History of Health Care - Ch 1-2

when/how did it begin?

• 400 BC, Hippocrates

• native Americans - herbal therapy

• various beliefs
    * credited health + illness to moods of gods
    * others used reason to try to explain diseases
    * religion - Greek temple of healing
    * ancient people even performed surgery

• manuscripts and books were hand copied as medical knowledge increased

middle ages 500-1500 AD

• reason replaced belief
• doctors began to keep careful notes (records)
• medicine was developed as a science
• regulation of health care - licensing, formal training (no women)
• religious hospitals

history of barbers

• became surgeons
• cut hair, treated cataracts, practice blood letting, treated injuries, amputated limbs
• story of the barber pole
    * after operation the bandages were hung on the pole outside and made red stripes when they twirled in the wind

renaissance 1300 - 1600 AD

• scientific method
• based on observation, careful notes
• microscope invented
• study of human anatomy

industrial revolution 1700 - 1800 AD

• machines invented
• capillaries discovered
• stethoscope invented
• health and environment connection
• vaccinations
• sterilization of equipment to avoid infection, medical asepsis
• discovery of pathogens, anesthesia

modern times 1900 - now

• hospitals became places for people to die
• engineering, chemistry and physics
• antibiotics and other medicine invented
• x rays
• organ transplants, artificial organs
• invitro fertilization (IVF)
• research, technology and computers

the caduceus

• Greek god of healing - Asclepius
• snake symbol

medical milestones

1518 - college of physicians in London

1628 - Harvey, blood circulation

1816 - Lannec, stethoscope

1839 - first dental school in Baltimore, MA

1842 - Lang, anesthesia

1893 - aspirin developed

1910 - Curie isolates radium

1922 - Banting, diabetes with insulin

1928 - Fleming, penicillin

1944 - first kidney dialysis machine

1953 - first heart/lung machine, successful open heart surgery

1953 - first successful kidney transplant

1963 - liver and lung transplant

1967 - successful heart transplant, Barnard

1967 - hospice in England

1969 - Cooley, first artificial heart, temporary

1972 - ct scan

1975 - lyme disease reported

1978 - test tube baby born in England

1981 - AIDS developed as a disease

1981 - successful fetus surgery

1998 - stem cells isolated from fetal tissues

2000 - human genome mapping completed

medical pioneers

Fleming - penicillin

Lister - aseptic technique (surgery)

Addams - 1st social worker in the US

Blackwell - 1st female physician

Barton - civil war nurse

Leeuwenhook - microscope

Nightingale - modern nursing

Heimlich - heimlich manuever

• these pioneers paved the way
• theories and observations weren’t always popular
• deal with lots of opposition

health care trends

technology

• non invasive diagnosis of soft tissue
• ultrasound
• radiology
• cancer treatments
• phones, cameras, scopes
• digital imaging
    * all very $$$

preventive medicine/wellness

• diet → exercise → good health
• wellness centers for chronic
• therapy
• holistic medicine
• disease screening
    * controls costs and encourages positive choices

underinsured and uninsured

• 16% have no health insurance
• some have insurance but limited coverage or high copays
• 74% of uninsured families have at least 1 full time worker
• tax supported hospitals → lack of care

ambulatory/outpatient surgery

• procedures done without overnight hospitalization
• technology, new medicine and research

aging population

• by 2005, 1 in 2 were 45+
• baby boom (1946 - 1964)
• elderly need more care

diagnostic related groups (DRG’s)

• groups of procedures or tests related to a specific diagnosis
• flat fee is based only on diagnosis

home health care

hospitals

• ex. religious, private ($), nonprofit, government and specialized

long term care

• day to day care, maybe can’t live alone, etc.
• see doctors monthly
• private
• nonprofit
• federally funded

assisted living center

• skilled nursing facilities

private offices

• individual and group practices

clinics

• share office and support staff but with different patients
• mobile clinics

laboratories

• specimen testing
• may be a part of a hospital or independent

emergency medical services

• provide care to ill and injured people asap

hospice (living angels)

• multidisciplinary care with patients who have terminal illnesses (less than 6 months to live)
• focuses on patient and family, not diseases
• goal is to reduce pain and other symptoms and provide emotional support
• generally in home but centers are available

government agencies

ex.

• NIH - DHHS, medical research, cancer, Alzheimer’s, arthritis, heart disease, AIDS, etc
• DHHS - president appoints secretary, health and welfare, elderly, needy kids and families, reduce errors and costs, improve quality
• WHO - sponsored by UN, directing and coordinating authority on international health and international disease stats
• LHD - provide immunizations, inspect restaurants, collect disease stats, mainly health education
• CDC - agency of DHHS, monitor and prevent outbreaks, international disease transmission, ensure health and safety for all
• FDA - agency of DHHS, ensure food safety, cosmetics, and safety of medical drugs and medical devices

volunteer and nonprofit

• supported by private contributions and fundraising
• most deal with specific or groups of diseases
• funding for research or education
• great influences on laws and standards

ex.

• american lung association
• march of dimes
• red cross

current health issues

• AIDS/HIV
• tuberculosis
• SARS
• tobacco control
• traveler’s health
• polio
• maternal safety
• road safety

national health care

• US health care is a mix of public and private programs, huge gaps in insurance coverage available and level of benefits to people of similar circumstances
• is health care a right or a privilege?
    * available on a basis of need not ability to pay for services

canada - pros and cons

pros

• 30 million citizens
• patient goes to physician of choice
    * no copays, limits, forms or deductibles
• 80 billion dollars spend annually, 70% publicly funded
• no private insurance, no public awareness of costs
• receive global operating budgets

cons

• no limits on demand
• no physician pay raises since 1993
• big decline in health care
• large wait times
• rationing of care

is national health care the answer?

other options

• medical savings account
• pooling
• sponsor creative federalism

health care initiatives

• health savings account
• out of pocket
• earn tax free initiatives
• $2600 individually, $5150 for family

health care tax credit

• tax credit to individuals without access to employer based coverage
• $1000 individually, $3000 for family

AHP - allows individuals and groups to purchase health care

medical malpractice reform

• congress should encourage states to reform destructive medical malpractice system in ways that are consistent with the constitutional principle of federalism

medicare

• new medicare law: drug discount law, help for low income seniors and an important of private plan competitioon
• medicare crisis: explosion of costs and unfunded liabilities, loss of retiree drug coverage

future of health care

• digital technology
• genetics
    * most illnesses are caused by genes
    * universal code of life