PAS 3301 - Health Policy Overview & Health Profession

Health Policy Overview: Public and Private

• One major change in the 20th century was that the government became much more involved in regulating health care

• 1. Pure Food and Drug Act - 1906

  • Created to protect consumers from unsafe or falsely labeled products

  • Tried to prevent the manufacture, sale, or transportation of:

    • Adulterated products → contaminated/impure

    • Misbranded products → incorrectly or falsely labeled

    • Poisonous or harmful foods, drugs, medicines, and liquors

• 2. Food, Drug, and Cosmetic Act (FDCA) - 1938

  • Passed in response to the Elixir Sulfanilamide disaster

    • A liquid medication contained diethylene glycol, a toxic solvent

    • It caused more than 100 deaths from posioning

  • After the FDCA:

    • A new drug could not simply be marketed immediately

    • The FDA had to be notified and given time to review the drug’s safety

  • It gave the FDA authority to oversee the safety of foods, drugs, and cosmetics

Health Policy Overview: Government Funding

• Another way the government became more involved in health care was through funding

• 1. Hill-Burton Act - 1946

  • Also called the Hospital Survey and Construction Act

    • Gave federal grants (money) to states to build new community hospitals and hospital beds

    • This increased the number of available hosptial beds:

      • 1946: 3.2 beds per 1,000 people

      • 1980: 4.5 beds per 1,000 people

    • Helped promote the growth of nonprofit community hospitals

• 2. Social Security Act - 1965

  • Created:

    • Medicare

    • Medicaid

Health Policy Overview: Prepaid Health Services

• The second major hallmark of the 20th century was growth of prepaid health services, also called the “Third-Party Payment System”

• Instead of patients paying the entire medical bill themselves, an insurance company helps pay

  • 1939 - Blue Cross

    • Approved by the American Hospital Association

    • Helped cover hospital costs

    • Patients could receive coverage at the hospital they choose

  • 1939 - Blue Shield

    • Approved by the California Medical Association

    • Helped cover physicians’ (doctors’) fees

Health Policy Overview: Medicare & Medicaid - 1965

• In 1965, Medicare and Medicaid were established

• Medicare originally had 2 parts:

  • Part A = mainly hospital/inpatient care

    • Inpatient hospital stays

    • Skilled Nursing Facility (SNF) care

    • Hospice care

    • Some home health care

  • Part B = mainly doctor/outpatient care

    • Physician services

    • Outpatient services

    • Preventive services

• Medicare Expanded in 1972

  • Originally, Medicare mainly covered people 65 years and older

  • In 1972, coverage was extended to certain:

    • Disabled individuals entitled to Social Security benefits

    • People with End-Stage Renal Disease (ESRD)

      • Permanent kidney failure requiring dialysis or a kidney transplant

Health Policy Overview: Medicare Part D & Medicaid

• Medicare Part D = Prescription Drugs

  • Part D covers prescription medications

  • It was added to Medicare under the Medicare Prescription Drug, Improvement and Modernization Act (MMA) of 2003

  • It officially took effect January 1st, 2006

  • Available to people who have Medicare Part A or Part B

• Medicaid

  • Medicaid helps finance health care for indigent people → people who lack the financial resources to pay for care

  • It is a joint federal-state program

    • Federal government contributes money

    • State governments contribute money

Health Policy Overview: HMO Act of 1973

• The HMO Act of 1973 was passed during the Nixon Administration because health care costs were rising quickly

  • Main goal: slow the increase in health care spending

  • The government provided federal money to help create and expand HMOs

  • HMOs used prepaid medical care as an alternative to traditional Fee-for-Service (FFS)
    
    

• Why HMO instead of FFS?

  • FFS (Fee-for-Service)

    • Providers are paid for each service they perform

    • More tests/services → more money for the provider

    • This was believed to contribute to higher health care spending

  • HMO

    • Providers generally receive a fixed/prepaid amount per patient

    • Doing extra unnecessary tests/procedures doesn’t automatically increase their income

    • This was intended to reduce unnecessary services, control costs, and increase competition

• Other Facts

  • Employers with more than 25 employees were required to offer an HMO option in their health plan

    • Goal by 1976: 1,700 HMOs with 40 million members

    • Reality: only 174 HMOs with 6 million members

Health Maintenance Organization (HMOs)

• By the 1980s:

  • Most Americans got health coverage through the private health care system

  • They usually had private health insurance

  • This insurance was commonly obtained through health plans offered by their employers

Health and Sickness Patterns in Historical Perspective

• From the beginning to the end of the 20th century (1900s):

  • 1. Leading causes of death changed

    • Before: Acute diseases → illnesses that develop quickly and are often short-term

      • Influenza (flu)

      • Pneumonia

      • Tuberculosis (TB)

    • Later: Chronic diseases → illnesses that last a long time

      • Heart disease

      • Cancer

  • 2. Life expectancy increased

    • People lived almost 60% longer on average

  • 3. Three reasons people lived longer

    • Improved standard of living: Better hygiene, nutrition/diet, and housing

    • Advances in public health: Better sanitation, vaccination programs, and disease prevention

    • Progress in medical practice: Better medications, treatments, and medical technology

What Is a Profession?

• Not all health care jobs are considered professions

• Professions exist to serve society → help people and meet their needs

• However, just helping people doesn’t automatically make a job a profession

5 Characteristics of a Profession

• A profession generally has 5 main characteristics:

  • 1. Systematic Theory and Body of Knowledge

    • Requires specialized education, knowledge, and training

  • 2. Professional Authority and Special Privileges

    • Professionals have expertise and certain responsibilities that others don’t

  • 3. Community Sanction and Social Utility

    • Community sanction: Society officially recognizes and accepts the profession

    • Social utility: The profession benefits society

  • 4. Ethical Codes and Internal Control

    • Professionals must follow ethical rules and standards

    • The profession helps regulate its members’ behavior

  • 5. Professional Culture and Organizations

    • Professionals share values, traditions, and goals

    • They have organizations that support their profession

Characteristics of a Profession (Cont.)

1. Systematic Theory and Body of Knowledge

• A profession required specialized knowledge, education, and skills that the general public usually doesn’t have

• What makes professionals different from the public?

  • Didactic education: Formal classroom learning at professional schools

  • Continuing education: Ongoing learning to maintain and update their knowledge and skills

• Members of profession are expected to:

  • Have extensive theoretical knowledge → deeply understand their field

  • Apply that knowledge and their skills when helping society

Characteristics of a Profession (Cont.)

2. Professional Authority and Special Privileges

• Professionals have specialized knowledge and authority to provide services in their field

  • Professional authority: The ability to practice in their area of expertise

• Clients surrender some autonomy: Patients allow professionals to make certain decisions or recommendations because they trust their expertise

  • Autonomy = ability to make your own decisions

  • Patients recognize that professionals have knowledge and skills they don’t have

  • Patients trust professionals to recommend the best course of action for their needs

Characteristics of a Profession (Cont.)

3. Community Sanction and Social Utility

• Social Utility = Helping Society

  • Professions provide important services that society needs

• Community Sanction = Society Gives Premission

  • Society officially recognizes and allows professionals to practice

  • This happens through:

    • Licensure: Professionals must obtain a license to legally practice

    • Protected professional titles: Only qualified individuals can use certain titles

Characteristics of a Profession (Cont.)

4. Ethical Codes and Internal Control

• Professionals are accountable

  • Professionals must follow the law and the rules of their profession

  • They are responsible for their actions

• Internal Control

  • A professional creates its own rules and standards to ensure members behave properly

  • These include:

    • Formal controls: Written rules, such as codes of ethics

    • Informal controls: Expectations of professional behvior

• Standards Beyond the Law

  • Professionals must follow higher standards than just what the law requires

  • Something may be legal but still be unethical

• Emotional Neutrality

  • Professionals should not let personal emotions or feelings affect their decisions

  • They must treat patients fairly and professionally

Characteristics of a Profession (Cont.)

• Professional Culture = The shared values, norms, and symbols of a profession

• 1. Values = The central beliefs of a profession

  • Professionals believer that:

    • Their profession has unique knowledge and expertise that benefits society

    • Their services cannot be better provided by another occupation

    • Their services are essential to society

      • Society would suffer if those services were no longer avaliable

• 2. Norms = Expected Behaviors

  • The accepted ways of behaving within a profession

  • How professions are expected to act

• 3. Symbols = Things that identify or represent a profession

  • Insignia → professional emblems or badges

  • Vocabulary → special terminology used in the profession

  • Dress → professional clothing

Individualized, Unstandardized Service Directly to Clients

• Main Idea: Healthcare professionals follow standard procedures, but care must be adjusted to each patient

• 1. Standardization in Healthcare

  • Healthcare professions have tried to standardize services to improve quality

  • Standardization = using the same procedures or guidelines

  • Help reduce or eliminate errors

• 2. Why Can’t Healthcare Be Fully Standardized?

  • Every patient is different

  • Patients have different:

    • Signs → what healthcare professions can observe or measure

    • Symptoms → what patients feel or experience

    • Personal characteristics → age, medical history, lifestyle, etc.

  • Healthcare professionals must use procedures while keeping the patient’s best interest in mind

• 3. Individualized Care

  • Healthcare professions must:

    • Understand each patient’s needs and preferences

    • Be flexible and adjust care when those needs or preferences change

Continuity & Change in Health Institution & Professions

• In 1910, Medical Education in the U.S. and Canada was published

  • Also called the Flexner Report

  • Its goal was to reform and improve medical education

• What Changed?

  • 1. Higher Standards

    • Higher accreditation standards → medical schools had to meet stricter requirements

    • Higher admission standards → students needed better qualifications to enter medical school

  • 2. Fewer Medical Schools and Students

    • 1904: 160 schools → over 28,000 students

    • 1920: 86 schools → over 14,000 students

    • 1935: only 66 schools

  • 3. Standardized Medical Education

    • Medical schools adopted the 4-year curriculum

    • Replaced the apprenticeship model with structured, science-based education

  • 4. Recognition of Physicians

    • Only allopathic physicians were legally recognized

Continuity & Change in Health Institution & Professions (Cont.)

• 1950s - “Golden Age” of Medicine

  • A period of major medical advancements:

    • Surgical techniques → safer and better surgeries

    • Immunizations → vaccines to prevent diseases

    • Drug discovery → development of new medications

    • Control of infectious diseases → better prevention and treatment of infections

• 1970s - 1990s - Social Inequities & Patient Care

  • Greater emphasis on social inequities → unfair differences in access to health care

  • New concerns about:

    • Physician autonomy → doctors’ freedom to make medical decisions without excessive interference from insurance companies

    • Quality of patient care → whether patients were receiving appropriate, effective treatment in managed care systems

• 21st Century - Team-Based & Patient-Centered Care

  • Greater focus on an interdisciplinary approach

    • Different health care professionals work together to treat patients

  • Exploration of patient-centered care models

    • Treatment focuses on the patient’s individual needs, preferences, and values

    • Patients participate in decisions about their care

Continuity & Change in Health Institution & Professions (Cont.)

• Pharmacy - 1900s

• More than 38,000 drugstores in the U.S. served approximately 76 million people

• Few pharmacists focused on professional pharmacy services

  • Most did more than prepare and dispense medications

• Most pharmacists worked in independent, druggist-owned stores

  • Independent = owned by individual rather than a large company

  • These stores sold a variety of products and provided different services, not just medications

• Chain drugstores began appearing in the early 20th century

  • Chain drugstores = multiple stores owned by the same company

  • They expanded quickly

Continuity & Change in Health Institution & Professions (Cont.)

• 1922 - Pharmacy Becoming a Profession

  • “The pharmacist was not a professional” (Abraham Flexner, 1915)

  • American Pharmaceutical Association (APhA) established a Code of Ethics

    • Code of Ethics = rules and standards that guide professional behavior

    • Pharmacy’s primary purpose was to serve and protect the public by ensuring proper

      • Handling → safely managing medications

      • Sale → responsibly selling medications

      • Compounding → preparing or mixing medications

      • Dispensing → providing medications to patients

• 1932 - Pharmacy Education Requirements

  • American Conference of Pharmaceutical Faculties (now AACP) required a minimum 4-year pharmacy curriculum

    • Pharmacy students had to complete as least 4 years of education

    • Helped strengthen pharmacy’s professional knowledge and training

Continuity & Change in Health Institution & Professions (Cont.)

• Pharmacy - 1960s

  • Defined as the years of revolution in pharmacy

  • Marked as the beginning of the Clinical Pharmacy Movement

• Clinical Pharmacy Movement

  • Pharmacists began focusing more on patient care, rather than just preparing and dispensing medications

  • Pharmacists became drug therapy experts who helped patients and other healthcare professionals

• What Is a Clinical Pharmacist?

  • A clinical pharmacist is a drug expert who acts as a therapeutic advisor

    • Drug expert → has specialized knowledge about medications

    • Therapeutic advisor → helps patients, doctors, and other healthcare professionals make medication treatment

Continuity & Change in Health Institution & Professions (Cont.)

• Pharmacy - 1975

  • Pharmacists for the Future was published by The Study Commission on Pharmacy

  • The report called for:

    • A 6-year pharmacy curriculum → pharmacy students would complete 6 years of education

    • An entry-level Pharm.D. degree → the Doctor of Pharmacy degree would become the qualification for entering the pharmacy profession

Continuity & Change in Health Institution & Professions (Cont.)

• Pharmacy - 1989-1990s

• Pharmaceutical Care was introduced as a practice philosophy

  • Practice philosophy = beliefs and responsibilities that guide how pharmacists care for patients

• Defined as a patient-centered practice in which pharmacists:

  • Assume responsibility for patients' drug-related needs

  • Are held accountable for fulfilling those responsibilities

• Connected pharmacists' responsibilities with therapeutic outcomes

  • Pharmacists help ensure medications achieve the intended treatment results

• Pharmacists became equal members of the healthcare team

  • Work alongside doctors, nurses, and other healthcare professionals

• Omnibus Budget Reconciliation Act of 1990 (OBRA '90)

  • Required pharmacies participating in Medicaid to offer medication counseling to patients

  • Pharmacists provide information about:

    • How to properly take medications

    • Potential medication misuse

    • Important precautions and side effects

Continuity & Change in Health Institution & Professions (Cont.)

• Pharmacy Education — 1995

  • American Council on Pharmaceutical Education (ACPE) adopted the proposal for a 6-year professional Pharm.D. degree program

  • Pharmacy curricula were to include:

    • Introductory Pharmacy Practice Experiences (IPPE)

      • Early hands-on pharmacy training

      • Students learn basic pharmacy practice skills

    • Advanced Pharmacy Practice Experiences (APPE)

      • More advanced clinical training

      • Students apply their knowledge while caring for patients under supervision