Health Care Health Care SystemsSystems

Health Care FacilitiesHealth Care Facilities Places that provide care or make it possible Places that provide care or make it possible

for some type of care to be delivered to for some type of care to be delivered to patientspatients

HospitalsHospitals– ReligiousReligious– Private (generally for profit)Private (generally for profit)– Nonprofit – any profit returned to the institution to Nonprofit – any profit returned to the institution to

pay for updates, expansionpay for updates, expansion– Government - funded by taxes (Military, Veterans)Government - funded by taxes (Military, Veterans)– Specialized – specialize in groups of patients or Specialized – specialize in groups of patients or

specific diseases/treatments (cancer, children, specific diseases/treatments (cancer, children, etc.)etc.)

Health Care FacilitiesHealth Care Facilities Long-Term CareLong-Term Care

– Provide nursing or other professional Provide nursing or other professional health care services on a regular basishealth care services on a regular basis

– Patients may not be safe to live alone or Patients may not be safe to live alone or may have needs their family cannot meetmay have needs their family cannot meet

– Generally see doctors on a monthly basisGenerally see doctors on a monthly basis– Private, non-profit, state/federally fundedPrivate, non-profit, state/federally funded

Assisted-Living CenterAssisted-Living Center Skilled Nursing FacilitiesSkilled Nursing Facilities

Health Care FacilitiesHealth Care Facilities Private OfficesPrivate Offices

– Individual and group practicesIndividual and group practices ClinicsClinics

– Share office and support staff but have Share office and support staff but have their own patientstheir own patients

– May specialize or combine different May specialize or combine different specialties – medical care plus allied specialties – medical care plus allied health carehealth care

– Mobile clinicsMobile clinics

Health Care FacilitiesHealth Care Facilities LaboratoriesLaboratories

– Specimen testingSpecimen testing– May be part of a hospital or May be part of a hospital or

independentindependent Emergency Medical ServicesEmergency Medical Services

– Provide care to ill and injured people Provide care to ill and injured people as quickly as possibleas quickly as possible

– Moving out in to the communitiesMoving out in to the communities

Health Care FacilitiesHealth Care Facilities HospiceHospice

– Multidisciplinary care for patients who Multidisciplinary care for patients who have a terminal illness – generally fewer have a terminal illness – generally fewer than six months to livethan six months to live

– Focuses on the ill person & family, not Focuses on the ill person & family, not the diseasethe disease

– Goal is to reduce pain and other Goal is to reduce pain and other symptoms and provide emotional symptoms and provide emotional supportsupport

– Generally provided in patient’s homeGenerally provided in patient’s home– Hospice centers are availableHospice centers are available

Health Care AgenciesHealth Care Agencies Government AgenciesGovernment Agencies

– Mainly conduct research, oversee Mainly conduct research, oversee programs and establish health care programs and establish health care policiespolicies

– ExamplesExamples National Institutes of HealthNational Institutes of Health U.S. Department of Health & Human ServicesU.S. Department of Health & Human Services World Health OrganizationWorld Health Organization Local Health DepartmentsLocal Health Departments Center for Disease Control & PreventionCenter for Disease Control & Prevention Food & Drug AdministrationFood & Drug Administration

Local Health Local Health DepartmentsDepartments

Provide immunizations, inspect Provide immunizations, inspect restaurants, oversee protection of restaurants, oversee protection of the environmentthe environment

Collect statistics about Collect statistics about communicable diseasescommunicable diseases

Health education, community Health education, community health-related serviceshealth-related services

U.S. Dept of Health & U.S. Dept of Health & Human Services (DHHS)Human Services (DHHS) President appoints Secretary of President appoints Secretary of

Health & Human Services – advises Health & Human Services – advises on matters of health and welfareon matters of health and welfare

Provide services to needy children & Provide services to needy children & families, at-home services to elderlyfamilies, at-home services to elderly

Reduce medical errors & costs, and Reduce medical errors & costs, and improve quality of health careimprove quality of health care

Centers for Disease Centers for Disease Control & Prevention Control & Prevention

(CDC)(CDC) Agency of DHHSAgency of DHHS Monitors and prevents the Monitors and prevents the

outbreak of diseasesoutbreak of diseases International disease transmission, International disease transmission,

national health statistics, researchnational health statistics, research Ensure health and safety of the Ensure health and safety of the

nationnation

Food & Drug Food & Drug Administration (FDA)Administration (FDA)

Agency of DHHSAgency of DHHS Ensure the safety Ensure the safety

of foods and of foods and cosmetics, and cosmetics, and the safety and the safety and usefulness of usefulness of medications and medications and medical devicesmedical devices

National Institutes National Institutes of Health (NIH)of Health (NIH)

Agency of DHHSAgency of DHHS World’s premier World’s premier

medical research medical research organizationorganization

Cancer, Cancer, Alzheimer’s, Alzheimer’s, diabetes, arthritis, diabetes, arthritis, heart disease, heart disease, and AIDSand AIDS

World Health World Health Organization (WHO)Organization (WHO)

International, sponsored International, sponsored by the United Nationsby the United Nations

authority on international authority on international healthhealth

Goal is to help all people Goal is to help all people attain the highest possible attain the highest possible levels of healthlevels of health

International health International health statisticsstatistics

Volunteer & Non-Profit Volunteer & Non-Profit Health AgenciesHealth Agencies

Supported by Supported by private fund-private fund-raisingraising

Most deal with a Most deal with a specific disease or specific disease or group of diseasesgroup of diseases

Provide funding for Provide funding for research and research and promote educationpromote education

May also provide May also provide services to patientsservices to patients

Great influence on Great influence on laws & standardslaws & standards

Examples:Examples:– American Lung American Lung

AssocAssoc– March of DimesMarch of Dimes– American Heart American Heart

AssocAssoc

Current World Health Current World Health IssuesIssues

AIDS/HIVAIDS/HIV TuberculosisTuberculosis Severe Acute Respiratory Severe Acute Respiratory

Syndrome (SARS) Syndrome (SARS) Tobacco controlTobacco control Traveler’s healthTraveler’s health PolioPolio Maternal healthMaternal health Road SafetyRoad Safety

National Health CareNational Health Care The U.S. health care system is a The U.S. health care system is a

mix of public and private programs mix of public and private programs with many people falling between with many people falling between the cracks.the cracks.

There are enormous gaps in the There are enormous gaps in the insurance coverage available and insurance coverage available and level of benefits to people of level of benefits to people of similar circumstances.similar circumstances.

National Health CareNational Health Care Is health care a right or a privilege?Is health care a right or a privilege? We assure a free, public education to all We assure a free, public education to all

children – how about affordable access to children – how about affordable access to at least basic health care?at least basic health care?

Canada ,United Kingdom, Singapore Canada ,United Kingdom, Singapore guarantee all citizens universal health guarantee all citizens universal health care – “medically necessary” services.care – “medically necessary” services.

Health care services are available on the Health care services are available on the basis of need, not on the ability to pay for basis of need, not on the ability to pay for services.services.

National Health CareNational Health Care Canada - Canada - ProsPros

– 30 million citizens (comparable to Calif).30 million citizens (comparable to Calif).– Patient goes to physician of choice; no Patient goes to physician of choice; no

deductibles, co-payments, limits, or deductibles, co-payments, limits, or forms.forms.

– *80 billion spent annually and 70% is *80 billion spent annually and 70% is publicly funded – no private insurancepublicly funded – no private insurance..

– Providers/facilities receive global Providers/facilities receive global operating budgets.operating budgets.

– No public awareness of actual costs.No public awareness of actual costs.

National Health CareNational Health Care Canada – Canada – ConsCons

– No limits on demand, patients seek as No limits on demand, patients seek as much health care as desired.much health care as desired.

– No physician pay raisesNo physician pay raises since 1993. since 1993.– Sharp Sharp decline in quality of servicesdecline in quality of services..– Huge wait time for specialist careHuge wait time for specialist care..

Heart bypass = 18.2 week wait.Heart bypass = 18.2 week wait. Gynecologist = 11.6 week wait.Gynecologist = 11.6 week wait. Orthopedic Surgery = 20.7 week wait.Orthopedic Surgery = 20.7 week wait. General Surgery = 7.1 week wait.General Surgery = 7.1 week wait.

– Rationing of careRationing of care..

National Health CareNational Health Care Is national health care the answer?Is national health care the answer? Other options?Other options?

– Medical savings account.Medical savings account.– Soft mandate Soft mandate that if you don’t take that if you don’t take

advantage of available insurance you advantage of available insurance you lose tax benefits and other gov’t lose tax benefits and other gov’t entitlements.entitlements.

– ““Pooling” to decrease insurance Pooling” to decrease insurance premiums and overhead.premiums and overhead.

Federal Initiatives – Federal Initiatives – Pres. BushPres. Bush

Health Care InitiativesHealth Care Initiatives– Health Savings AccountsHealth Savings Accounts

Out of pocket medical expenses, Out of pocket medical expenses, premiums during unemployment.premiums during unemployment.

Earn tax-free interest, rolled over year to Earn tax-free interest, rolled over year to year.year.

OBAMACAREOBAMACARE

Obamacare often also refers to the Obamacare often also refers to the Affordable Care Act (2010)(2010)

Improve/expand MedicaidImprove/expand Medicaid Expand employer coverageExpand employer coverage Improve Medicare for seniorsImprove Medicare for seniors Requires most people to have coverage as of 2014 or Requires most people to have coverage as of 2014 or

get exemption or pay feeget exemption or pay fee Tax deductions- Ex/small businesses may get tax breaks Tax deductions- Ex/small businesses may get tax breaks

for offering affordable insurancefor offering affordable insurance Establish a Health Care Marketplace (~comparative Establish a Health Care Marketplace (~comparative

shopping site)shopping site)

Future of Health CareFuture of Health Care The two areas of advancement The two areas of advancement

that will have the greatest impact that will have the greatest impact on the future of health care are:on the future of health care are:– Digital TechnologyDigital Technology– GeneticsGenetics

Future of Health CareFuture of Health Care Digital TechnologiesDigital Technologies

– Diagnostics/Imaging.Diagnostics/Imaging.– Remote medical care.Remote medical care.– Even shorter hospital stays.Even shorter hospital stays.

Home monitoring.Home monitoring.– Robotic medicine.Robotic medicine.– Injectable chips and computers.Injectable chips and computers.

Remote control by thought alone.Remote control by thought alone. Restore hearing, sight.Restore hearing, sight. Regenerative medicineRegenerative medicine Movement for paralyzed.Movement for paralyzed.

Future of Health CareFuture of Health Care GeneticsGenetics

– Most illnesses are influenced by our Most illnesses are influenced by our genes.genes.

– Predicting disease & response to meds.Predicting disease & response to meds.– New vaccines.New vaccines.– Human cloning, stem cells for Human cloning, stem cells for

replacement tissues.replacement tissues.– Universal code of life.Universal code of life.

Mix & match – scorpion into cabbage, etc.Mix & match – scorpion into cabbage, etc.– Designer babies.Designer babies.

Future of Health CareFuture of Health Care Get ready for the biggest shift in Get ready for the biggest shift in

values as people ask profound values as people ask profound questions about the meaning of life.questions about the meaning of life.– We are more than just complex We are more than just complex

machines.machines.– Emphasis on quality of life.Emphasis on quality of life.– Emphasis on the unique value of every Emphasis on the unique value of every

person.person.