Exam 1 Healthcare Delivery

Does the US spend more than other countries? If so, by how much

.S. spends about 80–90% more per capita than peer countries.

-about 14,570 dollars per capita (but check notes)

What are some concerns with the annual budget (Financing the United Kingdom Health Care System)?

Not a big enough budget

Pure Food and Drug Act of 1906

Hospitals

became major setting where individuals received health care services in the 19th and 20th centuries

Ecological Model** important

Societal, Community, Relationship, Individual

-provides a theoretical framework to talk about how interactions across each level of the model

Main idea: Provides a big picture

*think SCRI (scary)

Indivudal (of Ecological Model)

biological/genetic history factors of the person

Relationship (ecological Model)

influenced by culture, religion, etc

-based on upbringing

Community (Ecological Model)

where you get your health care

-essentially access (e.g: some people may have to travel farther than others to receive healthcare)

-having to travel 50 miles so patient can get dialysis rather than 10 miles from your house

Societal (Ecological Model)

we have different educational policies

-e.g: healthcare is a required course in high schools→ mandated at a federal and state level now

-other examples of policies: Medicare, Medicaid → impact healthcare availability for people

True or false. All levels of the ecological model interact with one another

True

We have a _____ system of care

fragmented

How Drugs were Viewed in the 1800s

Were just seen either as working or not depending on your symtpos

-wasn’t yet seen as a biological mechanism of action

Physicians in the 19th century

had no formal training

usually asked for payment right away

-as a result of this many turned to home remedies to offset the high costs of medical care

Commerical Manufacture of Meds in 19th century by physicians

proprietary meds (patented meds) - pharmacies started opening stores→ physicians began selling their concoctions, starting the beginning of retail pharmacy

Direct to consumer advertising

occurred in the later 19th century, rise of patent medicines advertised in newspapers

Pure Food and Drug Act of 1906

did NOT say your drug had to work (it didn’t even have to be safe0

-**only needed to tell you what was in the bottle→ it didn’t have to work*

-only mentioned ingredients but no warnings and precautions did not tell you about safety

Early 19th century

quarantined the ill→ and people died there

Early 20th century

providers admitted patients→ enhancing growth of their practices

Mid 1900s

HUGE outpouring of growth in building of hospitals

and different types of hospitals (e.g: specialty hospitals, general hospitals like Binghamton General, UHS and Guthrie, St. jude’s children facility

Hill Burton Act of 1946

government getting involved*

→ produced funding to construct a bunch of hospitals because of growing technology

-Antibiotics and IVs were also now available

• disparities in the placement of these hospitals existed→ m

Disparity in placement of hospitals

mainly were in middle income communities instead of rural

• they also weren’t properly placed in low income communities

Acute Disease Model

financed the disparity in hospital placement

• essentially curing the disease when you’re in the hospital

  • as we got antibiotics→ we became better at treating infections

National Institute of Health (NIH) for medical reserach

Medicare and Medicaid began to emerge from government’s pursuit for service programs

• federal funding = greater role of government in healthcare delivery

Medicare and Medicaid

hospitals tend to big users of these insurances→ most can’t make it without these programs based on their structure

Managed care (seeing certain doctors) and consumerism

began experienciung conflicts from 1900s to 2000s

2001 Release of “Quality Chasm”

goal was to make healthcare and hospitals more patient centered (as opposed to practice-centered)

1910 Flexner Report**. know

big change for physicians

• changed standards for medical education

  • raised accreditation status → weaker schools were closed, and less diversity in those admitted

• Abandoned apprenticeship model with nonallopathic physicians was banned, only allopathic (conventional) physicians were recognized

Post WWII (around the 40s), “Biomedical Model”

this model predominated where we placed emphasis on the molecular level of life (of processes and diseases)

• reliance on biological mechanism of action and organisms causing disease (unlike before**)

In world war I, people didn’t die from their gunshot wounds but rather from the ______that resulted from these wounds. In world war II, those same people were treated with _____, allowing them to survive. This stimulated the reliance on the _________ model

infection, antibiotics, biomedical

1970’s Emphasis

New emphasis on social inequities as more women and minorities were admitted to medical schools

1980s and 90s

response to managed care

• concern about physician not being able to treat (in the way in which they felt they should treat you)

21st century- Patient centered care

a model of primary care that helps support the expansion of better primary care and seeing patients as whole persons (not disease states)

• placing continuity of care as a priority

1860s and 1870s

lots of laboratory instruction

1900s: Expansion of schools and drugstores

• >50 colleges and departments of pharmacy

• Apprenticeship could no longer be used→ transition to pharmacy curriculum

• at one point there was >38,000 US drugstores serving 76 million people

1915: Challenges in pharmacy specialization

• Flexner modified physician education→ deemed pharmacy as not a real profession but really only there to support physicians