t public hospitals
• Largest player in the biomedical research arena
• Principal health agency: DHHS (Department of
Health and Human Services): runs federal social
security, state-run public assistance programs,
allocation of money to public & private entities
throughout nation
18. Chapter 1: Introduction
• Health agency part of state gov’t
• Local state gov’t-counties, cities also have
major healthcare agencies
• Non-healthcare Gov’t Agencies:
-Dept. of Labor
-Dept. of Agriculture
-Environmental Protection Agency
19. Chapter 1: Introduction
Private, Non-profit Sector
• Voluntary Agencies-non-governmental
agencies that play a role in the healthcare
system, AHA, Red Cross
• Professional Organizations: AMA, ANA-
organizational dues, journal subscriptions
20. Chapter 1: Introduction
Private, For-profit Sector:
-for-profit health services providers & suppliers
-corporations that deliver health services to their
employees as a benefit of employment
For-Profit Proprietary :
• Therapeutics production (pharmaceuticals)
• Commercial health insurance companies/malpratice
• Nursing homes
• For-profit general hospitals (managed care and
independent)
• For-profit managed care sector
• Employee Health Services
21. Chapter 1: Introduction
Types of Health Services:
• Primary care- most people need most of the
time for most of their health and illness
concerns(p.20)
• Secondary care-by referral to include surgical
procedures and the common diagnostic and
treatment interventions (radiology,
ophthalmology, cardiology)
• Tertiary-highly specialized diagnostic,
therapeutic, and rehabilitative services requiring
staff and equipment
22. Chapter 1: Introduction
Care of Special Populations and Diseases:
• Special care programs for defined population
groups are provided by the gov’t (military
personnel & dependents, service vets, and
Native Americans.
• Other US populations subgroups include railroad
workers, migrant farm workers, certain industrial
workers, schoolchildren, and college and univ.
students
• Special programs can also be organized by type
of illness-mental illness
23. Chapter 1: Introduction
Healthcare System Management:
1. Administration: Physician decision-making has
decreased as MCOs expanded-lead to cost
containment, used to delivering individual services
2. Planning: in US has been very weak-legally enforcing
planning has largely been confined to hospital
construction-left to institutional provider parties
3. Gov’t Regulation: more reactive, after serious
financial or quality issues arise-modest level
4. Evaluation: highly developed, academic program
evaluation-very little on MCO’s
24. Chapter 1: Introduction
Population Served- Major Characteristics:
• More racially and ethnically diverse-lack of
cultural competence by providers
• Broad range of social classes with large income
differentials-becoming wider over time
• Age structure-year 2020 population forecast
suggests increased spending on care for elderly
as Baby Boomer generation ages/retires,
heathcare expenditures will increase
25. Chapter 1: Introduction
Healthcare Performance:
• Plagued by long-term problems
• Increased dominance of for-profit activities
has transformed healthcare from a service
into a business
• Can be assessed at the micro/macro levels
26. Chapter 1: Introduction
Healthcare Performance Criteria:
1. Quality
2. Equity
3. Efficiency
Future:
-providing satisfactory services to all people at
reasonable costs
-changes occurring rapdly-in 10 yrs-what will
system look like? (Chinese Medicine, Chiropractic)
