Current Trends in Health Care AND health care delivery

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Current Trends in Health Care AND health care delivery
2013-10-20 19:06:33
Health Care

Health Care lectures 1 and 2
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  1. High Health Standard
    • Health care professionals need to ne licensed
    • Providers an facilities need to be certified
    • Drugs and devices need to be approved and regulalted
  2. paradoxes of the US Health Care Systems
    • high rate of medical errors
    • inadequate/dangerous care
    • disparities in access to importnat health care resources
    • unisured population
    • high health care expenditure
    • deficiency of health care workers
  3. advantages of technology on health care system
    • improve quailty of life
    • quicker diagnoses and better treatment
    • increased life expectancy
  4. disadvantages of technology in the health care system
    • expectations of the best care available
    • excess use of technology
    • deficient assessment of cost and effectiveness
    • disease-centered care instead of patient-centerd care
    • unequal access to technology
  5. Dimensions of performance of the health system
    • long, health and productive lives
    • access
    • quality 
    • efficiency 
    • equity
    • (under preformance on all of those dimesions
  6. before 5th century BC health was perceived as_____ and disease was percieved as _________
    • health :"devine gift"
    • disease "divine punishment"
  7. Hippocrates
    attempted to remove the supernautral as the cause of disease
  8. humoralism
    naturalistic explantion of the health/ disease
  9. Galenous (Galen)
    • prefected Hippocrates' ideas
    • health as a balance of our 4 fluids: blood, yellow bile, black bile, and phlegm
  10. World Health Organizations definition of Health (WHO)
    a state of complete, physical, mental, and social well-being, and not merely the abscenece of disease
  11. Health Care
    • Merriam- Webster: The maintaining and restoration of health by the treatment and prevention of disease especiialy by trained and liscensed professionals (as in medicine, dentistry, clinical psychology, and public health)
    • prevention, diagnosis, and treatment od disease, condition, and/or injur
  12. health care system
    a health system consists of all organizations, people, and acions who primary intent is to promote, restore, or maintain health
  13. epidemiology
    cause of disease
  14. 19th Century Health Values
    • Cause of disease: human sin, environmental (miasmic), unhelathy life style
    • share values- humoralism "interconnected whole"
  15. 16th- 18th Century Health Values
    • treatment: combo of folklore and magic
    • minerals, plants, and herbal remedies
    • medications used in Europe: Mercury and opium preparations
    • Native American Remedies: cinchona bark  (quinine)
  16. Health, disease, and treatment 19th century
    • every part of the body was related inevitably and inextricably with every other. 
    • In health the body's system was in balance
    • in disease, the body lost its balance and suffered disequilibrium
    • if health practitioners were able to treat effectively, the needed the knowledge of individual pts and the body's system of intake and outgo
  17. drugs in the 19th century
    • drugs had to be seen as adjusting the body's internal equilibrium 
    • in addition, the drug's action had, if possible, to alter there visible products of the body's otherwise instructable internal state
  18. 19th Century: orthodox physicians
    • mainstream or regular
    • treatment: "heroic medicine" : physicians bled, purged, sweated sweated their patients
    • Drugs: listed by the physiological effects: diuretics, emetics, narcotics, diaphoretics
  19. 19th century sectarians
    • irregular
    • treatment: alternative practice
    • drugs: folk, medicines, straightening tonics and astringents, temperance from alcohol, homeopathy, small dose therapeutics, regimens of fresh air, exercise, hydropathy (water cures)
  20. First half of the 19th Century: pharmacists
    • fast development of commercial manufacture of proprietary medicines
    • pharmacists open stores where they would fill the prescriptions and compound drugs
    • pharmacists shifted their allegiance from the physicians to the pt (counter prescribing, diagnosing, and treating
  21. second part of the 19th century pharmacists
    • "pt medicine": affordable medicines, manufactured in small factories, advertised in newspapers, home delivered (until 1860)
    • new role of the pharmacist retailer
  22. 19th Century legislation
    • role of the social reformers and public officials
    • production and distribution of pt medicine "quakery"
    • efforts to warn the public that the pt medicines are dangerous and to pass the nation legislation regulating the industry
  23. 19th century Health Care Service
    • delivered at home, physician's office, drugstore, and cure establishment from the upper and middle class
    • the working class and the lower class when sick will try to avoid seeking service from a physician (orthodox or sectarian) to avoid cost
  24. poorhouse or almshouse
    place to protect the community from the infectious or poor
  25. First half of the 19th century hospitals
    • were institutions with charitable and welfare function 
    • distinguished members of the community served as trustees
    • untrained caretakers
    • poorhouse or almshouse: places to protect the community from the infectious or poor
    • place where pts usually dies
    • no aseptic practice 
    • physicians from upper-class families provided free care
  26. 19th century hospitals charitable dispensaries
    • lower class
    • urban, new immigrant neighborhoods
    • outpt services: prescribing medication therapies, dental work, and minor surgeries
    • employees: a steward, a house physician (druggist)
  27. second half of the 19th century hospitals
    • after the Civil War, number of hospitals reached 6000
    • mental facilities, children hospitals, tuberculosis sanitariums
    • sponsored from religious organizations, ethnic associations, women's groups, physician groups, African- American association
  28. Medical 'clinic' at Cook County Hospital
  29. 20th Century: hospitals
    • Modern hospital
    • 1946 National Hospital Survey and Construction Act: federal funding
    • increase in govnt influence in medical education and research and operation in hospitals
    • pt-centered care for customer satisfaction
    • multidisciplinary teams
    • hospitals are "more pleasant, comfortable, and user friendly"
  30. First half of the 20th century: medicine and pharmacy
    • 1900: 38,000 drugstores in US (one store per 2,000 people)
    • drugstore independent owned store or shop-provided different services and products: soda fountains, perfumes, phone booths, candy
    • chain drug store 
    • "golden age" reputable profession
    • Flexner report, discovery of penicillin, and eradication of typhoid fever, cholera, diptheria
  31. Flexner Report
    • 1910
    • accreditation standards for medical school increased
    • admission standards for medical students increased
    • number of schools and enrolled students reduced
    • Medical education by scientific method
    • Hospitals became teaching and research centers
  32. 1928
    discovery of penicillin by A. Fleming
  33. 1930
    eradication of typhoid fever, cholera, diphtheria
  34. Second Half of the 20th century: medicine pharmacy
    • production and use of antibiotics change health care 
    • occurrence of infectious diseases leading cause of death decreases and occurrence of chronic conditions such as heart disease and cancer increases
    • focus on sub-cellular and molecular mechanisms of disease
    • biomedical model of care
    • 1980: eradication of the smallpox worldwide
    • 1981: first cases of AID appear in the US
  35. 1980
    eradication of the smallpox worldwide
  36. 1981
    first cases of AIDS appear in the US
  37. 20th Century: Health Policy Overview
    • 1906: Pure Food and Drug Act
    • 1912: Children's Bureau was established
    • 1921: Sheppard- Towner Maternity and Infancy Act
    • 1930: National Institutes of Health and the Veteran Administration established
    • 1937: National Cancer Act
    • 1938: Food, Drug, and Cosmetic Act
  38. Pure Food and Drug Act
    • 1906 
    • address accurate labeling
  39. Shappard- Towner Maternity and Infancy Act
    • 1921
    • federal funding for supporting children's health clinics
  40. workers compensation or compulsory sickness insurance
    • 1914 
    • provided cash payments for workplace related injuries or disease
  41. National Cancer Act
    • 1937
    • biomedical research
  42. Food, Drug and Cosmetic Act
    • 1938
    • Elixir Sulfanilamide scandal of 1937
  43. Medicare
    • Part A for hospital coverage
    • Part B for medical insurance: physicians and other medical services
    • 1972: adds people with disabilities from any age and those with permanent kidney failure
  44. Medicaid
    federal and state program for the low-income elderly or disabled and families with children
  45. Health Insurance Portability and Accountability act
    • 1996
    • a max of a 12-month waiting period for employee coverage usage and dissemination of health insurance information
  46. Children's Health Insurance Program
    • 1997
    • health insurance for children without coverage
  47. Medicare Prescription Drug, Improvement, and Modernization Act
    Medicare part D: voluntary rx drug benefit program
  48. 21st Century Hospitals
    • main focus on pt centered care
    • electronic record keeping
    • inter-professional education in academic hospitals 
    • outcomes
  49. outcome
    improved health quality and efficiency and reduction of medication errors