The introduction to the course and an introduction to the U.S. Health Care System

1. Health and the Health Care System Week 1 BNURS 323 Healthcare Politics and Policy Summer 2009

2. Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

4. Retrieved Nov/2008 from http://www.thewellspring.com/wellspring/introduction-to-wellness/357/key-concept-1-the-illnesswellness-continuum.cfm

5. Jean Watson’s 10 carative factors The formation of a humanistic-altruistic system of values The instillation of faith-hope The cultivation of sensitivity to one’s self and to others The development of a helping-trusting relationship The promotion and acceptance of the expression of positive and negative feelings

6. Jean Watson’s 10 carative factors cont’d The systematic use of the scientific problem-solving method for decision making The promotion of interpersonal teaching-learning The provision for a supportive, protective, and (or) corrective mental, physical, sociocultural, and spiritual environment Assistance with the gratification of human needs The allowance for existential-phenomenological forces (Watson, 1985, p. 9-10)

7. Non-caring 1986 study by Riemen found three themes emerging from patients descriptions of non-caring nurse behaviors: Physically present—emotionally distant Belittling and inhumane actions Devaluation of the patient as a unique individual

8. Patient satisfaction Care is the human service quality that makes health consumers either satisfied or dissatisfied with health services and it is the care not the cure that consumers really value. Question for Class: Do we value (health care provider) professional satisfaction? Where does it come in?

9. Health Services versus Health Care Service: Work done by one person or group that benefits another (Retrieved 6/22/09 from wordnet.princeton.edu/perl/webwn) Health care: Implies enactment of caring theory, patient satisfaction Health care services: implies combination of services and caring

10. Health care system Illness industry: a capitalist institution Focus on illness and injury versus prevention of problems and maintenance and promotion of health Care versus service versus profit Non-profit out-of-date term, now not-for-profit because business management same as for-profit

11. Health Maintenance =Health Protection Activities that preserve present health Primary prevention Health supervision Monitoring and surveillance

12. Health Promotion Risk Reduction Health Education: nutrition, physical activity, injury prevention, sleep, OTC medications, when to call MD and use of health care system, immunizations Anticipatory Guidance Physical G&D Psychological and emotional G&D Socialization, interactions, behavior

13. Public Health (One) Definition of public health: effort organized by society as a whole to protect, promote, and restore health Focus is on what requires group effort to accomplish as opposed to individual effort In U.S., mixed knowledge, attitudes, and beliefs about government, role of society in individual life

14. Economics, Politics, and Policy Economics: Study of distribution of scarce resources Politics: Study of power over the distribution of scarce resources; social relations involving authority or power Policy: A policy is typically described as a deliberate plan of action to guide decisions and achieve rational outcome(s). Retrieved 6/22/09 from http://en.wikipedia.org/wiki/Policy

15. Public Health Policy http://www.cdc.gov/nceh/ehs/EPHLI/core_ess.htm Policy Development as one of the Core Functions of Public Health: Assessment, Policy Development, Assurance

16. Public Health Core and Essential Functions (from webpage previous slide) Assessment Monitor environmental and health status to identify community environmental health problems Diagnose and investigate environmental health problems and health hazards in the community Policy Development Inform, educate and empower people about environmental health issues Mobilize community partnerships to identify and solve environmental health problems Develop policies and plans that support individual and community environmental health efforts Assurance Enforce laws and regulations that protect health and ensure safety Link people to needed environmental health services and assure the provision of environmental health services when otherwise unavailable Assure a competent environmental health workforce Evaluate the effectiveness, accessibility and quality of personal and population-based environmental health services Conduct research for new insights and innovative solutions to environmental health problems and issues

17. Questions for Class Given the definitions of politics and policy, what is the relationship between them?

18. Health Care System Providers: Hospitals, physicians (those who can bill third party payers directly for their services) In-patient/Out-patient: Hospital as basis of orientation; where does ED fall? Clinic, out-patient surgery, free-standing birth center Urgent care center, doc-in-the-box

19. Hospitals Public: Federal, state, county, city Community=voluntary=not-for-profit Proprietary=for profit

20. Questions for Class What is missing from this consideration of the health care system? (hint—who are we?) What/who makes the decision for in-patient care/admission to the hospital?

21. Medical therapeutics MDs: Diagnose and treat. How treat? Prescription of medications: Drugs and herbs Drug categories: Legend (scheduled and non-scheduled); OTC Surgery: historically done by barbers until discoveries of anesthesia and antisepsis Counseling: lifestyle advice and recommendations

22. Prevention Primary Prevention: prevention of occurrence of disease or injury. Code word—prevention. Secondary Prevention: prevention of progression of disease to symptoms. Code word—screening. Also early diagnosis and treatment. Tertiary Prevention: prevention of sequelae or severe consequences of disease. Prevent disability and death. Code word—rehab.

23. Public Health Allegory A man, walking along a riverbank, suddenly sees a person flailing his arms and hears him pleading for help as he bobs in the water while being pushed downstream. The man on the bank dives into the water, swims to the victim and rescues him by pulling him ashore. When the man turns toward the river, once again he hears someone screaming for help. Then another. And another. One after the other, the man pulls victims from the river.Exhausted, and pulling yet another victim to shore, he notices a woman walking by. “Help me!” he pleads. “All these people are drowning and I have to do something to save them. More people are falling in and need help. Look!” he says, pointing to the river where more victims are in the water and needing help.

24. Allegory cont’d Immediately, the woman starts to run upstream along the bank.“Where are you going?” he screams at the woman. “I need help now!”“I am helping right now,” says the woman. “I’m going upstream to find out how they’re falling into the river and to prevent that!” (Retrieved 6/22/09 from http://www.miph.org/blog/upstream-thinking)

25. Health and Health Care Given the definitions of health care and health, how are they connected? What does the research show is the connection between health care and health? Social and economic determinants of health: standard of living

26. Example: Tuberculosis http://ajrccm.atsjournals.org/cgi/content-nw/full/169/11/1181/FIG1

27. Historical Trends in Mortality From infectious disease and injury To chronic diseases Length of life has increased, quality of life now a concern for the old-old (> 85 y. o.) Premature death now more of a concern

28. Primary causes of death in U.S. 0-28 days: congenital anomalies 29-365 days: SIDS 1 year – 45 years: unintentional injuries, esp MVA (MVC) 45-65 years: 1. Cancer 2. unintentional injuries 65+: 1. cardiovascular disease 2. cancer