Introduction to Healthcare and Public Health in the US

1. Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c This material (Comp1_Unit1c) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Introduction and History of Modern Healthcare in the USLearning Objectives • Delineate key definitions in the healthcare domain (Lectures a, b, c, d) • Explore components of healthcare delivery and healthcare systems(Lecture a) • Define public health and review examples of improvements in public health (Lecture b) • Discuss core values and paradigm shifts in US healthcare (Lecture c) • Describe in overview terms, the technology used in the delivery and administration of healthcare (Lecture d) Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

3. Core Values in US Healthcare • Patient centricity and individual choice • Interdisciplinary care • Technology and innovation drive healthcare • Cost of healthcare • Options for financing healthcare • Taxation or general revenue • Social health insurance • Voluntary or private health insurance • Out-of-pocket payments • Internal donations • Healthcare expenditure • $253 billion in 1980 • $714 billion in 1990 • $2.3 trillion in 2008 (16.2% of GDP, $7681 per resident) • Need for cost containment! Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

4. Paradigm Shifts in Medicine:Physician-Centric to Patient-Centric Care • The old model: patient care options were determined by the provider -- patients were offered few opportunities to make decisions • The new model: cultural shift towards giving patients greater responsibility in their care • Shift from paternalism to patient autonomy Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

5. Paradigm Shifts in Medicine:Physician-Centric to Patient-Centric Care (continued) • Patient Self-Determination Act,1990 • Requires healthcare organizations to give adult individuals certain information about their rights including • the right to participate in and direct their own healthcare decisions • the right to accept or refuse medical or surgical treatment • the right to prepare an advance directive • information on the provider’s policies that govern the utilization of these rights • Providers, organizations and healthcare systems have become more responsive to patient needs Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

6. Paradigm Shifts in Medicine:Individual to Team-Based Care • Historically, patient care was provided by an individual clinician • With the increasing complexity of healthcare and patients, there has been an evolution towards collaboration between clinicians • An interdisciplinary team is a “…group of individuals with diverse training and backgrounds who work together as an identified unit or system” • Examples: intensive care units, hospice care, primary care outpatient settings Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

7. Paradigm Shifts in Medicine:Individual to Team-Based Care (continued) • The Patient Centered Medical Home - term introduced by the American Academy of Pediatrics in 1967, now endorsed by numerous organization including the AAFP, ACP, and the AOA • Hallmarks of the patient centered medical home include: • Personal physician • Physician directed medical care • Care is coordinated • Emphasis on quality and safety • Enhanced access to care Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

8. Paradigm Shifts in Medicine:Physician-Kept Records to Personal Health Records • The first medical records were maintained by physicians as notes • First individual patient medical records - 1907, at the Mayo Clinic in Rochester, Minnesota • Advances in technology have led to the electronic medical record, but these are still usually created, maintained and updated by the provider or the system • Current trend is towards the personal health record, which is created and maintained by the patient Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

9. Paradigm Shifts in Medicine: Dominance of Technology in Healthcare Delivery • Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between healthcare consumers and providers • HIT can: • improve healthcare quality and prevent medical errors • increase the efficiency of care provision • reduce unnecessary healthcare costs • increase administrative efficiencies and decrease paperwork • expand access to affordable care • improve population health Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

10. Paradigm shifts in medicine: Use of the ED for primary care • Emergency Department, ED, visits have increased from 90.3 million visits in 1996 to 119 million in 2006 • This may be related to a shortage of primary care physicians • Patients with Medicaid are more likely to visit ED than patients with private insurance Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

11. Introduction and History of Modern Healthcare in the US Summary – Lecture c • The core values in US Healthcare • Paradigm shifts in Medicine • Physician-centric to patient-centric care • Individual to team-based care • Physician-kept to personal health records • Paper-based to electronic-based management of medical records • Primary care to emergency department use Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c

12. Introduction and History of Modern Healthcare in the US References – Lecture c References Arvantes, J. (2008). Emergency Room Visits Climb Amid Primary Care Shortages, Study Results Show. Retrieved December 6, 2011, from American Academy of Family Physicians website: http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20080827er-visits.html. The electronic medical record at Mayo Clinic . (2011). Retrieved December 6, 2011, from Mayo Clinic website: http://www.mayoclinic.org/emr/. Health Policy Explained: US Health Care Costs – Background Brief. (2010, March). Retrieved December 6, 2011, from Kaiser EDU website: http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx. JAMA Special Communication – Uninsured Adults Presenting to US Emergency Departments. Assumptions vs. Data. (2008). Journal of the American Medical Association, 300(16), 1914-1924. Retrieved from http://jama.ama-assn.org/content/300/16/1914.abstract. Joint Principles of the Patient Centered Medical Home. (2007). Retrieved December 6, 2011, from Patient-centered Primary Care Collaborative - American Academy of Family Physicians (AAFP); American Academy of Pediatrics (AAP); American College of Physicians (ACP); American Osteopathic Association (AOA) website: http://www.pcpcc.net/node/14. Overview of Healthcare Financing, from Regional Overview of Social Health Insurance in South East Asia. (2004). Retrieved December 6, 2011, from World Health Organization SEARO website: http://www.searo.who.int/LinkFiles/Social_Health_Insurance_HSD-274.pdf. Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture c