Lecture 4- Health Policy Overview and Profession

two major hallmarks of 20th-century U.S. health care

• increased government involvement

• emergence of prepaid health services (third-party payment).

two major ways government influenced health care

• Regulation of health care products

• funding of health care services and facilities.

Pure Food and Drug Act of 1906

Prevent manufacture, sale, and transportation of adulterated, misbranded, or poisonous foods and drugs.

What disaster led to the Food, Drug, and Cosmetic Act of 1938?

Elixir sulfanilamide disaster: approximately 100 deaths from the toxic solvent diethylene glycol.

What was the main outcome of the Food, Drug, and Cosmetic Act of 1938?

• New drugs required FDA notification and safety review before marketing

• FDA oversight expanded.

Hill-Burton Act of 1946

• Provide federal grants to states to build community hospitals and increase hospital beds.

• Increased community hospital beds and promoted nonprofit community hospitals.

Social Security Act Amendments of 1965 establish

Medicare and Medicaid.

Medicare

Federal health insurance primarily for people age 65 and older and certain eligible younger individuals.

Medicaid

A jointly funded federal-state program providing health care for eligible low-income populations.

Medicare Part A

Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.

Medicare Part B

Physician services, outpatient care, and preventive services.

Medicare Part D

Prescription drugs.

What legislation created Medicare Part D?

Medicare Prescription Drug, Improvement, and Modernization Act of 2003; effective January 1, 2006.

Who became additionally eligible for Medicare in 1972?

Certain individuals with disabilities receiving Social Security benefits and people with end-stage renal disease.

What did Blue Cross and Blue Shield cover in 1939?

• Blue Cross covered hospital care

• Blue Shield covered physicians' fees.

thrid party payment system

A system in which an insurer or other third party pays for covered health care services.

HMO Act of 1973 passed

to slow rising health care expenditures by supporting prepaid medical care and competition.

purpose of the HMO Act of 1973

Provide federal support to establish and expand HMOs as alternatives to fee-for-service care.

fee-for-service (FFS) payment work

Providers are paid separately for each service performed.

HMO differ from FFS

Prepaid or fixed payments encourage avoiding unnecessary services

• unlike FFS where more services generate more revenue.

What were the HMO Act's goals versus actual results by 1976?

• Goal: 1,700 HMOs and 40 million members

• actual: 174 HMOs and 6 million members.

leading causes of death change during the 20th century

Shifted from acute infectious diseases to chronic diseases.

What happened to life expectancy during the 20th century?

Increased by almost 60%

What three factors contributed to increased life expectancy?

improved standard of living, advances in public health, and progress in medical practice

five characteristics of a profession

• Systematic knowledge

• professional authority and privileges;

• community sanction and social utility;

• ethical codes and internal control;

• professional culture and organizations.

What does systematic theory and body of knowledge mean?

Professionals possess specialized knowledge gained through formal education and maintained through continuing education.

What are professional authority and special privileges?

Society trusts professionals to use specialized expertise and judgment when providing services.

What is the difference between social utility and community sanction?

• Social utility means serving an important societal need

• community sanction means society officially recognizes the profession through licensure or protected titles.

What are ethical codes and internal control?

Professional standards and accountability that guide conduct beyond legal requirements.

What are professional values, norms, and symbols?

• Values are core beliefs

• norms are accepted behaviors

• symbols identify the profession, such as white coats and specialized vocabulary.

Why can't health care be completely standardized?

Patients have different needs, symptoms, and preferences, requiring individualized professional judgment.

Flexner Report of 1910

A report that transformed medical education through higher standards, structured science-based training, and a standardized four-year curriculum.

changes occurred in pharmacy professionalization during 1922 and 1932

• 1922: APhA established a Code of Ethics;

• 1932: a minimum four-year pharmacy curriculum was mandated.

How did pharmacy practice evolve from the 1960s through the 1990s?

• Clinical pharmacy emerged in the 1960s;

• pharmaceutical care emphasized patient-centered responsibility for drug therapy outcomes in the 1989–1990s.