Lecture 3 - US Health Care Delivery

two major paradoxes of the U.S. health care system

• Most advanced medical technology

• highest health care expenditure per capita.

What are the major problems with the U.S. health care system?

• Fragmented regulation, financing, and delivery;

• lack of insurance or underinsurance;

• medication errors;

• health disparities; (socioeconimic and racial disaparities)

• unequal access.

per capita

per person

Approximately what percentage of U.S. GDP is spent on health care according to the lecture?

17%, compared with approximately 8% in 1980.

what dieases affected clonial America

Tuberculosis, syphilis, anthrax, parasitic and fungal infections; settlers also brought influenza, yellow fever, malaria, smallpox, and measles.

Why were infectious diseases widespread in colonial America?

European settlers introduced illnesses, and public health policies were absent.

who provided healthcare in clonial America

Family members, neighbors, women in households, physicians, and apothecaries; few practitioners had formal training.

What remedies were commonly used in colonial America?

Herbs, minerals, plants, folklore, and traditional healing practices.

humoralism

Galen's theory that health depends on balanced bodily fluids and disease results from imbalance.

four humors

Blood, phlegm, yellow bile, and black bile.

miasma theory

The belief that disease is caused by bad air associated with rotting organic matter.

germ theory

The theory that specific microorganisms cause disease.

two types of health practitioners in 19th-century America

• Orthodox physicians (regulars/allopathic)

• sectarians (irregulars).

orthodox physicians

Practitioners with some medical education or apprenticeship who commonly used heroic medicine.

heroic medicine

Depletive treatments such as bloodletting, purging, and sweating intended to restore bodily fluid balance.

sectarians

Practitioners without formal medical training who offered alternative treatments such as folk medicine and homeopathy.

What is the law of infinitesimal in homeopathy?

The historical homeopathic belief that drugs become more effective at very small doses.

fee-for-service (FFS)

A payment system in which practitioners receive payment separately for each service provided.

How did socioeconomic status affect health care access in the 19th century?

Wealthier patients could afford physicians

• poorer patients often relied on home remedies and low-cost alternatives.

Why was health care access limited in rural areas?

Fewer physicians, often less-qualified practitioners, and limited transportation.

What were proprietary or patent medicines?

Commercial medicines advertised as OTC treatments regardless of demonstrated effectiveness

• often without disclosed active ingredients.

How did commercial medicine change pharmacists' roles?

Pharmacists increasingly sold prepared commercial medicines alongside compounded remedies.

Pure Food and Drug Act of 1906

An early consumer protection law addressing poisonous patent medicines and false or fraudulent claims about their composition.

What were almshouses and pesthouses?

• Almshouses sheltered poor people

• pesthouses isolated people with infectious diseases.

How did hospitals change from the early to late 19th century?

They evolved from charitable institutions associated with poverty and death into institutions for medical treatment.

• from death/poverty to medical treatment

What developments improved hospitals in the early 20th century?

Acceptance of germ theory, aseptic and antiseptic surgery, anesthesia, and X-rays.

What was the government's role in health care after WWII?

Expanded leadership and investment in medical education, research, hospitals, and access to care.

Hill-Burton Act

The National Hospital Survey and Construction Act of 1946, which supported construction of hospitals and health facilities.

• deals with funding

What did the Social Security Act of 1965 establish?

Medicare and Medicaid to improve health care access for targeted populations.

Why did federal cost-containment efforts increase in the 1970s?

Rapidly rising health care expenditures shifted attention from expanding resources to controlling costs.

What was the purpose of the HMO Act of 1973?

To encourage HMOs as an alternative to fee-for-service care and help control health care costs.

• example of federalization

How do HMOs differ from fee-for-service?

• HMOs provide comprehensive covered services in exchange for prepaid fees

• FFS pays separately for individual services.

What happened during the Reagan-era de-federalization period? I

ineffective regulations and obsolete programs were discontinued;

• OBRA 1981 ended funding for health professional schools except public health schools.

What is the continuing focus of U.S. health care reform according to the lecture?

Containing rising costs while improving access, especially through expanding insurance coverage.