MIT S1 Handbook

Cultural and Social Factors that Influence the US Health Care System

• Deep belief in individual’s responsibility and in having control

• Distrust of government

• Belief in “free enterprise”: competition and marker forces

• Love of technology

• Power and influence of private interest groups

• Professionalism

• Ability to tolerate inequity/disparity

Where is health care provided?

• Hospitals

• Physician Offices

• Health Centers

• Nursing Homes

• Pharmacies

• Specialty Clinics (visions, hearing, physical therapy)

• Rehabilitation settings (alcohol & drug, physical)

• Mental Health Clinics

• Family Planning Clinics

• Free Care Clinics

• Emergency Medical Care — ambulances

• School Health Clinic

• The patient’s home — Home Health Care, Hospice, VNA

Who provides health care?

• Physicians (e.g. internists, radiologists, pulmonologists, obstetricians, pediatricians)

• Registered nurses, license practical nurses, nurse practitioners, nurse midwives

• Psychologists, counselors, therapists

• Medical assistants, rehabilitation aides, certified nursing assistants, home health aides

• Phlebotomists, lab technicians, emergency medical technicians, paramedics

• Pharmacists, pharmacy technicians

• Dentists, dental technicians

• Dieticians, nutritionists

• Social workers, case managers, care coordinators

• Respiratory therapists, physical therapists, speech therapists, occupational therapists

• Receptionists, billing clerks, unit clerks

• Public health nurses, community health workers, patient navigators

• Health educators and outreach workers

• and Medical Interpreters

Who pays for health care?

• Medicare

• Medicaid

• Private insurance

• Managed care

Medicare

Federal health insurance for elderly (65+) or disabled, regardless of income

Medicaid

Joint federal-state program for low income individuals and eligibility and the services covered vary from state to state

Private insurance

About 60% of Americans get health insurance through employment

Managed Care

Single organizations takes responsibility for financing, insurance, delivery, and payment

No insurance

• About 44 million people in this country have no health insurance, and another 38 million have inadequate health insurance.

Leading Determinants of Health

• Behavior and lifestyle/life conditions (50%)

• Environment (20%)

• Heredity/Genetic makeup (20%)

• Medical care (10%)

• US ranks 27th in life expectancy

Disparities

• Exist relative to most preventive services, lung surgery, cardiac catheterization, angioplasty, coronary artery bypass graft, pain management, orthopedic procedures, renal and bone marrow transplants, and on and on…

• In rates of cancer, stroke, heart disease, diabetes, HIV, mental illness

Healthy People 2020

• Vision: A society in which all people live long, healthy lives

• Mission: Health people 2020 strives to:

  • identify nationwide health improvement priorities

  • Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.

  • blah blah look at the handbook

Massachusetts Emergency Room Interpreter Bill

All hospitals which provide acute care in emergency rooms or in acute psychiatric services, must use competent interpreter services when treating non-English speaking patients.

The Department of Public Health monitors to ensure that the mandate is followed.

Sample Policies for Interpreter Service

• Hospital personnel will take appropriate action to ensure that a patient’s inability to communicate in English does not interfere with that person’s medical care

• Family members or friends of non-English speaker or a person with limited English proficiency (LEP) will not serve as interpreters unless the non-English speaker or LEP person expressly requests such an arrangement. In this case, the non-English speaker or LEP patient must document in writing (complete with his or her signature) that this is his or her wish. Interpreters must remain present during the interpretation of legal documents or informed consents.

LEP

Limited English Proficiency

Benefits of Medical Interpreter Service

• Enhanced communication provider/patient (LEP = limited English Proficiency)

• Reduced misdiagnosis

• Increased provider/patient satisfaction

• Better access to and utilization of services

• Improved health outcomes

• Reduced legal risks

• Bottom line: reduced costs

Interpreter vs. Translator

Interpreter: renders information from source language into the target language in a spoken format.

Translator: renders information from the source language into the target language, usually from one written document into another written document.

Common Misconception of Interpretation

*Anyone with any level of bilingualism is capable of providing interpretation

Role of the Interpreter

The basic purpose of the interpreter is to facilitate understanding in communication between people who are speaking different languages

Functions of the Medical Interpreter (4 key functions)

• Conduit

• Clarifier

• Culture Broker

• Advocate