Brief history of health care delivery for Patients 2.0 session at Health 2.0, Santa Clara, CA, 9/2014

1. 
The Evolution of Healthcare
or How Did We Get Here?
Daniel Z. Sands, MD, MPH
Society for Participatory Medicine
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston, MA
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2.  Beliefs about health and disease
 Evolution of the physician
 Payment for health care services
 Access to information and
rise of consumerism
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Interlocking Themes
Photo © Copyright 2014 Michal Pikula

3. Illness as Punishment
Sermon on the Mount and Healing of the Leper, Rosselli 1482
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4. © Copyright 2014 D. Z. Sands, All Rights Reserved
Physician as High Priest
Imhotep, 27th Century BC, Egypt

5. © Copyright 2014 D. Z. Sands, All Rights Reserved
Physician as Professional
Hippocrates of Kos, 3rd Century BC, Greece

7. © Copyright 2014 D. Z. Sands, All Rights Reserved
Physician as Scientist
Paracelsus, 16th Century, Switzerland

8. Physician as Learned Professional
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“The good physician
treats the disease.
The great physician
treats the patient
that has the disease.”
Sir William Osler, 1849-1919

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10. © Copyright 2014 D. Z. Sands, All Rights Reserved
Health Care Payment

11.  Mid-20th C: Medicare and
employer-sponsored private
health insurance  costs rise
 Late 20th C: Managed care 
declining reimbursements &
shorter patient visits; rise of
concierge medicine
 Early 21st C:  patient
contribution; shift from FFS to
FFV
© Copyright 2014 D. Z. Sands, All Rights Reserved
Health Care Payment

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14. Medical Records
 Electronic health
records 1980s-present
 HIPAA 1996; patient
access to records
 Patient portals ~2000
 New documentation
requirements
 New audiences
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15. © Copyright 2014 D. Z. Sands, All Rights Reserved

16. Access to Health Information
 Whole Earth Catalog 1968
 Our Bodies, Ourselves 1971
 Medical Self Care 1975
 Medical textbooks at general bookstores 1970s
 Health websites ~1996
 PubMed free to public 1997
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17. Online Population Rising
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18. Online Health Habits of US Adults
Sources: www.pewinternet.org;
PwC HRI Social Media Consumer
Survey, 2012
 80% of online adults have looked for health info
 Each day, more people search for health information than see a
physician!
 More than half act on the information
 1/3 have read about others’ health experiences
 1/4 have tracked their health information online
 1/3 use social media for health
© Copyright 2014 D. Z. Sands, All Rights Reserved - @DrDannySands

19. http://participatorymedicine.org
Participatory Medicine is a cooperative model of health care
that encourages and expects active involvement by all connected
parties … as integral to the full continuum of care.
Society for Participatory Medicine
Community Advocacy Research Education
© Copyright 2014 D. Z. Sands, All Rights Reserved

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21. Health Care Today
Forward-thinking practices
establishing patient-family
advisory boards
Patient increasingly able to
view records and e-message
providers, but
resistance remains
(despite MU2)
Patients pushing for more
transparency of
information and charges
Heterogeneity of
payments models, with
value-based payment
models not yet changing
most medical practice
Declining reimbursements
and increasing
bureaucracy 
frustrated physicians
opting out
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24. Questions?
© Copyright 2014 D. Z. Sands, All Rights Reserved
Danny@DrDannySands.com
http://www.DrDannySands.com
@DrDannySands