HCOC Chapter One: U.S. Healthcare

CHAPTER ONE

The ACA (Affordable Care Act) increased our access to healthcare and overall deals with the rising costs of healthcare. This includes, but is not limited to, medical technology, prescription drugs, volume-based reimbursement systems, inadequate preventive systems & services, increased prevalence of chronic disease, and high administrative costs. There are many disparities in the healthcare system that result in variation in cost but no commensurate differences in health outcomes. People with income 200% below the FPL working for employers who don’t give out health insurance remain uninsured even with the ACA. 

The WHO says nutrition is the best natural support for vaccines. With the WHO, different countries are able to meet together and decide what’s best for global public health. Most accidental overdoses are because of opioids. Suicide, overdose, and liver disease are “deaths of despair”, or socioeconomic issue markers today. Recent trends include mortality and life expectancy. The leading causes of infant death are congenital malformation, preterm birth, low birth weight, SIDS (sudden infant death syndrome), maternal complications, and unintentional injuries. Doulas can provide prepartum and postpartum support to mothers. Some people who work with mothers and birth are nurse midwives, APRNs, CHWs, and social workers. Nurse midwives and APRNs can serve as PCPs in communities that lack them. People in rural areas have the least access to all kinds of healthcare because of the lack of PCPs in rural areas. 

Numbers of chronic and degenerative disease increase with the elderly population, who have 2-3 chronic diseases on average today. Heart disease, cancer, and diabetes are leading causes of death. Heart disease is the number one killer of males and females. Cancer kills women at the same rate as heart disease kills people in general. Chronic illness is associated with lifestyle. Smoking and obesity are associated with heart disease and cancer. Smoking while pregnant causes birth defects. Clinical preventive services like immunization and cancer screenings have become more common. Globalization and travel across nations increase infectious disease risk. Risk for spread of this risk increases with time. Viral gastroenteritis and salmonellosis are common infections. Foodborne illnesses can be prevented with vaccines. Animals and other organisms can spread zoonotic diseases, examples of these diseases being Ebola and avian viruses. MRSA is an antibiotic-resistant bacteria strain common in places with many kids. The Human Genome Project identifies genetic mutations that increase disease risk for lower cost. Because more kinds are getting an ASD diagnosis, we’ve developed things like ABA (applied behavior analysis) to help them. Brain disorders like Alzheimer’s and Parkinson’s impact productivity and quality of life.

America was unprepared for the pandemic because of our lack of PPE. Politics and personal beliefs during the pandemic interfered with healthcare solutions because people grew skeptical of the NIH and CDC. Medical professionals were unseen by our government and it delayed our response to COVID-19. Telehealth helped people get needed healthcare during lockdown. The American  government controls healthcare because of the monetary support it provides. Limits in funding limit available treatment. Public health expert teams work together to track & contain diseases and prevent outbreaks in all kinds of organisms. The CDC coordinates this collaboration and city and state level in the United States. The WHO works with different countries for this same purpose. Communication is vital for both these organizations. 

Medical tech advances have improved trauma victim and severe illness survival rates, allowing for clinical development that improves quality of life like infection control, minimal invasion surgical techniques, reproductive tech advances, etc. Drug therapy can extend the lifetime of the average person. Artificial intelligence and health IT have improved healthcare efficiency. AI goes through public health data to predict the spreading of diseases. EHRs are examples of technological advances. Medical technology can also prolong the suffering of the chronically ill. We have developed things like kidney dialysis, feeding tubes, etc. for the comatose (people in a deep state of unconsciousness). AI raises lots of ethical concerns. Technology as a whole brings increased efficiency and cost. 

There are nonmedical factors that can impact health like access, income, etc. SDOH (social determinants of health) are in this category and include where people are born, grow, work, live, and age. Consideration of SDOH helps improve prevention and acute & chronic illness treatment. SDOH influences care quality and outcomes. Health behaviors are also a large part of outcomes. Social and economic factors have the greatest influence on outcomes. Need to address SDOH is made clear by CMS innovation programs that want good healthcare for cheaper. Hospital payment determines quality of treatment rather than the amount of treatments. People with racial/ethnic minorities, lack of English proficiency, low health literacy, disability, and lack of PCP have the highest readmission rates. Hospitals have begun their own unique strategies and incentives to lower readmission rates. 

The AHA and AAFP have developed screenings to address unmet social needs of patients. Receptionists and MAs administer, while people like nurses, PAs and health educators review responses. Unmet social needs create disparities. Black people and natives experience the most discrimination. Equality is giving everyone the same no matter what, and health equity is giving people the same opportunity to achieve maximum health. To achieve true health equity, we would need to remove obstacles like poverty and discrimination.