Health Notes
HISTORY
4000-3000 BC
People believed that illness was caused by supernatural beings. Several herbs were used as medicine. These early treatments laid the groundwork for the development of more systematic approaches to medicine in later civilizations.
Ancient Egyptians and Babylonians
Egyptians
Magic and religious practices were prevalent.
Physicians were conservative.
Imhotep was a notable figure.
Babylonians
Their practices were similar to the Egyptians.
Physicians were paid for their services.
Both civilizations faced poor sanitation and hygiene.
Hindus and Chinese (1500)
Hospitals and nurses were established.
Many types of surgeries were performed.
Knowledge of drugs improved, and sewers were constructed.
Chinese Medicine
Documents recorded over 1000 medicinal herbs.
Acupuncture was practiced.
Ancient Greeks (2000-400 BC)
Hippocrates, known as the father of medicine, emphasized observation and note-taking.
The Hippocratic Oath was established.
Aristotle made contributions to anatomy through the dissection of animals.
Ancient Romans (200-500 AD)
Claudius Galen ignored the practice of patient observation and formulated several flawed theories based on four body fluids.
He established superior drainage systems and set up public hospitals.
Epidemics and Pandemics
Epidemic: A greater number of cases of an infectious disease than normal in a population or area.
Pandemic: An epidemic that spreads to a significantly larger population across several continents or countries.
The Dark Ages
542 AD marked the first episode of the bubonic plague.
Rome was overthrown by barbarians, and the study of medicine was forbidden.
People returned to reliance on gods and folklore for cures.
The End of an Era
This era ended just as it began, with a continued belief that sickness was tied to the gods and could only be cured with worship.
Middle Ages (800 to 1300 AD)
The Muslim Arab Empire made significant contributions to pharmacology.
Notable Figure: Rhazes
Established the first medical school in Salerno, Italy.
Common people were treated by barber surgeons.
The Black Death (1347 to 1352 AD)
This was the second episode of the bubonic plague.
Over one-third of the population of Europe died.
The plague was caused by bacteria from fleas on infected rats.
Many Europeans began to challenge the idea that religion was the cure.
The Renaissance (1350 to 1700 AD)
Many Europeans rejected their commitment to religion.
Andreas Vesalius published the first-ever anatomy book.
The microscope was invented by Anton van Leeuwenhoek.
Result of the Renaissance
Transitioned from reliance on religion to reason, although true understanding was still lacking.
The typical lifespan was approximately 40 years, and the reasons for diseases remained a mystery.
The Modern Era
1900 to Present
1928: Sir Alexander Fleming discovered penicillin.
Early 1900s: Wilhelm von Roentgen developed the X-ray machine.
Technological Advancements
Francis Crick and James Watson discovered DNA.
Organ transplants became successful.
Infertile couples have children through fertilization.
Childhood vaccinations eliminated many vital diseases.
Health
Health insurance plans were developed in the 1920s.
Medicare and Medicaid programs were established.
Hospitals were organized into specialized units.
The Future
The future of medicine is promising, but it should be explored with caution.
It is essential to remain open-minded about the scientific method.
Health Care Systems
System
System - a group of individual parts that work together to form a unified whole.
Systems Theory - a way of studying systems as one unit instead of individual parts.
Components
Input
Throughput
Output
Feedback Loop
Controls
Environment
Goals
Mission
Evaluating the System
The key to evaluating the system is to determine if the mission is fulfilled; it is important to "look at the big picture."
System Theories in Health Care
A healthcare system is made of many small systems. They must be evaluated using the systems theory to ensure that they are successful and efficient.
Healthcare Systems
Healthcare systems can be publicly or privately funded.
Public
Mainly funded by taxes and social security insurance.
Advantage: Every citizen is guaranteed healthcare.
Cons: Not all services are free, and there are higher taxes.
Examples: Norway, Canada.
Private
Funded by insurance agencies and out-of-pocket payments.
Pros: Better coverage, lower taxes, and economic growth is stimulated.
Cons: Not everyone is guaranteed healthcare.
Examples: USA, Switzerland.
Mixed
Some countries have a mix of public and private funding.
Examples: USA and Canada; there are assistant programs but still mostly private in the USA and the opposite for Canada.
Goals
The goals should be to provide quality healthcare, respond to citizens' expectations, and ensure financial protection and fair distribution of financing.
Evaluating a Private System
Evaluate the USA:
Does the private system provide quality healthcare to the entire population? Yes
Is the private system responsive to citizens' expectations? 1st
Does the system ensure financial protection and fair pricing? No (last place).
Neither system is perfect; all systems must be flexible and able to adapt to the changing needs of society.
Delivery Systems
A place that provides healthcare services to consumers by healthcare personnel and payment for services.
Hospitals
Size
Ownership
Proprietary
Nonprofit
Government
Religious
Services
General
Specialty
Long-term Care Systems
For the elderly, disabled, and rehabilitation:
Nursing homes for patients that can no longer care for themselves.
An independent living facility allows patients to use only the services they need.
Medical Offices
Some offices are small, while others are large. Some are wide-ranging, while others only treat one specialty or age group.
Behavioral Health
Services for individuals with mental health problems, addiction issues, and substance abuse.
Medical and Dental Services
Cosmetic surgery
Pulmonology
Chiropractic
Orthodontics
Surgical care
Palliative care
Other Systems
EMT
Acute care facilities
Ambulatory/outpatients
Hospice
Labs
Home healthcare
Health Delivery Systems
Government Facilities
•Government healthcare facilities exist at several levels:
▫International
▫National
▫State
▫Local
•Government facilities are supported by taxes.
World Health Organization
International agency sponsored by the United Nations
•192 member countries
•The goal of W.H.O. is that all people obtain the highest possible level of health, including physical, mental, and social well-being.
Department of Health and Human Services
•Its goal is to protect the health of American citizens and to provide essential human services, especially for those who cannot help themselves.
•It is broken into many divisions, including:
▫National Institute of Health
▫Center for Disease Control and Prevention
▫Food and Drug Administration
▫Agency for Healthcare Policy and Research
OSHA
•Occupational Safety and Health Administration
•Enforces safety standards in the workplace
•Specific workplace safety standards for healthcare facilities
VA
•United States Department of Veteran Affairs
•Provides healthcare services to military veterans
•Disability compensation
•Vocational rehabilitation
•Education assistance
•Home loans
•Life Insurance
•Burial and memorial benefits
Nonprofit Agencies
Focus on one disease or group of diseases.
•Research, search for a sure, promote public awareness, and provide services to victims.
•Supported by donations, membership fees, fundraisers, and government grants.
•Examples include:
▫American Cancer Society
▫American Heart Association
▫American Red Cross
▫March of Dimes
Healthcare Delivery Systems
Organizational Structure
•An organizational structure helps a facility run smoothly by outlining the responsibilities of employees.
•Four divisions:
▫Informational
▫Support
▫Diagnostic
▫Therapeutic
Line of Authority
The line of authority determines a worker’s position in a facility’s organizational structure.
•The line of authority also establishes levels of supervision.
Medical Office Structure
•The organizational structure and line of authority at a community medical office is different from a large medical facility.
•The doctor is the primary supervisor at a medical office.
Respecting Chain of Command
Following a chain of command reinforces organizational structure and provides:
•Strength
•Efficiency
•Focus
When to Escalate Problems
Each healthcare system or facility should have a process in place that helps healthcare workers determine when to apply problem-solving skills independently and when to escalate the issue to someone above them in accordance with the chain of command.
Reporting Issues
When reporting an issue, follow these guidelines:
•Follow your facility’s process for reporting issues
•Research the existing process
•Develop a thoughtful plan for how you'd address the problem
•Explain your concern to your supervisor and share your idea for resolving the issue
•Be tactful and confident
Interdependence
All members of the healthcare team are dependent on each other.
•If one worker does not fulfill the required duties, the entire team is hindered.
HEALTHCARE TRENDS
Trends, Technology, and Emerging Issues
Trends
•Technology
•Epidemiology
•Geriatric Care
•Wellness
•Cost Containment
Technology
•Computers and audiovisual devices
•Telemedicine
•“Long distance” surgery
Epidemology
•Epidemiology is the study of diseases.
•Many researchers are focusing of diseases that are influenced by lifestyle factors.
•Taking responsibility for one’s own health is a growing trend in today’s world.
Geriatric Care
•Because people are living longer, geriatric care is in high demand.
•Geriatric facilities have developed quickly in recent years:
▫Adult day care centers
▫Independent living facilities
▫Retirement communities
▫Nursing homes
Wellness
•Change in focus from “sick care” to “health care.”
•Wellness centers include:
▫Weight control facilities
▫Health food stores
▫Nutritional services
▫Stress reduction counseling
▫Habit cessation management
Public Health
Public health serves to protect the health of individual people and communities through:
◦Prevention
◦Education
◦Treatment
◦Research
◦Safety standards and programs
◦Tracking outbreaks
◦Laws that help protect public health
Cost Containment
•Outpatient Services – Reduce the length of hospital stays to reduce costs.
•Preventive Care – Get regular check-ups and vaccinations to prevent illness.
•Energy Conservation – Use energy-efficient lighting, solar power, and automatic faucets.
Consumer Responsibilities
The same team
•Healthcare providers and patients are on the same team, working towards the same goal—healthy people.
•Healthcare providers are encouraged practice patient-centered care.
Patient Centered care
•Partnership between the healthcare providers and the patient
•Empower patients
•Communicate with patients
•Advocate for patients
Patient responsibility
•Patients should communicate with healthcare providers
•Patients should advocate for themselves
•Patients should comply with their treatment plan.
Self Advocacy
Here are some ways to practice self-advocacy:
•Request copies of your medical records
•Review your medical records and use patient portals
•Ask questions
•Research treatment options
•Learn the pros and cons of options, including costs
Patient complience
•Patient compliance is cooperation or obedience to a prescribed treatment plan.
Pateint Bill of Rights
The Patient’s Bill of Rights includes eight key points.
•Right to emergency treatment
•Right to respect
•Right to informed consent
•Right to refuse treatment
•Right to choose providers
•Right to privacy
•Right to appeal
•Patient responsibilities
Technology and Emerging Issues
Impact of Imerging Issues
•Emerging issues and technologies results in changes in healthcare delivery systems
•Healthcare providers must be adaptable and learn new things quickly
Advancements in Tech
•Mobile Stroke Unit (MSU)
•Wireless wearable sensors
•Miniature wireless pacemakers
•Spectral CT
Bioethics
Bioethics is the application of ethics to healthcare. New discoveries must be considered through these principles:
•Autonomy
•Justice
•Beneficence
•Non-Maleficence
Addiction
•Addiction now viewed as a disease called substance abuse disorder
•Treatments are broader and more accessible
•Treated by a team of healthcare providers
Essetial lifelong learning
Emerging issues and new discoveries and technologies related to healthcare require that healthcare providers and patients be flexible and always willing to learn new things.
8 Bill of Rights points
8 key points:
Right to emergency treatment
Right to respect
Right to informed consent
Right to refuse treatment
Right to choose providers
Right to privacy
Right to appeal
Patient responsibilities
Heath Care Economics
Insurance
Health Care Insurance
•The rising cost of healthcare is good for the economy, but the expenses are a burden for most individuals and families.
•In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses.
•The Patient Protection and Affordable Care Act (ACA) of 2010 was passed to reduce the number of uninsured in the U.S.
Health Insurance Terms
•Premium – the amount paid to an insurance agency for a health insurance policy
•Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments
•Co-payment - an amount paid by the patient for a certain service
•Co-insurance: The co-insurance is the percentage of costs of a healthcare service that is paid by the patient after they have paid the deductible. For example, you have paid your deductible and have an $100 office visit with a co-insurance of 20%. You would be responsible for $20 and the health insurance agency would pay the rest ($80).
•Out-of-Pocket Expense: An out-of-pocket expense is a medical bill that must be paid by the patient. Many health insurance policies have a limit to the amount of out-of-pocket expenses to be paid by the patient during a year.
•Cost-Sharing Reduction (CSR): This discount applies to deductibles, copayment and co-insurance for qualified health plans. It lowers out-of-pocket expenses
•Premium Tax Credit: Based on your annual income and household information, this credit lowers your monthly insurance premium payment on qualified health plans
•Health Insurance Portability and Accountability Act (HIPAA): This law protects patient health information and confidentiality. Signed into law in 1996, HIPAA makes it illegal to gain access to a patient’s health information without their permission. It also places strict permissions on the transfer of personal health information (PHI) between organizations.
Healthcare Fraud
Healthcare fraud is a crime. Examples of healthcare fraud include:
•Using someone’s health information as if it were your own
•Billing for medical services that were not provided
•Delivery of unnecessary medical services
•Misrepresentation of medical services provided for higher reimbursement
•Providing or receiving money for participating in any of the above fraud schemes
Health Insurance Then and Now
The first broad coverage was Workers Compensation in 1914 and provided cash payments to injured workers with job related injuries or illnesses.
Today, the Affordable Care Act requires health insurance companies to cover 10 essential health benefits:
•Outpatient care
•Emergency services
•Hospitalizations
•Pregnancy, maternity and newborn care
•Mental health and substance abuse treatment
•Prescription drugs
•Rehabilitative and habilitative services and devices
•Laboratory services
•Preventative health services
•Pediatrics services
Individual and Group Insurance
•Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage.
•Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.
Indemnity Insurance
•In indemnity insurance, patients must pay for all healthcare expenses out of their own pockets. Afterward, the insurance agency will reimburse the patient for a percentage of the expenses.
•Indemnity insurance does not work for everyone. Many people cannot afford to pay for their medical expenses out-of-pocket.
Managed Care
•Two primary concepts of managed care:
▫To promote good health
▫To practice preventive medicine
•Managed care plans offer medical services through a system of healthcare
Managed Care versus Indemnity
•Payment for medical services
•Choosing a healthcare provider
Reimbursement
•Health insurance agencies do not always reimburse the full amount charged for services.
•Physicians will either “absorb” the loss, or they will charge the patient for the amount that was not paid by the insurance agency.
Health Plans
Managed Care
•Health Maintenance Organizations
•Preferred Provider Organizations
•Point of Service
Health Maintenance Organizations
•Clients must pay a premium, deductible, and co-payments.
•Clients must visit in-network doctors and select a primary care physician.
HMOs urge clients to practice healthy living and to receive preventive treatments.
Preferred Provider Organization
•Clients must pay a premium, deductible, and co-payments.
•Clients do not have to choose a primary care physician.
•Clients may visit non-network physicians, but coverage is greater with in-network physicians.
•PPOs often have otLoading…
Exclusive Provider Organizations
•Coverage for healthcare services is limited to care from providers or hospitals in the plan’s network, except for emergencies.
•Referral is not required to see a specialist.
•No coverage for care from out-of-network providers
Point of Service
•Clients must pay a premium.
•Clients must choose a primary care physician.
•For in-network physicians, there is usually no deductible and co-payments are low.
•Specialists may be non-network physicians, but coverage may be limited.
Managed Care Comparisons
HMOs, PPOs, EPOs, and POS plans have similarities and differences. It is important to know how these types of managed care compare with each other.Making Informed Decisions
•The most cost-effective plan depends on an individual’s healthcare need and the coverage included in the plan.
•Anyone who buys health insurance should research and compare the types of plans that are available.
•People who know in advance that they will need extensive healthcare should research prices for the expected care.
Government Programs
Public Health Insurance Programs
With public health insurance programs, the federal government finances healthcare services received by eligible groups of the population.
•Medicaid
•Medicare
•Military Health System
•TRICARE
•Veterans’ Health
Government Programs
•Public Medical Assistance:
◦Medicaid
◦Medicare
•Affordable Care Act (ACA)
▫Expanded eligibility criteria for Medicaid
▫Provided financial assistance for those who do not qualify for Medicaid or lack insurance from employer
Medicaid
•Needs-based program
•Designed by the federal government, administered by state governments
•Provides medical assistance to individuals and families who the state determines to be “medically needy.”
Medicaid Services
•Services typically include:
▫Hospital services
▫Prenatal care
▫Child vaccines
▫Pediatric services
▫Physician services
▫Diagnostic testing and X-rays
▫Rehabilitation and physical therapy
▫Prescription drugs
▫Home healthcare
Medicaid Expansion
The ACA provided the foundation for Medicaid expansion. Since it is a voluntary program and states may decide whether or not to participate, states also decide whether or not to expand Medicaid for their residents.
As of May 2019, 37 states including Washington, DC, have elected to expand Medicaid.
Medicare
•Entitlement program for any citizen age 65 or older
•Administered by the federal government
•After deductible, Medicare will cover 80% of all medical expenses
Medicare Services
•Part A: Hospital Care
▫Hospitalization
▫Skilled nursing facilities
▫Home healthcare
▫Hospice care
▫Long-term care facilities
•Part B: Outpatient Services
▫Medical expenses, including therapy, medical equipment, and testing
▫Preventive Care
Healthcare for the Military
•The U.S. Department of Defense operates the Military Health System which provides medical services to active duty and retired military members of the armed forces and their families.
•TRICARE is the health insurance program of the Military Health System.
•The Veteran