Intro to Health Care Science

1. Intro to Health Care Science UNIT 1: Standard 3: The student will analyze healthcare delivery system models and the role of health professionals within each given model. image from: www.healthcarelegislation.org

2. ELEMENTS UNIT 1 • a. Explain systems theory. • b. Research the history of healthcare delivery systems development including evaluating the impact of enhanced technology and other factors that may affect various healthcare delivery systems. • c. Analyze current trends in delivery systems. • d. Define, compare and contrast services performed in healthcare delivery systems to ensure the deliveryofquality healthcare. • e. Construct a healthcare delivery system model with a simulated organizational chart diagramming the • interdependence of healthcare professions within the system. • f. Analyze the economic impact of healthcare delivery and calculation of health insurance plans to include deductibles, co‐pays, PPOs and HMOs.

3. Overview/Ice Breaker

4. What is a health care system?

5. Let’s start with the definition of “Health” • WHO (World Health Organization) definition of Health • Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. bibliographic citation: Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 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. The Definition has not been amended since 1948

6. Now add the definition of “Care” • responsibility for or attention to health, well-being, and safety • (According to Merriam Webster Medical Dictionary)

7. So what is a system? • 1. A group of interacting, interrelated, or interdependent elements forming a complex whole. • 2. A functionally related group of elements, especially: a. The human body regarded as a functional physiological unit. • b. An organism as a whole, especially with regard to its vital processes or functions. • c. A group of physiologically or anatomically complementary organs or parts: the nervous system; the skeletal system. • d. A group of interacting mechanical or electrical components. • e. A network of structures and channels, as for communication, travel, or distribution. (from the Free Dictionary)

8. Combining these definitions would give us the following: • A complex that is responsible for providing complete physical, mental and social well-being and not merely the absence of disease or infirmity • And yet, that is not an accurate description of Health Care Systems in the United States…..

9. Defining a health care system is more complex…… • health care system an organized plan of health services. The term usually is used to refer to the system or program by which health care is made available to the population and financed by government, private enterprise, or both. In a larger sense, the elements of a health care system embrace the following: (1) personal health care services for individuals and families, available at hospitals, clinics, neighborhood centers, and similar agencies, in physicians' offices, and in the clients' own homes; (2) the public health services needed to maintain a healthy environment, such as control of water and food supplies, regulation of drugs, and safety regulations intended to protect a given population; (3) teaching and research activities related to the prevention, detection, and treatment of disease; and (4) third party (health insurance) coverage of system services.

10. How has the health care system changed? • FYI this is the ELEMENT for this essential question: • Research the history of healthcare delivery systems development including evaluating the impact of enhanced technology and other factors that may affect various healthcare delivery systems

12. History of Health Care/Medicine http://www.nlm.nih.gov/hmd/

13. 4000 BC to 3000 BC: Early Beginnings • 4000 BC to 3000 BC – • Trepanation to treat insanity, seizures • Methods of giving care: herbs, plants (such as digitalis for the heart) “organic” foods • Exorcism: Tribal doctors and witch doctors would try to drive out the evil spirits that made people sick • Average life expectancy 20 years

14. Early Beginning Medicines • Medicines of early times still used today • Digitalis (foxglove plant) used to slow & strengthen heart • Quinine (bark of cinchona tree) used for fever, muscle spasms, malaria • Belladonna (nightshade plant) used to relieve smooth muscle spasms of GI tract • Morphine (opium poppy) used to relieve severe pain; is addicting

15. 3000 BC to 300 BC: Ancient Egyptians • Earliest people to keep health records • Called upon Gods to heal, used magic and plants • Believed body was a system of channels for air and directed treatment at clearing channels through leeches etc… • Physicians were priests who studied medicine in Temple medical schools • Average life expectancy 20 to 30 years

16. Medicine in Ancient Times • Early civilizations contributions to medicine • Egyptians kept accurate health records, used medicines, developed the art of splinting fractures, superstitious and called on gods of healing, trained physicians such as Greek Galen. • Chinese (1700 BC to 200 AD) monitored the pulse/blood pressure to determine condition of the body; believed in treating the whole body; used acupuncture. • Searched medical reasons for illness

17. 1200 to 200 BC: Greek • Greeks began medical science: observed body and effects of disease on the body. • found that lack of sanitation caused disease • Hippocrates 400 B.C “Father of medicine” developed method to observe human body. • Hippocratic Oath : standard of ethics for doctors – still taken by doctors today • Average life span 25 to 35 years

18. Chiron • In Greek mythology, the centaur, Chiron, was wounded by Hercules. Though he was immortal, it is said that he invented medicine in order to heal himself. He taught Asclepius the art of healing, which became the source of all divine medical knowledge among the Greeks. Chiron was also the teacher of the hero, Achilles, who was thought to have had some special medical knowledge.

19. CADUCEUS CONTROVERSY: • Many "medical" organizations use a symbol of a short rod entwined by two snakes and topped by a pair of wings, which is actually the caduceus or magic wand of the Greek god Hermes (Roman Mercury), messenger of the gods, inventor of (magical) incantations, conductor of the dead and protector of merchants and thieves. It is derived from the Greek karykeion = "herald's staff", itself based on the word "eruko" meaning restrain, control. • Who was Asclepius? Asclepius was most probably a skilled physician who practised in Greece around 1200BC (and described in Homer's Iliad). Eventually through myth and legend he came to be worshipped as Asclepius, the (Greek) god of Healing such as the NZMA, in fact most medical Associations around the world including the World Health Organization) use the "correct" and traditional symbol of medicine, the staff of Asclepius with a single serpent encircling a staff, classically a rough-hewn knotty tree limb. Asclepius (an ancient greek physician deified as the god of medicine) is traditionally depicted as a bearded man wearing a robe that leaves his chest uncovered and holding a staff with his sacred single serpent coiled around it, (example right) symbolizing renewal of youth as the serpent casts off its skin. The single serpent staff also appears on a Sumerian vase of c. 2000 B.C. representing the healing god Ningishita, the prototype of the Greek Asklepios

20. The caduceus was formally adopted by the Medical Department of the United States Army in 1902 • Changed to the staff of Asclepius although caduceus still used as insignia

23. 753 to 410 AD: ROMANS • Romans organized medical care and started hospitals especially for the military. They sent equipment and doctors to treat wounded soldiers. • Hospitals developed when doctors kept the sick in their homes. • Dissected animals to determine body function • Began public health and sanitation methods: Aqueducts for clean water, sewers to carry waste away from the cities, drained marshes to stop spread of MALARIA

24. ROMANS CONTINUED • Galen was born in Pergamos in Asia Minor in the year 131 C.E. After receiving medical training in Smyrna and Alexandria, he gained fame as a surgeon to the gladiators of Pergamos. He was eventually summoned to Rome to be the physician of the Emperor Marcus Aurelius. • Four fluids or “humors: blood, phlegm, black bile, yellow bile: imbalances of these caused disease • Galen spent the rest of his life at the Court writing an enormous corpus of medical works until his death in 201 C.E • Diet, exercise and medicine used to treat disease

25. Thermae: large imperial bath complexes

26. Europe: Dark Ages400 A D to 800 A D • Custodial care given in convents and monasteries by Christians • Emphasis on saving the soul and medicine prohibited • Not much interest in what caused disease • Average life span: 20 to 30 years

27. 800 to 1400 A.D.: Middle Ages • Renewed interest in information from Greeks and Romans • Universities for medical information • Terrible epidemics such as Black Death or bubonic plague killed 60 million people • Other epidemics: smallpox, diphtheria, tuberculosis, syphilis • Use of animal gut for suture material • Average life span: 20 to 35 years

28. Renaissance (1350-1650 A D) • Rebirth of science as medicine • Printing press invented • Books now published so universities and medical schools could do more research • Acceptance of dissection of the human body • Michelangelo and Leonardo da Vinci used dissection to draw more realistic pictures of the human body • ANDREAS VESALIUS – published first anatomy book • Average life span 30 to 40 years

29. Brain illustration from Vesalius text

30. 16th-17th Centuries Scientists • William Harvey- heart is a pump which pumps blood through out the body • Gabrielle Fallopius- identifies and names fallopian tubes and vagina and tympanic membrane • Bartolomeo Eustachio identified and named the tube leading from ear to the throat

31. 16th-17th (cont) • Anton van Leeuwenhoek invented the microscope • Apothecaries (early pharmacists) made, prescribed, and sold medications during this period • Average life span 35 to 45 years

32. 18th Century Scientists • Rene Laennec invented the first stethoscope (was wooden) • Joseph Priestly discovered the element oxygen • Benjamin Franklin invented bifocal glasses • Edward Jenner discovered a smallpox vaccine 1796 • Gabrielle Fahrenheit created first mercury thermometer • James Lind: lime juice for scruvy in 1795 • Average life span: 40 to 50 years

33. 19th Century • IgnazSemmelweiss found cause of puerperal (childbirth) fever and importance of handwashing (1840s) • Louis Pasteur discovered heating milk destroys bacteria; rabies vaccine (1885) • Joseph Lister started using antiseptics in surgery (1865) • Florence Nightingale: founder of modern nursing (1820 to 1910) • Clara Barton: American Red Cross

34. 19th Century cont • Robert Koch is “father of microbiology” developed culture plate to isolate bacteria causing TB & created vaccine • Wilhelm Roentgen discovered x-rays (1895) • Paul Ehrlich discovered a treatment for syphilis on his 606th experiment • Average life span: 40 to 60 years

35. 20th Century • Health insurance plans and social reforms started in 1920s • Alexander Fleming discovered penicillin (1928) • Jonas Salk developed a “dead polio” vaccine in 1952 • Albert Sabin developed an oral “live-virus polio” vaccine in 1950s • Walter Reed found that mosquitoes carried yellow fever in 1900. His vaccine helped the building of the Panama Canal

36. Women in Medicine • Florence Nightingale made nursing a respectable profession and started first nursing schools in 1860 • Clara Barton found the American Red Cross in 1881 • Lillian Wald started the public health nursing and visited homes to give care in New York City in 1893

37. Women in Medicine (cont) • Elizabeth Blackwell was first female physician in United States in 1849 • Dorothea Dix cared for wounded during the American Civil War, worked for humane treatment of mentally ill • Marie Curie isolated radium in 1910

38. Let’s look at each part of the Health Care System and then put them together • SEE HANDOUT Health Care Delivery Systems

39. Hospitals • provide longer-term inpatient stays and departments for emergency, intensive care, surgery, childbirth • Can have specialty hospitals

40. Long-term care facilities •  rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living

41. Medical offices • primary care/ general practitioners who provide outpatient treatment for acute and chronic illnesses and provides preventive care and health education for all ages and both sexes

42. Dental offices • evaluation, diagnosis, prevention, and surgical or non-surgical treatment of diseases, disorders and conditions of the oral cavity

43. Clinics • small private or public health facility that is devoted to the care of outpatients

44. Emergency care services • emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care

45. Laboratories • laboratory where tests are done on clinical specimens in order to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of disease

46. Home health care • health care or supportive care provided in the patient'shome by healthcare professionals

47. Hospice • care which focuses on the mitigation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature

48. Mental health • provide inpatient and outpatient services for psychiatric illnesses and behavioral health, and in some cases substance abuse rehabilitation

49. Rehabilitation • Rehabilitation is the process of assisting someone to improve and recover lost function after an event, illness or injury that has caused functional limitations.

50. Industrial health care centers • provide services to employers & their employees such as services involving drug screening, occupational injuries, job placement assessments, and preventative medicine