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Defining Health and its Role in Determining Health System Goals and Activities

Defining Health and its Role in Determining Health System Goals and Activities. PA 574: Health Systems Organization Session 2 – April 10, 2013. Institute of Medicine Six Aims/Ten Rules. Six Aims Safe Effective P atient-centered Timely Efficient E quitable

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Defining Health and its Role in Determining Health System Goals and Activities

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  1. Defining Health and its Role in Determining Health System Goals and Activities PA 574: Health Systems Organization Session 2 – April 10, 2013

  2. Institute of Medicine Six Aims/Ten Rules • Six Aims • Safe • Effective • Patient-centered • Timely • Efficient • Equitable • Ten Rules for System Redesign…

  3. Institute of Medicine Ten Rules for System Redesign • Care is based on continuous healing relationships; • Care is customized according to patient needs/values; • The patient is the source of control; • Knowledge is shared and information flows freely; • Decision making is evidence-based; • Safety is a system property; • Transparency is necessary; • Needs are anticipated; • Waste is continuously decreased; and, • Cooperation among clinicians is a priority.

  4. Levels of the Health Care System (Berwick, 2002) • Level 1: Patient and Community • Experience of patients • Level 2: Microsystem • Functioning of small units of care delivery • Level 3: Organization • Functioning of organizations that house microsystems • Level 4: Environment • Policy, payment, regulation, accreditation • Shapes behavior, interests and opportunities of Level 3 organizations

  5. Defining Health • Medical Model Health defined by lack of presence of illness or disease (health defined by non-health) • Illness defined by person – Disease by medical professional • Sociological (Parsons) – Health is state of optimum capacity to fulfill social roles • Defined disease/illness not needed • But can be “ill” and still perform(?)

  6. Defining Health Society for Academic Emergency Medicine – Health is a state of physical &mental Well-being that facilitates the achievement of individual and social goals. WHO – Health is a complete sate of physical, mental &social well-being, and not merely the absence of disease and infirmity.

  7. Defining Health • Holistic Health – encompasses physical, mental, social and spiritual aspects of well-being. • Two “indirect” views: • Acute, subacute & chronic conditions • Primary, secondary & tertiary prevention? • Last but not least..Public health – • “societies interest in assuring conditions in which people can be healthy”. • Population health

  8. Defining Health • ..And the Community Health Model: • Add care, prevention, health promotion & health education to attain holistic health • So what makes the most sense…Are these all “functional” definitions: • Are they feasible/doable? • Do they delineate reasonable boundaries for a health system? • How do we decide????

  9. Health Determinants & Justice • Health Determinants: • Lifestyle (personal?) • Environmental (social?) • Heredity • Care • Justice • Market – health/health care is individual good • Social – health/health care is social good

  10. Defining Health System Goals • How do/should these combine to determine health system goals: • Definition of health • Health determinants • Health/Healthcare as a individual or social good

  11. Historical Forces of Transformation Brainstorm: What has transformed health services delivery over past few decades?

  12. Transformation • Professional sovereignty • Urbanization • Science and technology • Growth of institutions • Dependency • Cohesion among medical professionals • Licensing and regulation • Health professions education

  13. Transformation Growth in public health Consumer advocacy Increase in chronic conditions and longevity Services to special interest groups (veterans, disease, racial/ethnic) New forms of coverage

  14. Evolution and Transformation of the Health Care Delivery System Shi & Singh: Figure 3.1; p. 113 Science & Technology Mid 18th to late 19th Late 19th to late 20th Late 20th to 21st Consumer Professional Corporate Sovereignty Dominance Dominance Beliefs and Values Social, Economic & Political Constraints

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