Overview ofHealthcare ServicesTMHG 541: Fundamentals of Health Care and          Medical Terminology             January 8...
2         A Few Words About Me...2003 Doctor of Medicine (1st-Class Honors), Ramathibodi2009 M.S. (Health Informatics), Un...
3  TMHG 541Course Overview
4Course Outline• Health Care Delivery  • Overview of Healthcare Services  • Operations in the Clinical Settings  • Quality...
5Aims• To introduce basic concepts of healthcare services and medical terminologies• To familiarize non-healthcare student...
6Grading• Class Attendance      10%• Class Participation   30%• Assignments           60%
7Outline• Health• Health Systems & Healthcare Systems• Functions & Components• Characteristics of a Desirable Health Syste...
8“Health”
9Class Discussion:What Is Health?
10Health• Health vs. Illness and Disease• Medical Model:     Health = Absence of Illness or Disease• So what’s the problem...
11Problems with the Medical Model• Emphasis on treatment of illness/disease• Promotion and Prevention deemphasized• Not tr...
12The WHO Model & Definition• “Health is a state of complete physical, mental and social well-being and not merely the abs...
13Holistic Health• The well-being of every aspect of what makes a person whole and complete                         Physic...
14 Health Systems &Healthcare Systems
15Health Systems• A health system consists of all  organizations, people and actions whose  primary intent is to promote, ...
16Health Systems• Includes • A mother caring for a sick child at home • Private providers • Behavior change program • Vect...
17Health Care• Health care: Activities and services performed to improve a person’s health and well-being, through prevent...
18Healthcare Systems• An organization that delivers healthcare• In general, healthcare systems • promote good health in po...
19Healthcare Systems• Different models of healthcare systems • Purely public (care conducted by the state) • Purely privat...
20Healthcare Systems• Privately owned, commercial organizations  may also act as healthcare systems• These organizations m...
21Healthcare Systems• Healthcare systems can be measuredusing benchmarks• One framework for assessment:  • Patient assesse...
22Public Health“is the science and art of preventing disease, prolonging life  and promoting health through the organized ...
What is Public Health?• Private Health                                     • Public Health • Clinicians, Health           ...
2410 Great Public Health Achievements –US, 1900-1999• Vaccination• Motor-vehicle safety• Safe workplaces• Control of infec...
25How Has Public Health ImprovedHealthcare?• Improvements in understanding disease • Epidemiology is considered the basic ...
26How Has Public Health ImprovedHealthcare?• An example of epidemiology at work:     • In 1854: epidemic of cholera in Lon...
27How Has Public Health ImprovedHealthcare?• Improvements in data collection  • Original methods of data collection were c...
28How Has Public Health ImprovedHealthcare?• Improvements in data analysis (use of tools such as  multivariate analysis an...
29How Has Public Health ImprovedHealthcare?• Improvement in training  • Establishment of many schools of public health in ...
30Functions & Components   of Health Systems
31Functions of Healthcare Systems                                                      Governance,                        ...
32Components of Health Systems                        32                               WHO (2009)
33Key Stakeholders in Health Care (4Ps)                      Providers         Payers &     Public/            Policy-    ...
34Healthcare Delivery• Healthcare is delivered in different places• Inpatient facilities • Hospitals     • Institutions fo...
35Healthcare Delivery• Hospitals may be publicly or privately owned• Patients can be admitted to a hospital through • Emer...
36Healthcare Delivery• Nursing and residential care facilities • Can be short term facilities or long term   facilities • ...
37Healthcare Delivery• Outpatient facilities• Hospitals in some countries provide  ambulatory care through internal outpat...
38Healthcare Delivery • Dental offices    • General dentists or specialists • Medical and diagnostic laboratories • Pharma...
U.S. Healthcare Industry                                       Industry segment                                  Employmen...
40  Characteristics of aDesirable Health System
41WHO Framework                41                     WHO (2009)
42EQESAR Framework• E - Equity• Q - Quality• E - Efficiency• SA - Social Accountability• R - Relevance                    ...
43Equity• Equal services for equal needs• Unequal services for unequal needs• Accessibility • Physical • Psychological • F...
Quality• Safety• Timeliness• Effectiveness• Patient-centeredness                         Adapted from IOM (2001)
45Efficiency• Cost-effectiveness• Output or outcome versus cost• Technical/operational efficiency• Allocative efficiency  ...
46Social Accountability• Good governance• Adequate oversight and monitoring• Transparency                                 ...
47Relevancy• Relevant to issues/problems in the context  of interest• Context-dependent                                   ...
48Models of Healthcare     Systems
49Models of Healthcare Systems     Model            Financing         Provider              Example of                    ...
50 HealthcareProfessionals
51Healthcare Professionals• Physicians • Doctor of Medicine (M.D.)   • Allopathic medicine - views medical treatment as   ...
52Healthcare Professionals• Physicians • Generalists   • General practitioners (GP)   • Primary care physicians (PCP) • Sp...
53Healthcare Professionals• The following are often considered generalists working as primary care physicians (but they ty...
54Healthcare Professionals• Dental Professionals • Dentists • Dental hygienists • Dental assistants• Pharmacists          ...
55Healthcare Professionals• Nurses • Practical nurses (PN) • Registered nurses (RN) • Advanced practice nurses (APN)   • C...
56Healthcare Professionals• Allied Health Professionals • Physical therapists • Occupational therapists • Respiratory ther...
57Healthcare Professionals• Other health professions • Optometrists • Psychologists • Podiatrists • Chiropractors• Presenc...
58Other Roles & Professions• Alternative and traditional medicine practitioners• Health services administrators• Researche...
59Determinants of Health
60The Epidemiology Triangle             Host             Disease  Agent                 Environment                       ...
61Determinants of Health    Individual                                   Environment   - Genetics                         ...
62Major Issues in Health Care
63Major Issues in Health Care• Public Policy & Healthcare Reform • Universal Healthcare Coverage • Cost Containment • Qual...
64Major Issues in Health Care• Evidence-Based Practice• Increased Expectations & Patient Volumes• Prevention vs. Treatment...
Paradigm Shifts in Medicine• Physician-centric to patient-centric care• Individual to team-based care• Paper-based to elec...
66References• Centers for Disease Control and Prevention (CDC). Ten great public health achievements--United States, 1900–...
67References• Constitution of the World Health Organization. Geneva,  Switzerland: World Health Organization; 1948. Availa...
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Overview of Healthcare Services

  1. 1. Overview ofHealthcare ServicesTMHG 541: Fundamentals of Health Care and Medical Terminology January 8, 2013 Nawanan Theera-Ampornpunt, M.D., Ph.D. Health Informatics Division Faculty of Medicine Ramathibodi Hospital Mahidol University
  2. 2. 2 A Few Words About Me...2003 Doctor of Medicine (1st-Class Honors), Ramathibodi2009 M.S. (Health Informatics), University of Minnesota2011 Ph.D. (Health Informatics), University of MinnesotaCurrently • Deputy Chief, Health Informatics Division, RamathibodiContacts @Nawanan @ThaiHealthIT nawanan.the@mahidol.ac.th SlideShare.net/Nawanan www.tc.umn.edu/~theer002 groups.google.com/group/ThaiHealthIT
  3. 3. 3 TMHG 541Course Overview
  4. 4. 4Course Outline• Health Care Delivery • Overview of Healthcare Services • Operations in the Clinical Settings • Quality in Healthcare Organizations • Clinical Processes and Judgment • Case Studies• Medical Terminology • Basic Word Structure • Prefixes/Suffixes • Terminologies in Specific Areas
  5. 5. 5Aims• To introduce basic concepts of healthcare services and medical terminologies• To familiarize non-healthcare students to healthcare context for their further study in the curriculum
  6. 6. 6Grading• Class Attendance 10%• Class Participation 30%• Assignments 60%
  7. 7. 7Outline• Health• Health Systems & Healthcare Systems• Functions & Components• Characteristics of a Desirable Health System• Models of Healthcare Systems• Healthcare Professionals• Determinants of Health• Major Issues in Health Care
  8. 8. 8“Health”
  9. 9. 9Class Discussion:What Is Health?
  10. 10. 10Health• Health vs. Illness and Disease• Medical Model: Health = Absence of Illness or Disease• So what’s the problem with this model?
  11. 11. 11Problems with the Medical Model• Emphasis on treatment of illness/disease• Promotion and Prevention deemphasized• Not true sense of the word “Health” but rather just “Lack of ill health”• So what’s a better model of health? Shi & Singh (2004)
  12. 12. 12The WHO Model & Definition• “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” WHO Constitution (1948)• Also known as biopsychosocial model of health
  13. 13. 13Holistic Health• The well-being of every aspect of what makes a person whole and complete Physical Spiritual Holistic Mental Health Social Shi & Singh (2004)
  14. 14. 14 Health Systems &Healthcare Systems
  15. 15. 15Health Systems• A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health.• Includes efforts to influence determinants of health as well as more direct health- improving activities.• More than the pyramid of publicly owned facilities that deliver personal health services. WHO (2007)
  16. 16. 16Health Systems• Includes • A mother caring for a sick child at home • Private providers • Behavior change program • Vector-control campaigns • Health insurance organizations • Occupational health and safety legislation. • Inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health. WHO (2007)
  17. 17. 17Health Care• Health care: Activities and services performed to improve a person’s health and well-being, through prevention and treatment of illness.• Similar terms • Healthcare services • Healthcare delivery Adapted from Shi & Singh (2004)
  18. 18. 18Healthcare Systems• An organization that delivers healthcare• In general, healthcare systems • promote good health in populations • balance levels of actual care provided with the expectations of the population they serve• Narrower definition than WHO’s “Health Systems” Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  18 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  19. 19. 19Healthcare Systems• Different models of healthcare systems • Purely public (care conducted by the state) • Purely private (care conducted by independent, privately funded organizations) • Often a mixed model• In countries with state run healthcare system, a private system may coexist in parallel or offer services not available under the public system Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  19 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  20. 20. 20Healthcare Systems• Privately owned, commercial organizations may also act as healthcare systems• These organizations may serve a single area or multiple geographic locations• Private healthcare systems may be: • Not-for-profit organizations (governed by principle of non-distribution) or • For profit organizations (distribute surplus funds to shareholders or owners) Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  20 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  21. 21. 21Healthcare Systems• Healthcare systems can be measuredusing benchmarks• One framework for assessment: • Patient assessed value • Performance on clinical interventions • Efficiency Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  21 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  22. 22. 22Public Health“is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.“(Winslow, C.E.A. 1920) Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  22 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  23. 23. What is Public Health?• Private Health • Public Health • Clinicians, Health • Agencies Practitioners • Treat/Maintain Health of • Treat Individual Health Populations Problems • Actions include • Action usually taken after Education, Policy, illness/injury occurs Research, Monitoring Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  National Coordinator for Health Information Technology, U.S. Department of Health and Human  23 Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 7a).
  24. 24. 2410 Great Public Health Achievements –US, 1900-1999• Vaccination• Motor-vehicle safety• Safe workplaces• Control of infectious diseases• Decline in deaths from coronary heart disease and stroke• Safer and healthier foods• Healthier mothers and babies• Family planning• Fluoridation of drinking water• Recognition of tobacco use as a health hazard Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  24 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  25. 25. 25How Has Public Health ImprovedHealthcare?• Improvements in understanding disease • Epidemiology is considered the basic science of public health and is • a quantitative basic science • a method of causal reasoning based on developing and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality • a tool for public health action to promote and protect the public’s health Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  25 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  26. 26. 26How Has Public Health ImprovedHealthcare?• An example of epidemiology at work: • In 1854: epidemic of cholera in London, England • Cholera is a bacterial disease • Lack of sanitation and overcrowding led to the spread of disease • Dr. John Snow linked the spread of disease to a contaminated public water pump • Snow’s hypothesis: cholera was spread by contaminated water Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  26 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  27. 27. 27How Has Public Health ImprovedHealthcare?• Improvements in data collection • Original methods of data collection were crude • progressive improvement in methodology led to the use of sophisticated scientific methods to collect data • cohort studies • randomized controlled trials Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  27 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  28. 28. 28How Has Public Health ImprovedHealthcare?• Improvements in data analysis (use of tools such as multivariate analysis and meta-analysis)• Improvement in disease surveillance • Example: the Real-Time Outbreak and Disease Surveillance (RODS) Laboratory at the University of Pittsburgh, Department of Biomedical Informatics Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  28 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  29. 29. 29How Has Public Health ImprovedHealthcare?• Improvement in training • Establishment of many schools of public health in the early 20th century • Professional degrees such as Master of Public Health (M.P.H.)• Improvements in infrastructure • Federal • State • Local health departments Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  29 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).
  30. 30. 30Functions & Components of Health Systems
  31. 31. 31Functions of Healthcare Systems Governance, Policy & Healthcare Administration Financing Funding Funding Access Healthcare Health Service Insurance Delivery Claims & Reimbursements Healthcare Payment 31 Adapted from Shi & Singh (2004) by Theera‐Ampornpunt
  32. 32. 32Components of Health Systems 32 WHO (2009)
  33. 33. 33Key Stakeholders in Health Care (4Ps) Providers Payers & Public/ Policy- Purchasers Population Makers Patients 33 Adapted from Parchariyanon (2012) by Theera‐Ampornpunt
  34. 34. 34Healthcare Delivery• Healthcare is delivered in different places• Inpatient facilities • Hospitals • Institutions for treating sick or injured people • Historically places for shelter, almshouses • Different types of hospitals • General medical and surgical hospitals • Specialty hospitals (orthopedic, pediatrics, women’s services, psychiatric, neurological, infectious disease) Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  34 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  35. 35. 35Healthcare Delivery• Hospitals may be publicly or privately owned• Patients can be admitted to a hospital through • Emergency room • An internal outpatient clinic • Directly admitted from an external physician’s office• Depends on local practices Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  35 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  36. 36. 36Healthcare Delivery• Nursing and residential care facilities • Can be short term facilities or long term facilities • Long term care classified by level of care • Nursing homes gradually shifted from being part of the welfare system to being a part of the healthcare system Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  36 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  37. 37. 37Healthcare Delivery• Outpatient facilities• Hospitals in some countries provide ambulatory care through internal outpatient clinics• Physicians offices (also known as private clinics) • Primary care offices • Specialty care offices • Single specialty or multispecialty offices Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  37 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  38. 38. 38Healthcare Delivery • Dental offices • General dentists or specialists • Medical and diagnostic laboratories • Pharmacies • Internal pharmacies of hospitals • Private pharmacies • Community health centers • Other ambulatory health services Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  38 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  39. 39. U.S. Healthcare Industry Industry segment Employment EstablishmentsTotal 100.0 100.0Ambulatory healthcare services 42.6 87.3 Offices of physicians 17.0 36.0 Home healthcare services 7.2 3.7 Offices of dentists 6.2 20.4 Offices of other health practitioners 4.7 19.6 Outpatient care centers 4.0 3.6 Other ambulatory healthcare services 1.8 1.4 Medical and diagnostic laboratories 1.6 2.4Hospitals 34.6 1.3 General medical and surgical hospitals 32.5 1.0 Other specialty hospitals 1.4 0.2 Psychiatric and substance abuse hospitals 0.7 0.1Nursing and residential care facilities 22.8 11.4 Community care facilities for the elderly 5.2 3.5 Residential mental health facilities 4.1 4.0 Other residential care facilities 1.3 1.11.1 Table: Percent distribution of employment and establishments in health services by detailed industry sector, 2008. Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  39 National Coordinator for Health Information Technology, U.S. Department of Health and Human  Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).
  40. 40. 40 Characteristics of aDesirable Health System
  41. 41. 41WHO Framework 41 WHO (2009)
  42. 42. 42EQESAR Framework• E - Equity• Q - Quality• E - Efficiency• SA - Social Accountability• R - Relevance 42 Department of Community Medicine,  Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  43. 43. 43Equity• Equal services for equal needs• Unequal services for unequal needs• Accessibility • Physical • Psychological • Financial • Information 43 Leerapan B. Department of Community Medicine,  Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  44. 44. Quality• Safety• Timeliness• Effectiveness• Patient-centeredness Adapted from IOM (2001)
  45. 45. 45Efficiency• Cost-effectiveness• Output or outcome versus cost• Technical/operational efficiency• Allocative efficiency 45 Adapted from Leerapan B. Department of Community Medicine,  Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  46. 46. 46Social Accountability• Good governance• Adequate oversight and monitoring• Transparency 46 Adapted from Leerapan B. Department of Community Medicine,  Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  47. 47. 47Relevancy• Relevant to issues/problems in the context of interest• Context-dependent 47 Adapted from Leerapan B. Department of Community Medicine,  Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  48. 48. 48Models of Healthcare Systems
  49. 49. 49Models of Healthcare Systems Model Financing Provider Example of Ownership CountriesEmployer-based Multipayer, Private United States (market-based) voluntaryprivate insurance National health Single-payer Public/Private Canada insurance (general taxes) National health Single-pyaer Public United Kingdom system (general taxes)Socialized health Employer- Private Germany insurance employee, mandatory Hybrid Multiple models Public/Private Thailand 49 Adapted from Shi & Singh (2004)
  50. 50. 50 HealthcareProfessionals
  51. 51. 51Healthcare Professionals• Physicians • Doctor of Medicine (M.D.) • Allopathic medicine - views medical treatment as active intervention to produce a counteracting reaction in an attempt to neutralize effects of disease • Doctor of Osteopathic Medicine (D.O.) • Osteopathic medicine - emphasizes musculoskeletal system, stresses preventive medicine as factors that might influence natural resistance 51 Adapted from Shi & Singh (2004)
  52. 52. 52Healthcare Professionals• Physicians • Generalists • General practitioners (GP) • Primary care physicians (PCP) • Specialists • Certified in an area of medical specialization • Residency: graduate medical education in a specialty in the form of paid on-the-job training (trainees called residents) • Fellowship: subspecialty training after residency (trainees called fellows) 52 Adapted from Shi & Singh (2004)
  53. 53. 53Healthcare Professionals• The following are often considered generalists working as primary care physicians (but they typically underwent residency training after medical school, i.e. not just GPs) • Family medicine physicians • General internal medicine physicians (internists) • General pediatricians 53 Adapted from Shi & Singh (2004)
  54. 54. 54Healthcare Professionals• Dental Professionals • Dentists • Dental hygienists • Dental assistants• Pharmacists 54 Adapted from Shi & Singh (2004)
  55. 55. 55Healthcare Professionals• Nurses • Practical nurses (PN) • Registered nurses (RN) • Advanced practice nurses (APN) • Clinical nurse specialists (CNSs) • Certified registered nurse anesthetists (CRNAs) • Nurse practitioners (NPs) • Certified nurse midwives (CNMs)• Physician Assistants 55 Adapted from Shi & Singh (2004)
  56. 56. 56Healthcare Professionals• Allied Health Professionals • Physical therapists • Occupational therapists • Respiratory therapists • Medical records technicians • Medical technologists • Radiology technicians • Dietitians • Social workers • Speech therapists • Public health practitioners 56 • etc. Adapted from Shi & Singh (2004)
  57. 57. 57Healthcare Professionals• Other health professions • Optometrists • Psychologists • Podiatrists • Chiropractors• Presence, numbers and authorized practices vary by location 57 Adapted from Shi & Singh (2004)
  58. 58. 58Other Roles & Professions• Alternative and traditional medicine practitioners• Health services administrators• Researchers• Educators• Informaticians• Engineers• Other administrative staff 58 Adapted from Shi & Singh (2004)
  59. 59. 59Determinants of Health
  60. 60. 60The Epidemiology Triangle Host Disease Agent Environment 60
  61. 61. 61Determinants of Health Individual Environment - Genetics - Physical - Attitudes - Biological - Behaviors - Social, cultural, - Lifestyles Health economic, political, technological Healthcare Systems 61 Adapted from Leerapan B. Department of Community Medicine,  Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
  62. 62. 62Major Issues in Health Care
  63. 63. 63Major Issues in Health Care• Public Policy & Healthcare Reform • Universal Healthcare Coverage • Cost Containment • Quality & Patient Safety • Innovative Models of Healthcare Delivery & Financing 63
  64. 64. 64Major Issues in Health Care• Evidence-Based Practice• Increased Expectations & Patient Volumes• Prevention vs. Treatment• Rise of Aging Population & Chronic Diseases• Legal Issues (e.g. Malpractice)• Patient engagement• Workforce: Shortages, maldistributions & evolving competency requirements• Technological Advances 64
  65. 65. Paradigm Shifts in Medicine• Physician-centric to patient-centric care• Individual to team-based care• Paper-based to electronic-based management of medical records• Provider-kept to personal health records Adapted from materials developed by Oregon Health & Science University, funded by the Office of the  National Coordinator for Health Information Technology, U.S. Department of Health and Human  65 Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1c).
  66. 66. 66References• Centers for Disease Control and Prevention (CDC). Ten great public health achievements--United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999 Apr 2;48(12):241-3.• Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p.• McKee M. Measuring the efficiency of health systems. The world health report sets the agenda, but there’s still a long way to go. BMJ. 2001 Aug 11;323(7308):295-6.• Shi L, Singh DA. Delivering health care in America: a systems approach. 3rd ed. Sudbury (MA): Jones and Bartlett Publishers; 2004. 652 p.• Winslow CE. The untilled fields of public health. Science. 1920 Jan 9;51(1306):23-33.
  67. 67. 67References• Constitution of the World Health Organization. Geneva, Switzerland: World Health Organization; 1948. Available from: http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf• Everybody’s business. Strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, Switzerland: World Health Organization; 2007. Available from: http://www.who.int/healthsystems/strategy/everybodys_business.pdf• Systems thinking for health systems strengthening. Geneva, Switzerland: World Health Organization; 2009. Available from: http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf

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