Introduction to Health Care and Public Health in the U.S.

1. Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S. Lecture a This material (Comp 1 Unit 1) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Introduction to and History of Modern Health Care in the U.S.Learning Objectives - 1 • Define key terms in health care and public health (Lectures a, b, c, d) • Describe components of health care delivery and health care systems (Lecture a) • Discuss examples of improvements in public health (Lecture b)

3. Introduction to and History of Modern Health Care in the U.S.Learning Objectives - 2 • Define core values and paradigm shifts in U.S. health care (Lecture c) • Describe the technology used in the delivery and administration of health care (Lecture d)

4. Some Definitions: Health • Often thought of as the absence of disease • World Health Organization (WHO) • “…state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” • “Illness” is a state of poor health

5. Health Care • The prevention and treatment of illness • Delivered by people from varied disciplines • Medicine • Dentistry • Nursing • Laboratory Science • Pharmacy • Other allied health professions • Work together as interdisciplinary teams to deliver care

6. Health Care Delivery • Delivered in different places • Inpatient facilities • Hospitals • Institutions for treating sick or injured people • Historically places for shelter, almshouses • Hospital Survey and Construction Act (also known as the Hill-Burton Act) passed in 1946 • Nursing and residential care • Outpatient facilities

7. Health Care Delivery - Hospitals • Types of hospitals: • General medical and surgical • Specialty (orthopedic, pediatrics, women’s services) • Psychiatric • Publicly or privately owned • Patients can be admitted: • Via emergency department • Directly from physician’s office

8. Health Care Delivery – Nursing and Residential Care Facilities - 1 • Short-term or long-term facilities • Long-term care classified by level of care • Skilled nursing facilities (nursing homes) • Proliferated after amendment of the Social Security Act • Originally part of the welfare system • Now part of the health care system

9. Health Care Delivery – Nursing and Residential Care Facilities - 2 • 1969 - Medicare drastically reduced coverage for nursing homes • 1970 - Miller Amendment established a new standard, “intermediate care” • 1990s - “Sub-acute care” Provided care for patients discharged from hospitals who briefly need a higher level of care “than is provided to the majority of patients in a skilled nursing facility.”

10. Health Care Delivery – Outpatient Facilities – 1 • Physicians offices • Primary care • Specialty care • Single specialty or multispecialty • Dental offices • General dentists • Specialists • Orthodontists • Endodontist • Oral Surgeons

11. Health Care Delivery – Outpatient Facilities – 2 • Medical and diagnostic laboratories • X-rays • CT Scans and MRIs • Biologic Specimens • Other ambulatory health services • Ambulance services • Home health care • Hospice • Visiting Nurse Services

12. The Health Care Industry • One of the largest industries in the U.S. and rapidly growing in employment • 2014 - 18.0 million jobs for wage and salary workers • Estimated to grow to 21.9 million jobs by 2024 • Top four fastest growing job categories • Home health care services • Outpatient care centers • Offices of other health practitioners • Other ambulatory health care services

13. Overviews of Health Care Systems • Askin (2014) • Started by two medical students who are now physicians • Overview of U.S. health care system, now in second edition, https://healthcarehandbook.wustl.edu • Reid (2010) • Comparative overview of different models of health care around world assessed by Washington Post journalist

14. Reid’s Four Systems and Their U.S. Analogs (2010) Reid, 2010

15. Some Definitions of Care • Primary care: Initial and ongoing care, typically provided in an office or clinic • Secondary care: Specialty care provided in the community • Tertiary care: Highly specialized care usually provided by referral in a large, typically academic, medical center

16. Health Care System Stakeholders (the “p”s) • Patient: The one who gets health care, often called a consumer or citizen when they are well • Provider: Those who provide health care, e.g., physicians, nurses, allied health • Purchaser: Those who buy health care, usually employers or the government • Payor: Those who pay the health care system, i.e., the insurance companies and government • Public health: Protectors of the public’s health

17. How Health Care is Financed - 1 • No matter who pays the cost (patient, employer, or government), most health care is financed on the notion of insurance • Everyone pays some, those who need it use it • Although modern system may be better described as “pre-paid” health care than insurance

18. How Health Care is Financed - 2 • Payment methods • Private fee-for-service • Private managed care, a.k.a., HMOs • Government-financed, a.k.a., single-payor • Government-provided

19. Insurance – Some Use More Than Others http://www.nihcm.org/concentration-of-health-care-spending-chart-story http://www.nihcm.org/concentration-of-health-care-spending-chart-story

20. Brief History of Health Care Finance - 1 • Mid-20th century • Introduction of health insurance • Growth of “open-ended” spending • Late 20th century • Efforts to control costs, culminating in managed care • Empowerment of patients/consumers and growth of Internet

21. Brief History of Health Care Finance - 2 • 21st century • Costs continued to rise well above inflation but have leveled off in recent years • Still, are we on a collision course with increasing costs, aging baby boomers, more costly technology, etc.?

22. Major Health Care Payors in U.S. - 1 • Private health insurance: For most employed citizens and their dependents, except those in lower-paying jobs • Medicare: Government insurance for elderly and disabled • Medicaid: Government insurance for indigent

23. Major Health Care Payors in U.S. - 2 • State Children’s Health Insurance Program (S-CHIP): Government insurance for uninsured low-income children • Other expenses due to out-of-pocket, public health, and other expenditures

24. Organization of the Health Care Industry 1.1 Table: Percent distribution of employment and establishments in health services by detailed industry sector, 2008.

25. Introduction to and History of Modern Health Care in the U.S. Summary – Lecture a • Important definitions • Health • Health care • Health care systems • Different types of health care delivery • Inpatient • Outpatient • Different models that range from private to public funding – most are combination

26. Introduction to and History of Modern Health Care in the U.S. References – 1 – Lecture a References Askin, E and Moore, N (2014). The Health Care Handbook - A Clear and Concise Guide to the United States Health Care System, Second Edition. St. Louis, MO, Washington University in St. Louis. Definition of Healthcare. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. A. (n.d.). Health Care Careers Directory 2012-2013. American Medical Association. ISBN#: 978-1-60359-770-8. Health Care and Social Assistance: NAICS 62, US Bureau of Labor Statistics, http://www.bls.gov/iag/tgs/iag62.htm.

27. Introduction to and History of Modern Health Care in the U.S. References – 2 – Lecture a References Henderson, R (2015). Industry employment and output projections to 2024. Monthly Labor Review, , Retrieved January 17, 2017, http://www.bls.gov/opub/mlr/2015/article/industry-employment-and-output-projections-to-2024.htm Reid, TR (2010). The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York, NY, Penguin Books. World Health Report 2000 - Health systems: improving performance. (2000). Retrieved January 20, 2017, from WHO website: http://www.who.int/whr/2000/en/. Charts, Tables, Figures 1.1 Table: BLS Quarterly Census of Employment and Wages, 2008. (2008). Retrieved January 20, 2017, from US Bureau of Labor Statistics website: http://www.bls.gov/cew/.

28. Introduction to Health Care and Public Health in the U.S. Introduction to and History of Modern Health Care in the U.S.Lecture a This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001.