Overview Health Care Systems

Access to Health Care (Barriers)
Cost( out of pocket vs insurance), Language, culture, Location availability.
Acupuncture
Access human meridian system, form of palpatory medicine, encourages good chi to move throughout the body which is a life force.
Ayurvedic medicine
Says the body is made up of elements, pita = energy of fire, kappa = energy of building/lubrication/structure, vata = energy of movement, and all must be in balance.
Agency for health care research quality (AHRQ)
Uses evidence to make health care safer, higher quality, more accessible, equitable, and affordable. Also to work with US department of health and human services and others to make sure the evidence is understood and used. Quality indicators are used to quantify the performance of health providers: Prevention quality indicator (PQI) is used to identify hospital admissions that could’ve been avoided. Inpatient quality indicator (IQI) quality of care inside the hospital. Patient safety indicators (PSI) quality of patient care with mortality rates concerned with complications that could’ve been avoided.
Affordable Care Act – Goals/Key Provisions
-New consumer protections: protects the who are purchasing insurance and who have insurance from a companies scheme to get more money or being denied. (refuse to sale bc preexisting conditions, deny children, charging higher bc gender, website to compare health coverage)
-Improving Quality and Lowering Costs: Improves the quality of the publics health by funding PH initiatives, innovations, screening for mammograms& colonoscopies, lowering drug costs for the elderly, pay physicians based on value
-Increase access to affordable care: Makes getting health care easier for those who are sick, young, and elderly. Expands health care.
-Holding insurance companies accountable: For large biz 85% of Premium dollars must be spent on health care. For individuals it is 80%.
Aging population – impact on cost
Large consumers because almost everyone 65 and older is eligible for medicaid. More people on medicaid than paying for it. Older people require more care but rarely pay for it.
Allopathic medicine/allopathy
Combat disease by the use of remedies such as drugs or surgery. Producing effects that are different from those that are produced by the disease.
Age-specific death rate
(Deaths of persons in age range/Total pop. in age range) * 1000
Availability of care vs access
People in certain locations may be able to access health care but certain services may not be available to them.
Anesthesia and asepsis as medical advances
Began by using chloroform and whiskey then developed anesthesia for surgeries and other procedures. Asepsis refers to proper sterilization techniques. Surgical fatalities increased after anesthesia but decreased after asepsis.
Balance
Need proper balance in order to maintain humors. Rebalancing was often done with opposites. (hot and dry sunburn would be treated with cool & wet treatment like tree bark)
Baylor plan
This plan enlisted 1250 public school teachers at 50 cents a month for a guaranteed 21 days of hospital care. This plan aimed to accomplish to goals:
1)Get people spending money on health care
2)Get people to use their health care more often meaning they didn’t just go to the hospital when death was knocking.
-This is blue cross’s front running campaign.
Bloodletting
The withdrawing of a patients blood to prevent or cure a disease or illness. based on ancient properties of medicine where blood and other bodily fluids were regarded as humors and had to maintain proper balance for health. Risk in losing too much blood, drop in blood pressure causing cardiac arrest.
Behavioral risk factor surveillance system (BRFSS)
A US telephone survey that collects data about health related risk behaviors, chronic health conditions, and use of preventative services. Over all goal is to serve as a tool to build targeted health promotions. Improve health status of minorities. Advocates for Adverse childhood experiences (provides info on child abuse and experiences). Sexual orientation and gender identity (improvement for LGBT community). Alzheimers association (funding data collection for cognitive impairment). BRFSS allows for identification of ways to reduce health disparities, disease prevention and health promotion is improved, achieve health objectives among pop. especially for minorities.
Challenges of cost containment
One persons cost is another’s income. System savings are not necessarily payer’s or states. Cost shifts have multiple participants and time horizons. Leaving some uninsured may appear to save money but actually inflates costs. A preventable ill ness that is not prevented may cost tax payers. Uninsured people do get care but only when sick enough to be hospitalized.
Crude death rate
# of deaths in a specific geographical area in a given year. (# of deaths/ mid yr. population) *1,000
Disease
what you have. a physical state non-normal, harmful to the individual, measurable deviation from normality. Causes may be an interplay of genetics, behavior, and environment. May be acute (sudden onset, short duration) or Chronic (slow, insidious onset, long-term, possibly life long. Origin may be parasitic, infectious, communicable, viral, bacterial, genetic, behavioral, etc).
Emergent issues in public health
Empiricism
Treatments from pre-scientific heath that work. Could be natural and resembles a real drug. Could be discovered from treating something separate. Health systems that only treat causes that they recognize. Most pre-scientific health systems still incorporate empirically correct treatments. Modern medicine still discovers uses through empiricism.
Employment Retirement Income Security Act ERISA – impact on health insurance
Employers must fund pension plans sufficiently so they can pay out promised benefits when employees retire even even after bankruptcy; preempts state laws; cannot be sued and usually aren’t required for payouts if they do.
Etiology
the root cause of disease or illness.
Folk Medicine/Folk Medical Beliefs
4 types of healing: undifferentiated traditional (fold aloe, urine), undifferentiated modern/scientific (vitamins,OTC’s), differentiated traditional (shamans, voodoo, homeopathy), and differentiated modern/scientific (physicians, dentists); palliative (deals with the symptoms not curing the root problem).
Health insurance exchange
included in the ACA, subsidizes insurance plans to make them more affordable, also allows for the purchase of plan despite a pre-existing condition.
HMO Act of 1973
Non prof orgs. Were responsible for delivering health care to patients while controlling cost. (organization responsible for the financing and delivery of comprehensive health services to an enrolled population for a prepaid, fixed fee) developed these through grants to combine insurance and health care and included primary care and prevention services.
H pylori (and peptic ulcer disease)
Bacteria in the gut that can lead to stomach ulcers and stomach cancers and can be eliminated with antibiotics. Gastroenterologists were skeptical until Barry Marshall experimented on himself.
Humoral model of disease
The 4 humors (Back bile- liver, Yellow bile- pancreas, Blood- Heart, Phlegm- Brain) must be in correct amount, thickness and coction in order to be healthy; allopatric to treat people with opposite.
ICD-9-CM and ICD-10 (International classification of disease)
ICD 9 says what the the general illness or injury is along with the cause/manifestation, and any extra information. ICD-10 says the same thing except for the region of the body that is affected and the first encounter; switching helps with international communication and increases quality of care.
Illness
How you feel, experiencing symptoms. Stages include: Symptom recognition, lay consultation, professional consultation, patient hood, return to normal.
Infant mortality
(#Deaths from birth-1yr/# live births) *1000=PrenatalMortalityRate. Mostly reflects the environment and quality of life for an infant: feeding, shelter, medical care, parenting. Neonatal mortality + Post neonatal mortality = infant mortality. 75-85% is neonatal in developed countries.
Interest groups
Federal and state executive get pressure by these groups (providers, insurers, consumer, business, and labor)
Iron Triangle
comprises of the three competing health care issues, access, quality, and cost containment. Says there is no way to do all three at the same time.
Managed Care and Backlash
Complaints by providers and consumers about overly restrictive practices caused employers to offer CDHP (Consumer driven health plan) for more freedoms.
McAllen, TX healthcare costs
Health care costs were significantly higher in this city despite their health being congruent with the rest of the world. This was found to be because of overspending when it came to ordering tests and procedures.
Opposition to medicare
Medical loss ratio (MLR)
The amount of money spent on premiums on actual medical expenses. A low MLR means that less was spent on their members and more went towards companies profits.
Morbidity
Presence of disease illness or sickness; incidence (# new cases) vs prevalence (total # cases); acute vs chronic
Morbidity measures and problems
pathology(examines or body tissues) present, organ disfunction (impairment), Organism dysfunction (disability), uncorrectable dysfunction (handicap), feeling poor (illness), and impaired social function (sickness)…..reporting issues, diagnosis from access, preventable diseases, social causation.
Mortality
Death within a population; crude death, cause-specific death, infant deaths.
Neonatal mortality
Death during the first 28 days of life, can reflect maternal factors (smoking, alcohol, nutrition, genetics). (# deaths 0-1 month/# of live births) * 1000
Oregon death with dignity act
Made physician assisted suicide legal when certain criteria are met
Palliation/palliative treatment
To treat symptoms of illness and not cure root cause.
Population health model
Health of a group of individual, also explaining outcomes within the group. Explains and intervenes in the causes of systematic differences in health among different population groups. 4Health determinate are assessed in combination, including: The social and economic environment, physical environment, Health related behavior, genetics and medical care.
Postneonatal mortality
(#Newborns who die between 28-364 days in a specific area/# resident live births from same area) *1000. Reflection of the environment and quality of life (feeding, shelter, medical care).
Public Health – Role of governments
All parts of the government must play a part in maintaining the publics health at the national ,state, and local levels. The have partnered with organization such as hospitals businesses, churches, schools, public transportation, health care providers, etc..
Remote area medical
Rural health systems/hospital closures
Rural health systems often struggle to provide various services. Federal and state programs have started non profit organizations and works with the community to help enrolled counties. With increasing cost and decreasing population hospitals have closed and hospitals provide economy and jobs. Have switched from inpatient care to outpatient care and ambulatory care.
Sickness
What you do sociologically opposed to biologically or physiologically. Inability to perform usual roles as the result of disease or illness.
Small area variations in health care
Small towns with fewer medical facilities, fewer physicians and less specialties see fewer surgeries and procedures than larger areas.
Doctrine of Specific Etiology
All disease is caused by agents which are identifiable as germs, parasites, trauma, and bacteria.
stakeholders in the health care system
Patients, physicians, insurance companies, pharmaceutical companies, employers and government. Stakeholders are anyone who is involved in the health care system and would be significantly affected by reforms to the system.
Technology on cost
Provides earlier diagnosis and early screening but also delays health which increases end of life care which cost lots of money in the long run.
US health care system
US health care system spends the most money per capita on health care compared to other nations with almost the least amount of efficiency. We have the highest GDP. Most privately funded system in the world. We excel in research and development and emergency medicine.
Vital statistics
Stats concerning human life such as quantitative data like marriages, births, and deaths not including disease rates.

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