1. Overview of
Healthcare Services
TMHG 541: Fundamentals of Health Care and
Medical Terminology
January 8, 2013
Nawanan Theera-Ampornpunt, M.D., Ph.D.
Health Informatics Division
Faculty of Medicine Ramathibodi Hospital
Mahidol University

2. 2
A Few Words About Me...
2003 Doctor of Medicine (1st-Class Honors), Ramathibodi
2009 M.S. (Health Informatics), University of Minnesota
2011 Ph.D. (Health Informatics), University of Minnesota
Currently
• Deputy Chief, Health Informatics Division, Ramathibodi
Contacts
@Nawanan @ThaiHealthIT
nawanan.the@mahidol.ac.th
SlideShare.net/Nawanan
www.tc.umn.edu/~theer002
groups.google.com/group/ThaiHealthIT

3. 3
TMHG 541
Course Overview

4. 4
Course Outline
• Health Care Delivery
• Overview of Healthcare Services
• Operations in the Clinical Settings
• Quality in Healthcare Organizations
• Clinical Processes and Judgment
• Case Studies
• Medical Terminology
• Basic Word Structure
• Prefixes/Suffixes
• Terminologies in Specific Areas

5. 5
Aims
• To introduce basic concepts of healthcare
services and medical terminologies
• To familiarize non-healthcare students to
healthcare context for their further study in
the curriculum

6. 6
Grading
• Class Attendance 10%
• Class Participation 30%
• Assignments 60%

7. 7
Outline
• Health
• Health Systems & Healthcare Systems
• Functions & Components
• Characteristics of a Desirable Health System
• Models of Healthcare Systems
• Healthcare Professionals
• Determinants of Health
• Major Issues in Health Care

8. 8
“Health”

9. 9
Class Discussion:
What Is Health?

10. 10
Health
• Health vs. Illness and Disease
• Medical Model:
Health = Absence of Illness or Disease
• So what’s the problem with this model?

11. 11
Problems with the Medical Model
• Emphasis on treatment of illness/disease
• Promotion and Prevention deemphasized
• Not true sense of the word “Health” but
rather just “Lack of ill health”
• So what’s a better model of health?
Shi & Singh (2004)

12. 12
The WHO Model & Definition
• “Health is a state of complete physical,
mental and social well-being and not
merely the absence of disease or infirmity.”
WHO Constitution (1948)
• Also known as biopsychosocial model of
health

13. 13
Holistic Health
• The well-being of every aspect of what
makes a person whole and complete
Physical
Spiritual
Holistic Mental
Health
Social
Shi & Singh (2004)

14. 14
Health Systems &
Healthcare Systems

15. 15
Health Systems
• A health system consists of all
organizations, people and actions whose
primary intent is to promote, restore or
maintain health.
• Includes efforts to influence determinants of
health as well as more direct health-
improving activities.
• More than the pyramid of publicly owned
facilities that deliver personal health
services. WHO (2007)

16. 16
Health Systems
• Includes
• A mother caring for a sick child at home
• Private providers
• Behavior change program
• Vector-control campaigns
• Health insurance organizations
• Occupational health and safety legislation.
• Inter-sectoral action by health staff, for
example, encouraging the ministry of education
to promote female education, a well known
determinant of better health. WHO (2007)

17. 17
Health Care
• Health care: Activities and services
performed to improve a person’s health and
well-being, through prevention and
treatment of illness.
• Similar terms
• Healthcare services
• Healthcare delivery
Adapted from Shi & Singh (2004)

18. 18
Healthcare Systems
• An organization that delivers healthcare
• In general, healthcare systems
• promote good health in populations
• balance levels of actual care provided
with the expectations of the population
they serve
• Narrower definition than WHO’s “Health
Systems”
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
18
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

19. 19
Healthcare Systems
• Different models of healthcare systems
• Purely public (care conducted by the state)
• Purely private (care conducted by independent,
privately funded organizations)
• Often a mixed model
• In countries with state run healthcare
system, a private system may coexist in
parallel or offer services not available under
the public system
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
19
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

20. 20
Healthcare Systems
• Privately owned, commercial organizations
may also act as healthcare systems
• These organizations may serve a single area
or multiple geographic locations
• Private healthcare systems may be:
• Not-for-profit organizations (governed by
principle of non-distribution) or
• For profit organizations (distribute surplus
funds to shareholders or owners)
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
20
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

21. 21
Healthcare Systems
• Healthcare systems can be measured
using benchmarks
• One framework for assessment:
• Patient assessed value
• Performance on clinical interventions
• Efficiency
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
21
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

22. 22
Public Health
“is the science and art of preventing disease, prolonging life
and promoting health through the organized efforts and
informed choices of society, organizations, public and
private, communities and individuals.“
(Winslow, C.E.A. 1920)
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
22
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

23. What is Public Health?
• Private Health • Public Health
• Clinicians, Health • Agencies
Practitioners • Treat/Maintain Health of
• Treat Individual Health Populations
Problems • Actions include
• Action usually taken after Education, Policy,
illness/injury occurs Research, Monitoring
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
National Coordinator for Health Information Technology, U.S. Department of Health and Human
23
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 7a).

24. 24
10 Great Public Health Achievements –
US, 1900-1999
• Vaccination
• Motor-vehicle safety
• Safe workplaces
• Control of infectious diseases
• Decline in deaths from coronary heart disease and stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning
• Fluoridation of drinking water
• Recognition of tobacco use as a health hazard
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
24
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

25. 25
How Has Public Health Improved
Healthcare?
• Improvements in understanding disease
• Epidemiology is considered the basic science of public
health and is
• a quantitative basic science
• a method of causal reasoning based on developing
and testing hypotheses pertaining to occurrence and
prevention of morbidity and mortality
• a tool for public health action to promote and protect
the public’s health
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
25
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

26. 26
How Has Public Health Improved
Healthcare?
• An example of epidemiology at work:
• In 1854: epidemic of cholera in London, England
• Cholera is a bacterial disease
• Lack of sanitation and overcrowding led to the spread
of disease
• Dr. John Snow linked the spread of disease to a
contaminated public water pump
• Snow’s hypothesis: cholera was spread by
contaminated water
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
26
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

27. 27
How Has Public Health Improved
Healthcare?
• Improvements in data collection
• Original methods of data collection were crude
• progressive improvement in methodology led to the use
of sophisticated scientific methods to collect data
• cohort studies
• randomized controlled trials
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
27
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

28. 28
How Has Public Health Improved
Healthcare?
• Improvements in data analysis (use of tools such as
multivariate analysis and meta-analysis)
• Improvement in disease surveillance
• Example: the Real-Time Outbreak and Disease
Surveillance (RODS) Laboratory at the University of
Pittsburgh, Department of Biomedical Informatics
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
28
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

29. 29
How Has Public Health Improved
Healthcare?
• Improvement in training
• Establishment of many schools of public health in the
early 20th century
• Professional degrees such as Master of Public Health
(M.P.H.)
• Improvements in infrastructure
• Federal
• State
• Local health departments
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
29
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

30. 30
Functions & Components
of Health Systems

31. 31
Functions of Healthcare Systems
Governance,
Policy &
Healthcare Administration
Financing
Funding
Funding
Access Healthcare
Health
Service
Insurance
Delivery
Claims & Reimbursements
Healthcare
Payment
31
Adapted from Shi & Singh (2004) by Theera‐Ampornpunt

32. 32
Components of Health Systems
32
WHO (2009)

33. 33
Key Stakeholders in Health Care (4Ps)
Providers
Payers & Public/ Policy-
Purchasers Population Makers
Patients
33
Adapted from Parchariyanon (2012) by Theera‐Ampornpunt

34. 34
Healthcare Delivery
• Healthcare is delivered in different places
• Inpatient facilities
• Hospitals
• Institutions for treating sick or injured people
• Historically places for shelter, almshouses
• Different types of hospitals
• General medical and surgical hospitals
• Specialty hospitals (orthopedic, pediatrics, women’s
services, psychiatric, neurological, infectious disease)
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
34
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

35. 35
Healthcare Delivery
• Hospitals may be publicly or privately owned
• Patients can be admitted to a hospital through
• Emergency room
• An internal outpatient clinic
• Directly admitted from an external physician’s office
• Depends on local practices
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
35
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

36. 36
Healthcare Delivery
• Nursing and residential care facilities
• Can be short term facilities or long term
facilities
• Long term care classified by level of care
• Nursing homes gradually shifted from being
part of the welfare system to being a part of
the healthcare system
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
36
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

37. 37
Healthcare Delivery
• Outpatient facilities
• Hospitals in some countries provide
ambulatory care through internal outpatient
clinics
• Physicians offices (also known as private
clinics)
• Primary care offices
• Specialty care offices
• Single specialty or multispecialty offices
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
37
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

38. 38
Healthcare Delivery
• Dental offices
• General dentists or specialists
• Medical and diagnostic laboratories
• Pharmacies
• Internal pharmacies of hospitals
• Private pharmacies
• Community health centers
• Other ambulatory health services
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
38
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

39. U.S. Healthcare Industry
Industry segment Employment Establishments
Total 100.0 100.0
Ambulatory healthcare services 42.6 87.3
Offices of physicians 17.0 36.0
Home healthcare services 7.2 3.7
Offices of dentists 6.2 20.4
Offices of other health practitioners 4.7 19.6
Outpatient care centers 4.0 3.6
Other ambulatory healthcare services 1.8 1.4
Medical and diagnostic laboratories 1.6 2.4
Hospitals 34.6 1.3
General medical and surgical hospitals 32.5 1.0
Other specialty hospitals 1.4 0.2
Psychiatric and substance abuse hospitals 0.7 0.1
Nursing and residential care facilities 22.8 11.4
Community care facilities for the elderly 5.2 3.5
Residential mental health facilities 4.1 4.0
Other residential care facilities 1.3 1.1
1.1 Table: Percent distribution of employment and establishments in health services by detailed industry sector, 2008.
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
39
National Coordinator for Health Information Technology, U.S. Department of Health and Human
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

40. 40
Characteristics of a
Desirable Health System

41. 41
WHO Framework
41
WHO (2009)

42. 42
EQESAR Framework
• E - Equity
• Q - Quality
• E - Efficiency
• SA - Social Accountability
• R - Relevance
42
Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

43. 43
Equity
• Equal services for equal needs
• Unequal services for unequal needs
• Accessibility
• Physical
• Psychological
• Financial
• Information
43
Leerapan B. Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

44. Quality
• Safety
• Timeliness
• Effectiveness
• Patient-centeredness
Adapted from IOM (2001)

45. 45
Efficiency
• Cost-effectiveness
• Output or outcome versus cost
• Technical/operational efficiency
• Allocative efficiency
45
Adapted from Leerapan B. Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

46. 46
Social Accountability
• Good governance
• Adequate oversight and monitoring
• Transparency
46
Adapted from Leerapan B. Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

47. 47
Relevancy
• Relevant to issues/problems in the context
of interest
• Context-dependent
47
Adapted from Leerapan B. Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

48. 48
Models of Healthcare
Systems

49. 49
Models of Healthcare Systems
Model Financing Provider Example of
Ownership Countries
Employer-based Multipayer, Private United States
(market-based) voluntary
private insurance
National health Single-payer Public/Private Canada
insurance (general taxes)
National health Single-pyaer Public United Kingdom
system (general taxes)
Socialized health Employer- Private Germany
insurance employee,
mandatory
Hybrid Multiple models Public/Private Thailand
49
Adapted from Shi & Singh (2004)

50. 50
Healthcare
Professionals

51. 51
Healthcare Professionals
• Physicians
• Doctor of Medicine (M.D.)
• Allopathic medicine - views medical treatment as
active intervention to produce a counteracting
reaction in an attempt to neutralize effects of
disease
• Doctor of Osteopathic Medicine (D.O.)
• Osteopathic medicine - emphasizes
musculoskeletal system, stresses preventive
medicine as factors that might influence natural
resistance 51
Adapted from Shi & Singh (2004)

52. 52
Healthcare Professionals
• Physicians
• Generalists
• General practitioners (GP)
• Primary care physicians (PCP)
• Specialists
• Certified in an area of medical specialization
• Residency: graduate medical education in a
specialty in the form of paid on-the-job training
(trainees called residents)
• Fellowship: subspecialty training after residency
(trainees called fellows) 52
Adapted from Shi & Singh (2004)

53. 53
Healthcare Professionals
• The following are often considered
generalists working as primary care
physicians (but they typically underwent
residency training after medical school, i.e.
not just GPs)
• Family medicine physicians
• General internal medicine physicians (internists)
• General pediatricians
53
Adapted from Shi & Singh (2004)

54. 54
Healthcare Professionals
• Dental Professionals
• Dentists
• Dental hygienists
• Dental assistants
• Pharmacists
54
Adapted from Shi & Singh (2004)

55. 55
Healthcare Professionals
• Nurses
• Practical nurses (PN)
• Registered nurses (RN)
• Advanced practice nurses (APN)
• Clinical nurse specialists (CNSs)
• Certified registered nurse anesthetists (CRNAs)
• Nurse practitioners (NPs)
• Certified nurse midwives (CNMs)
• Physician Assistants
55
Adapted from Shi & Singh (2004)

56. 56
Healthcare Professionals
• Allied Health Professionals
• Physical therapists
• Occupational therapists
• Respiratory therapists
• Medical records technicians
• Medical technologists
• Radiology technicians
• Dietitians
• Social workers
• Speech therapists
• Public health practitioners
56
• etc. Adapted from Shi & Singh (2004)

57. 57
Healthcare Professionals
• Other health professions
• Optometrists
• Psychologists
• Podiatrists
• Chiropractors
• Presence, numbers and authorized practices vary
by location
57
Adapted from Shi & Singh (2004)

58. 58
Other Roles & Professions
• Alternative and traditional medicine practitioners
• Health services administrators
• Researchers
• Educators
• Informaticians
• Engineers
• Other administrative staff
58
Adapted from Shi & Singh (2004)

59. 59
Determinants of Health

60. 60
The Epidemiology Triangle
Host
Disease
Agent Environment
60

61. 61
Determinants of Health
Individual Environment
- Genetics - Physical
- Attitudes - Biological
- Behaviors - Social, cultural,
- Lifestyles Health economic, political,
technological
Healthcare
Systems
61
Adapted from Leerapan B. Department of Community Medicine,
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

62. 62
Major Issues in
Health Care

63. 63
Major Issues in Health Care
• Public Policy & Healthcare Reform
• Universal Healthcare Coverage
• Cost Containment
• Quality & Patient Safety
• Innovative Models of Healthcare Delivery &
Financing
63

64. 64
Major Issues in Health Care
• Evidence-Based Practice
• Increased Expectations & Patient Volumes
• Prevention vs. Treatment
• Rise of Aging Population & Chronic Diseases
• Legal Issues (e.g. Malpractice)
• Patient engagement
• Workforce: Shortages, maldistributions &
evolving competency requirements
• Technological Advances 64

65. Paradigm Shifts in Medicine
• Physician-centric to patient-centric care
• Individual to team-based care
• Paper-based to electronic-based
management of medical records
• Provider-kept to personal health records
Adapted from materials developed by Oregon Health & Science University, funded by the Office of the
National Coordinator for Health Information Technology, U.S. Department of Health and Human
65
Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1c).

66. 66
References
• Centers for Disease Control and Prevention (CDC). Ten great public
health achievements--United States, 1900–1999. MMWR Morb
Mortal Wkly Rep. 1999 Apr 2;48(12):241-3.
• Institute of Medicine, Committee on Quality of Health Care in
America. Crossing the quality chasm: a new health system for
the 21st century. Washington, DC: National Academy Press;
2001. 337 p.
• McKee M. Measuring the efficiency of health systems. The world
health report sets the agenda, but there’s still a long way to go.
BMJ. 2001 Aug 11;323(7308):295-6.
• Shi L, Singh DA. Delivering health care in America: a systems
approach. 3rd ed. Sudbury (MA): Jones and Bartlett Publishers;
2004. 652 p.
• Winslow CE. The untilled fields of public health. Science. 1920 Jan
9;51(1306):23-33.

67. 67
References
• Constitution of the World Health Organization. Geneva,
Switzerland: World Health Organization; 1948. Available from:
http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf
• Everybody’s business. Strengthening health systems to improve
health outcomes: WHO’s framework for action. Geneva,
Switzerland: World Health Organization; 2007. Available from:
http://www.who.int/healthsystems/strategy/everybodys_business.pdf
• Systems thinking for health systems strengthening. Geneva,
Switzerland: World Health Organization; 2009. Available from:
http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf