Transcript Chapter 2 Health Care Systems

Health Care
Science Technology
Chapter 2
Health Care Systems
Copyright © The McGraw-Hill Companies, Inc.
History of Health Care
2-1
 Prehistory and the Ancient World
 The Middle Ages
 The Renaissance
 The Industrial Revolution
 Modern Times
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Prehistory and the Ancient
World
 Ancient healers used diet, rest,
plants, and herbs, and performed
surgery.
 The caduceus, which is the symbol
of the physician, may have evolved
from the symbol for Asclepius, the
Greek god of healing.
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Prehistory and the Ancient
World (cont.)
 The Hippocratic Oath is a code
of ethics developed by
Hippocrates around 400 B.C.
 This code promotes patient
confidentiality and forbids the
deliberate harming of a patient.
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Hippocratic Oath
(Modern Version)
 I swear to fulfill, to the best of my ability and judgment,
this covenant:
 I will respect the hard-won scientific gains of those
physicians in whose steps I walk, and gladly share such
knowledge as is mine with those who are to follow.
 I will apply, for the benefit of the sick, all measures [that]
are required, avoiding those twin traps of overtreatment
and therapeutic nihilism.
 I will remember that there is art to medicine as well as
science, and that warmth, sympathy, and understanding
may outweigh the surgeon's knife or the chemist's drug.
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 I will not be ashamed to say "I know not," nor will I fail to call in
my colleagues when the skills of another are needed for a patient's
recovery.
 I will respect the privacy of my patients, for their problems are not
disclosed to me that the world may know. Most especially must I
tread with care in matters of life and death. If it is given me to
save a life, all thanks. But it may also be within my power to take
a life; this awesome responsibility must be faced with great
humbleness and awareness of my own frailty. Above all, I must
not play at God.
 I will remember that I do not treat a fever chart, a cancerous
growth, but a sick human being, whose illness may affect the
person's family and economic stability. My responsibility includes
these related problems, if I am to care adequately for the sick.
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 I will prevent disease whenever I can, for prevention is
preferable to cure.
 I will remember that I remain a member of society, with
special obligations to all my fellow human beings, those sound
of mind and body as well as the infirm.
 If I do not violate this oath, may I enjoy life and art, respected
while I live and remembered with affection thereafter. May I
always act so as to preserve the finest traditions of my calling
and may I long experience the joy of healing those who seek
my help
Written in 1964 by Louis Lasagna, Academic Dean of the School
of Medicine at Tufts University, and used in many medical
schools today.
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Prehistory and the Ancient
World (cont.)
 Galen was a Greek trained by the
Egyptians and appointed as physician
to the gladiators.
 He is credited with performing tracheotomies and
documenting the importance of the spinal cord in the
movement of limbs.
 His manuscripts were used to train physicians until
the Renaissance, which began in the 14th century.
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The Middle Ages
 500 A.D. – 1500 A.D.
 Reason began to replace belief in spiritual or
superstitious causes for illness.
 Rhazes was a Persian doctor.
 He wrote about the differences between
smallpox and measles.
 He provided a clearer understanding of the
causes of disease.
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The Middle Ages
(cont.)
 The Barber-Surgeon
 Barbers performed cataract surgery,
limb amputations, and phlebotomy
(bloodletting).
 The red and white barber pole may
have begun as a pole to hang bandages,
or may have symbolized blood, veins,
and bandages (red, blue, and white).
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The Middle Ages (cont.)
 The Beginning of Medical Care
Regulation
 Physicians were licensed after
formal training with experienced
doctors.
 Women were not allowed to
practice medicine.
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The Middle Ages (cont.)
 Religion and Medicine
 Religious principles led to the
founding of many Islamic
hospitals and Christian
monasteries where the sick were
treated.
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The Renaissance
 14th – 17th Centuries
 15th Century

The invention of the printing press
allowed discoveries to be published.
 16th Century

The scientific method came into use and
the microscope was invented.
 Age of Enlightenment (1700s)

The study of anatomy was allowed by
the church.
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The Industrial Revolution
 Late 18th and Early 19th Centuries
Stethoscope invented.
Vaccination began.
Marked the beginning of modern medicine.
Louis Pasteur’s experiments formed the basis of
microbiology.
 Joseph Lister began disinfecting surgical
equipment and hand washing (medical asepsis).
 Robert Koch found that pathogens are the source of
some diseases.
 Ether used as an anesthesia.
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Modern
Times
 20th Century
 Antibiotics invented.
 Radium discovered.
 CAT scans, MRI, and
ultrasound are used.
 Organ transplants
commonplace.
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Section 2-1
Apply Your Knowledge
What did the invention of the
printing press allow?
Answer:
The printing press made it possible
to publish books about discoveries.
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Trends in Health
Care 2-2
 Technology
 Preventive Medicine and Wellness
 Aging Population
 Underinsured and Uninsured
 Ambulatory Care and Outpatient
Surgery
 Home Health Care
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Technology
 Computer technology allows
noninvasive diagnosis of soft
tissue diseases and injuries.
 Ultrasound used to examine body
cavities.
 Field of radiology no longer
limited to X rays.
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Technology (cont.)
 Miniaturization allows
cameras and instruments to be
inserted into the body for
surgical procedures.
 Digital images can be
transmitted to a consulting
specialist.
 Client’s records can be made
available anytime and
anywhere.
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Preventive Medicine and
Wellness
 Wellness idea began about 20 years ago with the
introduction of fitness centers.

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Wellness industry
growth spurred by
baby boomers,
physicians, insurance
companies, and fitness
professionals.
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Preventive Medicine and
Wellness (cont.)
 Hospital wellness centers offer services such as:
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Cardiac rehabilitation.
Pulmonary rehabilitation.
Occupational medicine.
Sports medicine.
Clinical weight management.
Physical therapy.
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Preventive Medicine and
Wellness (cont.)
 Most hospital wellness centers offer wellness
programs for clients with chronic diseases
such as:
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Arthritis.
Diabetes.
Osteoporosis.
Neuromuscular disorders.
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Preventive Medicine and
Wellness (cont.)
 Many hospital wellness centers offer complementary
classes in:
 Yoga.
 Nutrition.
 Stress management.
 Some hospital wellness centers provide screening for
diseases that include:
 Breast, cervical, and prostate cancer.
 High blood pressure.
 High cholesterol.
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Preventive Medicine and
Wellness (cont.)
 Factors relating to personal responsibility for
wellness include:
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Fitness.
Preventive care.
Spiritual health.
Safety.
Nutrition.
Tobacco addiction.
Stress management.
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Aging Population
 Caused by fewer births and fewer
deaths.
 Baby Boom, 1946-1964.
 Population of 65 and older
expected to double between the
years 2000 and 2030, from 35
million to 70 million.
 As the population ages, demands
on the health care services will
increase.
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Underinsured and
Uninsured
 16% of U.S. population (42
million) have no health
insurance.
 Some have health insurance, but
coverage is limited by a large copayment or deductible in
addition to the insurance
premium.
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Underinsured and
Uninsured (cont.)
 As new technology and products
emerge, costs increase.
 County hospitals, supported by
taxes, care for uninsured low
income people.
 Costs associated with the uninsured
are passed on to those who are
insured or can afford to pay.
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Ambulatory Care and
Outpatient Surgery
 Technology, research,
and new medications
make same-day
surgery possible.
 Costs can be reduced
when patients do not
remain overnight.
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Home Health Care
 Became popular in the late 1980s.
 Medicare began paying hospitals a flat fee for
diagnostic related groups (DRGs).
 Patients are released from the hospital early
and receive home visits by a skilled
professional.
 Patient benefits by exposure to fewer
pathogens, lowered stress and anxiety, and
decreased cost.
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Section 2-2
Apply Your
Knowledge
What can be done to contain the
cost of health care?
Answers:
1. Home health care.
2. Ambulatory care.
3. Preventive care/wellness.
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Health Care Facilities 2-3
 Hospitals
 Long-Term Care
 Practitioners’ Offices
 Clinics
 Laboratories
 Emergency Medical Services
 Home Health Care
 Rehabilitation
 Hospice
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Hospitals
 Hospitals Run by Religious
Organizations
 Private Hospitals
 Nonprofit Hospitals
 Hospitals Run by Government
Organizations
 Specialized Hospitals
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Long-Term Care
 Residents may be frail, elderly,
handicapped, or disabled.
 Residents seen by the physician
monthly.
 Assisted-living centers offer separate
living quarters, and provide meals
and housekeeping.
 Some residents are able to perform
many of their own activities of daily
living (ADL).
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Practitioners’ Offices
 Many offer testing and
minor surgery.
 Dentists and dental
hygienists are
included in this group.
 May be an individual
or a group practice.
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Clinics
 Practitioners have separate clients,
but share billing, reception, and
record-keeping staff.
 Clinic may specialize or offer a wide
variety of services.
 “Clinic” may refer to a type of care
provided on a specific day and may
move from location to location.
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Laboratories
 May perform tests on blood or
body tissues.
 Can be part of a clinic or hospital.
 Some are supported by public
money.
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Emergency Medical Services
 Developed to provide care to ill and
injured as quickly as possible.
 May be part of the 911 phone system.
 Police officers, firefighters, and
ambulance staff may perform EMS.
 In rural areas, volunteers, park
rangers, or ski patrol may provide
EMS.
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Home Health Care
 Can be considered another type
of health care facility.
 May be long term or short term.
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Rehabilitation
 Designed to help clients regain
physical or mental abilities or to
help them live with disabilities.
 May be part of a hospital, clinic,
or privately owned.
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Hospice
 Services are
provided to the
terminally ill.
 Includes treatment
from doctors,
nurses, therapists,
dieticians, social
workers, clergy, and
volunteers.
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Hospice (cont.)
 Therapy is designed to:
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Improve quality of life.
Use pain medications effectively.
Relieve symptoms.
Prepare the person and his or her
family for death.
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Section 2-3
Apply Your Knowledge
What are four types of care that may
be provided in a long-term care
facility?
Answer:
1. Regular professional health care services
2. Therapy
3. Physical rehabilitation
4. Skilled nursing care
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Health Care Agencies 2-4
 Government Agencies
 Volunteer and Nonprofit Health
Agencies
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Government Agencies
 Local Health Departments
 Provide immunizations, inspections, and
environmental protection.
 Collect statistics about communicable
diseases.
 May provide health education and other
health-related services to the community.
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Government Agencies (cont.)
 U.S. Department of Health and
Human Services (DHHS)
 National agency that deals with health in
the United States.
 Important agencies under DHHS include:
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Centers for Disease Control (CDC).
Food and Drug Administration (FDA).
National Institute of Health (NIH).
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Government Agencies (cont.)
 World Health Organization (WHO)
 International agency sponsored by
the United Nations.
 Primary goal is to help all people
attain the highest possible level of
health.
 Compiles statistics on disease.
 Provides training for medical
personnel.
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Volunteer and Nonprofit
Health Agencies
 Can be on the state, local, or national
level.
 Supported by private contributions and
fund-raising.
 Usually focus on a single disease.
 Examples include:
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 American Lung Association (ALA).
 March of Dimes.
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Section 2-4
Apply Your Knowledge
What are three ways volunteer and
nonprofit organizations have contributed
to health and health care?
Answer:
1. Influenced laws.
2. Created standards of care for infants.
3. Educated doctors and other health
professionals in new techniques.
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Health Insurance 2-5
 Paying for Health Care
 Medicare and Medicaid
 Managed Care
 Workers’ Compensation
 Military Health Care
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Paying for Health Care
 Insurance company decides what
medical services will be covered.
 Group insurance coverage is offered to
employees by many employers.
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Medicare and Medicaid
 Programs are result of federal
legislation.
 Programs target people who lack access
to care.
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Medicare
 Largest health insurance program
in the nation.
 Must be at least 65 years old or
disabled to qualify.
 Part A provides for hospital care,
limited skilled nursing facility
services, home health services, and
hospice care.
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Medicare (cont.)
 Part B helps pay for the services of
physicians, outpatient hospital
services, and medical equipment
and supplies.
 The insured pays a premium for
Part B and may have to pay a
deductible or have other private
insurance.
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Medicaid
 Government
insurance for
certain lowincome people.
INDIANA MEDICAID
AND OTHER MEDICAL ASSISTANCE PROGRAMS
 Dental coverage
may be available.
 No co-payment or
deductible.
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07/19/62
001
Managed Care
 Health care plans specifically designed to control
costs.
 Advantages
 Most include preventive care, such as annual
physicals, mammograms, and well-baby
care.
 Monthly premiums and out-of-pocket
expenses are usually lower than with
traditional insurance.
 Reduced paperwork.
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Managed Care (cont.)
 Disadvantages
 Limited choice of doctors and hospitals,
except for emergency treatment.
 Must be referred to specialist by primary
care physician.
 Usually more restrictive than ordinary
insurance.
 Not all health expenses count toward
deductible.
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Health Maintenance
Organizations
 Focus on prevention and wellness.
 Businesses or individuals pay
premiums to the HMO instead of
an insurance company.
 HMOs focus on wellness care not
usually covered by insurance.
 Popular in the 1980s and 1990s.
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Workers’ Compensation
 Insurance that covers accidents,
injuries, or diseases that occur in
the workplace.
 Federal law requires businesses to
purchase and maintain a
minimum amount of workers’
compensation insurance.
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Workers’ Compensation (cont.)
 Types of services provided for
injuries occurring in the workplace:
 Basic medical treatment for inpatient and
outpatient care.
 Weekly payments to employees for temporary
disabilities.
 Monthly payments to employees with permanent
disabilities.
 Death benefits.
 Rehabilitation costs.
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Military Health
Care
 Provided to current military
personnel, retired military
personnel, and veterans
through
CHAMPUS/TRICARE
program.
 Public Health Service and
National Oceanic and
Atmospheric Administration
Chapter 2 are also covered by this
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Section 2-5
Apply Your Knowledge
List 3 advantages to managed care.
Answer:
1. Most policies include preventive care.
2. Monthly premiums and out-of-pocket
expenses are lower than with traditional
insurance.
3. Paperwork is reduced, and there are no
claim forms.
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Chapter 2 Credits
Slide 16
Grantpix/Photo Researchers
Slide 20
Healthcare Medical Communication
Systems, Inc.
Slide 21
Daniel Miller/CORBIS
Slide 26
PhotoDisc
Slide 29
Doug Martin
Slide 30
KS Studios
Slide 33
Ron Chapple/Getty Images
Chapter 2
Slide 35
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Matt Meadows