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64 Cards in this Set

  • Front
  • Back
ASTHO
Association of State and Territorial Health Officials
a. The Association of State and Territorial Health Officials (ASTHO) is a not for profit organization that provides support for state and territorial health agencies.
b. They provide research, expertise and guidance for health policy issues.
c. The federal government looks to ASTHO for their expertise in developing health policy. They frequently testify in front of Congress regarding major health issues.
d. They advocate for increased public health funding and campaign against any funding reductions.
Surgeon General
a. The U.S. Surgeon General is the chief health educator in the US
b. The Surgeon General is the U.S. chief health educator who provides information on how to improve U.S. health. The Surgeon General, who is appointed by the President of the United States, the Office of the Surgeon General oversees the operations of the commissioned U. S. Public Health Service Corps who provide support to the Surgeon General.
i. The U.S. Public Health Service Commissioned Corps consists of 6,000 public health professionals that are stationed within federal agencies and programs.
ii. These commissioned employees include many professionals such as dentists, nurses, physicians, mental health specialists, environmental health specialists, veterinarians, and therapists.
Local Health Departments
a. There are 3,000 local health departments in the U.S.
i. Nearly 100% of local health departments have internet access, with 70% having a web site
b. Local health departments are the government organization that provides most direct services to the population. There are approximately 3,000 local health departments across the U.S.
c. Although their organizational structures may differ across the U.S, their basic role is to provide direct public health services to their designated areas.
d. It is difficult to generalize what types of services are offered by local health departments because they do vary according to geographic location but most are involved in communicable disease control.
e. Local health departments receive funding from their state government, federal government direct funding such as the Centers for Disease Control and reimbursement for services from Medicaid, Medicare, private health insurance, fees for services.
f. Due to population size and coverage, local health department funding varies state to state.
The Centers for Disease Control and Prevention
a. Established in 1946, and headquartered in Atlanta, GA, the CDC’s mission is to protect health and promote quality of life through the prevention and control of disease, injury, and disability.
b. The CDC has created four health goals that focus on:
i. healthy people in healthy places
ii. preparing people for emerging health threats
iii. positive international health
iv. healthy people at all stages of their life.
The Indian Health Services
a. Established in 1921 and headquartered in Rockville, MD, their mission is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.
b. It is also their mission to assure that that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.
c. They are also responsible to promote their communities, and cultures and to honor and protect the inherent sovereign rights of these people
The Food and Drug Administration
a. Established in 1906 as a result of the Federal Food, Drug and Cosmetic Act, the FDA is responsible for ensuring that the following products are safe:
i. food,
ii. human and veterinary products,
iii. biological products,
iv. medical devices,
v. cosmetics and
vi. electronic products.
b. The FDA is also responsible for ensuring that product information is accurate . The agency monitors approximately $1 trillion worth of goods on an annual basis
Residential Care Centers
a facility that provides care to persons who, because of physical, mental, or emotional disorders, are not able to live independently.
o Assisted Living: A living arrangement in which people with special needs, especially older people with disabilities, reside in a facility that provides help with everyday tasks such as bathing, dressing, and taking medication
Home Health Services
the medically-related services provided to patients in a home setting rather than in a medical facility.
o include medical or psychological assessment, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational therapy, skilled nursing in addition to speech, occupational and physical therapy.
o In home health service the home care practitioner will aid patients  increase their ability to perform their daily activities.
American Medical Association
founded in 1847 largest association of medical doctors (M.D. and D.O.) and medical students in the United States
o Mission promote the art and science of medicine for the betterment of public health, promote public health, lobby for legislation favorable to physicians and patients, and to raise money for medical education
o Publishes the Journal of the American Medical Association(JAMA) Largest circulation of any weekly medical journal in the world
o List of Physician Specialty Codes which are the standard method in the U.S. for identifying physician and practice specialties.
o The AMA is aggressively involved in advocacy efforts related to the most vital issues in medicine today.
Employment in Healthcare
o 14 million employed in healthcare industry 3 million new jobs by 2016
o Health diagnostic and treatment providers are the most educated workers in US but most healthcare workers have jobs that don’t require 4 year college degree
o Healthcare employment predominant in larger states: FL, NY, Texas, Pennsylvania
o Working middle-class adults experienced most recent increase in number of uninsured  South highest uninsured rate, Midwest lowest uninsured rate
o Defining of jobs and staff employment can be viewed as a set of logical steps
 Job analysis: review of a job to determine the context in which it is performed- responsibilities, skills required, standards
 Job description: document indentifies character of a job through job summary, basic duties, work conditions, training etc
 Person specification: links job analysis and description to characteristics required of a job holder- physical, educational, skills,  used for recruitment and selection
 Recruitment: managers seek to identify candidates for the job, look inside or outside the organization
 Selection: the most appropriate person for the job is selected  can be effected by patronage and corruption – defined selection techniques such as interview, aptitude tests
 Posting: new employee posted to a workplace
 Induction: needs to gain understanding of the organization
American Hospital Association
Health Care Industry Stakeholder
o Professional Association: represents physicians, nurses, hospitals to protect their interests. The AHA and Pharmaceutical Research and Manufacturers of America (PhRMA) are examples
o Other healthcare industry stakeholders include consumers, employers ( hospitals etc), educational and training organizations, research organizations and government
Alternative Medicine
Alternative medicine is any healing practice "that does not fall within the realm of conventional medicine.” It may be based on historical or cultural traditions, rather than on scientific evidence
o Alternative medicine is frequently grouped with complementary medicine or integrative medicine, which, in general, refers to the same interventions when used in conjunction with mainstream techniques
o Alternative medicine methods are diverse in their foundations and methodologies. Methods incorporate or based on traditional medicine, folk knowledge, spiritual beliefs, or newly conceived approaches to healing
o Examples: focus on individualizing treatments, treating the whole person, promoting self-care and self-healing, recognizing the spiritual nature of each individual.
o CAM systems have characteristics common of mainstream healthcare focus on good nutrition and preventive practices.
o Unlike mainstream medicine, CAM often lacks or has only limited experimental and clinical study
o NCCAM: National Center for Complementary and Alternative Medicine
o Defining CAM according the NCCAM the field is very broad and constantly changinggroup of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine. Conventional medicine (also called Western or allopathic medicine) is medicine as practiced by holders of M.D. (medical doctor) and D.O. (doctor of osteopathic medicine) degrees and by allied health professionals, such as physical therapists, psychologists, and registered nurses.
Outpatient Care Centers
Ambulatory care is a personal health care consultation, treatment or intervention using advanced medical technology or procedures delivered on an outpatient basis (i.e. where the patient’s stay at the hospital or clinic, from the time of registration to discharge, occurs on the same calendar day)
o Medical investigations/ treatments for acute illness and preventive health care can be performed on an ambulatory basis minor surgical and medical procedures, most dental services, dermatology, diagnostic procedures ( blood tests, X-rays, endoscopy and biopsy),emergency visits, rehabilitation
o Ambulatory care services represent the most significant contributor to increasing hospital expenditures
o Sites where ambulatory care can be delivered include:
 Doctor's offices  most common site for the delivery of ambulatory care in many countries, and usually consists of a physician's visit. Physicians of many specialties deliver ambulatory care. These physicians include specialists in family medicine, internal medicine, obstetrics, gynaecology, cardiology, gastroenterology, endocrinology, ophthalmology
 Clinics: Including ambulatory care clinics, ambulatory surgery centers, and urgent care centres
 In the United States, the Urgent Care Association of America (UCAOA) estimates 15,000 urgent care centers deliver urgent care services.  designed to evaluate and treat conditions that are not severe enough to require treatment in a hospital emergency department but still require treatment beyond normal physician office hours or before a physician appointment is available.
 Hospitals: Including emergency departments and other hospital-based services such as day surgery services and mental health services.
Center for Medicare and Medicaid Services (CMS)
a. Part of the Social Security Act (SSA)
b. Medicaid
i. For low income children/eldery, blind, disabled
ii. Linked with the supplemental security income program (SSI)
c. Medicare
i. Covers those under 65 with permanent disabilities (effective in 1972)
d. CMS also over sees the State Children’s Health insurance program (SCHIP, title XXI of the SSA)
Hazard Communication Agency
a. Ensures that all hazardous chemicals are properly labeled and that companies are informed of this risk
b. Requires employers to: determine hazardous materials, take inventory, provide info to employees, train employees on safe use and proper handling
Occupational Safety and Health Act
a. 1970, signed by Richard Nixon
b. Ensures that employers provide employees with an environment free from recognized hazards, such as exposure to toxic chemicals, excessive noise levels, mechanical dangers, heat or cold stress, or unsanitary conditions.
Occupational Safety and Health Administration
a. Ensures that employees have a safe and healthy workplace environment
b. Oversees:
i. Hazard communication standard
ii. Medical waste tracking act
iii. Occupational exposure to blood born pathogen standard
U.S. Public Health Service Corps
a. Overseen by surgeon general
b. Consists of 6000 commissioned public health professionals stationed within federal agencies and programs
c. Health professionals:
i. Dentists, nurses, physicians, mental/environmental health specialists, vets, therapists
Primary Prevention
a. Focus of public health
b. Activities that focus on reducing disease development
i. Smoking cessation
ii. Immunizations
iii. Educational programs
iv. Employee safety education
Public Health Functions
a. Assessment
i. Monitor health status and identify community health problems
ii. Diagnose/investigate health problems/hazards
iii. Evaluate effectiveness, accessibility, quality of health services
b. Policy development
i. Develop policies/plans to support individual and community health
ii. Enforce laws and regulations that protect health/ensure safety
iii. Research new insights and solutions to health problems
c. Assurance
i. Link people to needed personal services, assure provision of health care when it is otherwise unavailable
ii. Assure competent public health and personal health care workforce
iii. Inform, educate, empower people about health issues
iv. Mobilize community partnerships to identify and solve health problems
HAS (Health Spending Account)
• One of the most common health CDHPs (consumer driven health plans)
• Authorized by the Medicare Prescription plan
• Pairs high deductible plans with fully portable employee owned tax advantaged accounts
• This plan encourages consumers to be more cost conscious when using the healthcare system because they are using their own funds for health care services
• This is a portable account – can be transferred to another employer when the employee changes jobs
Medicare
• 88% of Medicare enrollees are 65 years and older (56% female)
• 43 million Medicare enrollees (projections are expected to increase to 60 mil by 2050)
• 41% poor/needy
• Entitlement program – people, after paying into the program for years, are entitled to receive benefits
• Medicare AND Medicaid have provided access to health care services through their programs
• Number of uninsured people in the US would be much higher if these programs didn’t exist
• The health care industry’s LARGEST payer
• It was originally designed as a 2 part structure:
o Part A – hospital insurance – primarily financed from payroll taxes
 Covers hospital inpatient services, care in a skilled nursing facility, home health visits, hospice care
 The employer and the employee contribute the Social Security (Medicare) fund
o Part B – supplemental or voluntary medical insurance – covers physician services
 Coverage includes physician care, durable medical equipment, physician ordered supplies, ambulatory surgical services, outpatient hospital care, outpatient mental health services, laboratory services
 Part B is made available when enrollees sign up for Part A
• Recently, 2 additional parts were added:
o Part C – Medicare+Choice/Medicare Advantage
 This was designed to move Medicare patients into a more cost effective health insurance program such as HMO or PPOs
 Required to cover all the services from Parts A and B
o Part D – prescription drug plan benefit
 Produces the largest additions and changes to Medicare and was projected to cost nearly $750 billion in the first 10 years
 Purpose was to provide relief from costly prescription costs for seniors
 It is a voluntary program (like Part B) because members pay a premium for coverage
Medicaid
• Provides health insurance to the medically indigent (poor)
• It is a welfare program that is administered at the state government level
• Serves 45 mil low-income Americans
• It is NOT a federally mandated program but every state has Medicare in the US except Arizona
• People who are eligible include:
o Families with children receiving support under the Temporary Assistance for Needy Families (TANF)
o People receiving Supplemental Security Income (SSI)
o Children and pregnant women with income at or below 133% of the Federal Poverty Level
o Children whose parents that have income too high for Medicaid but too low for private insurance
IPA – Independent Practice Association
• a type of managed care model
• contracts with a group of physicians who are in private practice to see MCO members at a prepaid rate per visit
• physicians may sign contracts with many HMOs & may also see non-HMO patients
HMO (Health Maintenance Organization)
• oldest type of managed care
• members must see their primary care provider first before going to see a specialist
• “gatekeeper” – idea is to keep people from going straight to the specialist since they are more expensive than a PCP
• 4 types of HMOs:
o Staff Model – hires providers to work at a physical location
o Group Model – negotiates with a group of physicians exclusively to perform services
o Network Model – similar to group model but these providers may see other patients who are NOT members of the HMO
 There is a negotiated rate for service for members to see providers who belong to the network
o IPA
HAS (Health Spending Account)
• One of the most common health CDHPs (consumer driven health plans)
• Authorized by the Medicare Prescription plan
• Pairs high deductible plans with fully portable employee owned tax advantaged accounts
• This plan encourages consumers to be more cost conscious when using the healthcare system because they are using their own funds for health care services
• This is a portable account – can be transferred to another employer when the employee changes jobs
PPO (Preferred Provider Organization)
• These providers agree to a relative value-based fee schedule or a discounted fee to see members
• NO gatekeeper like HMO so they don’t need a referral to see a specialist
• Has a deductible (no co-pay) – this was developed by providers and hospitals to ensure that non-members could still be served while providing a discount to MCOs for their members
• A member can see a provider that is not in their network, but they may have to pay out of pocket for their services
o The bill could be as much as 50% of the total bill  currently the popular type of plan
Medicare
• 88% of Medicare enrollees are 65 years and older (56% female)
• 43 million Medicare enrollees (projections are expected to increase to 60 mil by 2050)
• 41% poor/needy
• Entitlement program – people, after paying into the program for years, are entitled to receive benefits
• Medicare AND Medicaid have provided access to health care services through their programs
• Number of uninsured people in the US would be much higher if these programs didn’t exist
• The health care industry’s LARGEST payer
• It was originally designed as a 2 part structure:
o Part A – hospital insurance – primarily financed from payroll taxes
 Covers hospital inpatient services, care in a skilled nursing facility, home health visits, hospice care
 The employer and the employee contribute the Social Security (Medicare) fund
o Part B – supplemental or voluntary medical insurance – covers physician services
 Coverage includes physician care, durable medical equipment, physician ordered supplies, ambulatory surgical services, outpatient hospital care, outpatient mental health services, laboratory services
 Part B is made available when enrollees sign up for Part A
• Recently, 2 additional parts were added:
o Part C – Medicare+Choice/Medicare Advantage
 This was designed to move Medicare patients into a more cost effective health insurance program such as HMO or PPOs
 Required to cover all the services from Parts A and B
o Part D – prescription drug plan benefit
 Produces the largest additions and changes to Medicare and was projected to cost nearly $750 billion in the first 10 years
 Purpose was to provide relief from costly prescription costs for seniors
 It is a voluntary program (like Part B) because members pay a premium for coverage
MCO (managed-care organizations)
• Managed care plans all establish relationships with organizations and providers to provide a designated set of services to their members
• They establish measures to contain cost control, provide incentives to encourage health service resources,
• and they all provide and encourage utilization of programs to improve the health status of their enrollees
Medicaid
• Provides health insurance to the medically indigent (poor)
• It is a welfare program that is administered at the state government level
• Serves 45 mil low-income Americans
• It is NOT a federally mandated program but every state has Medicare in the US except Arizona
• People who are eligible include:
o Families with children receiving support under the Temporary Assistance for Needy Families (TANF)
o People receiving Supplemental Security Income (SSI)
o Children and pregnant women with income at or below 133% of the Federal Poverty Level
o Children whose parents that have income too high for Medicaid but too low for private insurance
Prospective Utilization
- is implemented before the service is actually performed by having the procedure authorized by the MCO (Managed Care Organization) based on clinical guidelines
National Committee on Quality Assurance
-established in 1990 to monitor health plans and improve health care quality
-focus: measure, analyze, and improve health care programs
-accredits MCO although a voluntary review process it includes surveys by managed care experts and physicians
-evaluate access, service, and quality of MCO’s providers, primary prevention activities and case management for the chronically ill
IPA – Independent Practice Association
• a type of managed care model
• contracts with a group of physicians who are in private practice to see MCO members at a prepaid rate per visit
• physicians may sign contracts with many HMOs & may also see non-HMO patients
Cost Control Measure of MCOs
Restriction on Provider Choice:
-members of an MCO often have restrictions on choice for a provider
-as types of MCOs have evolved, restrictions have lessened
-although – penalty such as higher copayment or deductible for choosing provider out of network

Gate Keeping:
-primary care provider is the gatekeeper of all care for the patient member
-any secondary or tertiary care would be coordinated by gatekeeper
-primary care provider responsible for case management of a member

Services Review:
-Utilization review evaluates the appropriateness of the types of services provided; there are 3 types of utilization reviews – prospective, concurrent, and retrospective
1. Prospective Utilization Review – defined above is implemented before the service is actually performed by having the procedure authorized by the MCO (Managed Care Organization) based on clinical guidelines
2. Concurrent Utilization Review – decisions made during actual course of service such as length of inpatient stay or additional surgery
3. Retrospective Utilization Review – evaluation of services once services have been provided – may occur to assess treatment patterns of certain diseases
Practice Profiling – offshoot of retrospective - examines specific provider patterns of practice.
-type of employee performance review because of focus to determine which provider also fits in with organizational culture of MCO
HMO (Health Maintenance Organization)
• oldest type of managed care
• members must see their primary care provider first before going to see a specialist
• “gatekeeper” – idea is to keep people from going straight to the specialist since they are more expensive than a PCP
• 4 types of HMOs:
o Staff Model – hires providers to work at a physical location
o Group Model – negotiates with a group of physicians exclusively to perform services
o Network Model – similar to group model but these providers may see other patients who are NOT members of the HMO
 There is a negotiated rate for service for members to see providers who belong to the network
o IPA
PPO (Preferred Provider Organization)
• These providers agree to a relative value-based fee schedule or a discounted fee to see members
• NO gatekeeper like HMO so they don’t need a referral to see a specialist
• Has a deductible (no co-pay) – this was developed by providers and hospitals to ensure that non-members could still be served while providing a discount to MCOs for their members
• A member can see a provider that is not in their network, but they may have to pay out of pocket for their services
o The bill could be as much as 50% of the total bill  currently the popular type of plan
MCO (managed-care organizations)
• Managed care plans all establish relationships with organizations and providers to provide a designated set of services to their members
• They establish measures to contain cost control, provide incentives to encourage health service resources,
• and they all provide and encourage utilization of programs to improve the health status of their enrollees
Prospective Utilization
- is implemented before the service is actually performed by having the procedure authorized by the MCO (Managed Care Organization) based on clinical guidelines
National Committee on Quality Assurance
-established in 1990 to monitor health plans and improve health care quality
-focus: measure, analyze, and improve health care programs
-accredits MCO although a voluntary review process it includes surveys by managed care experts and physicians
-evaluate access, service, and quality of MCO’s providers, primary prevention activities and case management for the chronically ill
Cost Control Measure of MCOs
Restriction on Provider Choice:
-members of an MCO often have restrictions on choice for a provider
-as types of MCOs have evolved, restrictions have lessened
-although – penalty such as higher copayment or deductible for choosing provider out of network

Gate Keeping:
-primary care provider is the gatekeeper of all care for the patient member
-any secondary or tertiary care would be coordinated by gatekeeper
-primary care provider responsible for case management of a member

Services Review:
-Utilization review evaluates the appropriateness of the types of services provided; there are 3 types of utilization reviews – prospective, concurrent, and retrospective
1. Prospective Utilization Review – defined above is implemented before the service is actually performed by having the procedure authorized by the MCO (Managed Care Organization) based on clinical guidelines
2. Concurrent Utilization Review – decisions made during actual course of service such as length of inpatient stay or additional surgery
3. Retrospective Utilization Review – evaluation of services once services have been provided – may occur to assess treatment patterns of certain diseases
Practice Profiling – offshoot of retrospective - examines specific provider patterns of practice.
-type of employee performance review because of focus to determine which provider also fits in with organizational culture of MCO
Informatics
-refers to the science of computer application to data in different industries
-Health or Medical Informatics: science of computer application that supports clinical and research data in different areas of health care
-methodology of how health care industry thinks about patients and how treatments are defined/evolved
CDSS – Clinical Decision Support Systems
-Artificial Intelligence (AI): field of computerized methods and technologies to imitate human decision making
-technique of AI  expert systems: developed to imitate expert’s knowledge in decision making
-can be used to alert and remind HCP of patient’s condition change, or to have lab test performed, or have intervention performed
-assist with diagnosis using the system’s database – can expose any weaknesses in treatment plan or check for drug interactions/allergies
-can interpret imaging tests routinely to flag abnormalities
-Electronic Clinical Decision Support Systems: designed to integrate medical info, patient info, and decision making tool to generate info to assist with cases – type of knowledge-based system
-Key Functions:
1.) administrative 2.)case management 3.)cost control 4.)decision support
PBM – Pharmacy Benefit Managers
-e-prescribing will become more commonplace with mandates of Medicare
-in order to manage this technology effectively/efficiently….
PBM uses technology based tools to assess and evaluate the management of prescription component so it can be customized to address needs of organization
-PBM  companies that administer drug benefits for employers and health insurance carriers
-contract with managed care organizations, self insured employers, Medicaid, Medicare, federal insurance programs, and local government organizations
-approximately 95% of all patients with drug coverage received benefits through a PBM
RFID Chip in Healthcare
Radio Frequency Identification Chips
-transmit data to receivers – uniquely identified by a signal indicating where it is located
-can be used for:
-tracking of pharmaceuticals as they are shipped from manufacturer to customer
-tracking costly medical equipment to ensure easy access
-identifying providers in hospitals to ensure efficiency in care
-identifying laboratory specimens to reduce medical errors
-tracking patients including infants while in hospitals
-tracking hazardous materials that pose public health threat
-Currently…
-approximately 25% of RFID tags are used to identify people to ensure they are given the appropriate medication and interventions
-approximately 16% are used for expensive equipment, 13% used for pharmaceuticals, and 4% used for blood identification to reduce medical errors
-anticipated that in next 10 years – will be used primarily on labels of drugs to eliminate any drug counterfeiting by providing the full custody info on RFID tag of the drug
Biometric authentication:
• Developed by eMedicalFiles, the IntelliFinger is a biometric authentication technology which authenticates the identification of a patient by their fingerprint which is scanned when they enter an office for a medical visit, pre-surgery visit, at check out and at the pharmacy
• Technology translates the fingerprint into a numeric combination that is matched with the patient’s medical information
• Prevents fraudulent use of insurance cards and should reduce Medicaid and Medicare fraud.
• May be added to any electronic health record system
Stakeholder management
• A stakeholder is an individual or group that has an interest in an organization or activity
o Different than shareholder – financial interest in an organization because they own part of it
• Stakeholder management focuses on the relationship between organizations and all of their constituents, including shareholders, and how management recognizes the different expectation of each group
• Health Care Stakeholder Management Model
o Basic stakeholder relationship in the health care industry is the relationship between the physician and the patient
o Patient will have relationships that impact their interaction with the physician
o The physician also has relationship with other stakeholders who have expectations of the physician
o Example: the patient will have family and friends and the health insurance company or the government that is paying for the health procedure
 The family and friends have expectations that the physician will cure their friend or family member. They have an emotional relationship.
 Health insurance company’s relationship with the patient is professional. They will reimburse standardized treatment procedures.
o Physician’s stakeholder relationships are more complex
 May be a part of a managed care facility or have admitting privileges at a hospital so they have the relationship with the entity and their expectations of how they will treat the patient
 Also impacted by health insurance companies who want them to treat the patient according to standardized diagnostic procedures
 Drug companies have an interest in the physician because they have the provider to use their products
o Stakeholders have expectations on the simple relationship between the patient and provider
o When these stakeholders place undue pressure on this relationships, the decision making process of the provider may not always place the patient first.
Autonomy
• Respect for autonomy: decision making may be different and that health care providers must respect their patient’s decisions even if they differ from their own
o Part of health care ethics
Stewardship model
• model addresses the issues of paternalism in public health
• paternalism: concern that the individual freedom will be restricted for the sake of public health activities because the government infringes on individual choices for the sake of protecting the community
• Stewardship model: states that public health officials should achieve the stated health outcomes for the population while minimizing restrictions on people’s freedom of choice
• Focus of public health is to reduce the population’s health risks from other people’s actions such as drunk driving, smoking in public places, environmental conditions, inaccessibility to health care, and safe working environment
• While promoting a healthy lifestyle, it is also important that public health programs should not force people into programs without their consent or introduce interventions that may invade people’s privacy
• 5 justifications for public health interventions that infringe on individual choices:
o Effectiveness is essential to demonstrating that the public health efforts were successful and therefore it was necessary to limit individual freedom of choice
o Need for a public health intervention must be demonstrated to limit individual freedom
o if the proportionality of public health intervention outweighs freedom of choice, then the intervention must be warranted
o if the public health intervention satisfies effectiveness, need, and proportionality, the least restrictive intervention or minimal infringement on individual freedoms should be considered first
o lastly, public health must provide public education to explain their interventions and why the infringement on individual choices is warranted
Alternative reproductive methods
• Alternative Reproductive methods such as pre-implantation genetic diagnosis (PGD): methods for children that parents have conceived from in vitro fertilization which means that the embryo is fertilized in a clinic using the sperm from the father. The embryo is tested for tissue compatibility with their siblings prior to being transplanted into the mother
o if one of the children becomes ill, the child can save the existing siblings life by providing bone marrow transplants. If It has been determined that the embryo is not compatible, it could be destroyed.
• All human beings possess stem cells which are “starter” cells for the development of body tissue which have yet to be formed into specialized tissues for certain parts of the body
• “cloning” applies to any procedure that recreates a genetic replica of a cell or organism
o reproductive cloning: creates cloned babies
o therapeutic or research cloning: uses the same process as reproductive cloning but focus is replicating sources for stem cells to replace damaged tissues
Genetic testing
• genetic testing: carried out on populations such as age, gender, or other risk factors to determine if they are at risk for a serious genetic disease or if they have a carrier gene that they may pass on to their children.
• Diagnostic testing: used to identify the disease when a person is exhibiting symptoms
• Predictive and asymptomatic (no symptoms) tests are used to identify any gene changes that may increase the likelihood of a person developing a disease
• Carrier testing is used to identify individuals who carry a gene that is linked to a disease. The individual may exhibit no symptoms but may pass the gene to offspring who may develop the disease or carry the gene themselves
• Prenatal testing is offered to identify fetuses for potential diseases or conditions
o Newborn screening is performed during the first one to two days of life to determine if the child has a disease that could impact development
• Pharmacogenomics testing is performed to assess how medicines react to an individual’s genetic make up
• Research genetic testing: focuses on how genes impact disease development
• Human Genome Project: a long term government funded project completed in 2003, indentified all of the 20,000-25,000 genes found in human DNA
o Catalogued these genes which have made it easier when performing genetic testing to quickly determine the genes an individual possesses
o Result of genetic research – several genes have been identified as markers of prediction of disease in families such as breast cancer, colon cancer, cystic fibrosis, and Down’s syndrome in fetuses
Duty to treat
any person deserves care
- The US healthcare system has a principle of DUTY TO TREAT.
Infant mortality rate
is calendar year the number of deaths per 1,000 live births occurring among the population of a designated area during the same
- In 2000, Turkey and Mexico had infant mortality rates of 28.9 and 23.3 per 1000 live births.
- Fortunately, by 2005, these rates decreased to 23.6 and 18.8 per 100 live births. The lowest infant mortality rates are Iceland, Japan and Sweden.
- Their rates in 2000 were 3.0, 3.2 and 3.4 respectively. By 2005, the rates dropped to 2.4, 2.8 and 2.3 which points to the quality of prenatal care in their health care system.
- The U.S. ranks 6th out of the 30 countries from the bottom. In 2000, the infant mortality rates were 6.9 which remained the same for 2005.
- One of the criticisms of the U.S. delivery system is the poor prenatal care received by different ethnic groups.
Mortality rate
is a measure of the number of deaths (in general, or due to a specific cause) in a population, scaled to the size of that population, per unit time. Mortality rate is typically expressed in units of deaths per 1000 individuals per year
• Diabetes mellitus is a disease in which the body does not produce or properly use insulin which is a hormone that is needed to convert sugar, starches which are needed for energy .
2000-2005 diabetes deaths per 100,000:
- It has become a common chronic disease that can cause serious health conditions worldwide. There are different types of diabetes but a common form of diabetes, Type II, is often the result of being overweight.
- Although these statistics do not differentiate the different forms of this disease, it can be fatal if not addressed.
- In 2000, Mexico was clearly the leader of deaths due to diabetes at 90.2 which increased to 109 by 2005.
- The second highest rate was Korea, which reported rates of 33.7 in 2000 which decreased to 30.2 by 2005.
- The United States ranked 4th in this category at 20.6 which slightly decreased to 20.3.
- These high rates are a result, in part, of the increase in overweight individuals in the U.S.
- The lowest 2000 rates occurred in Greece and Iceland at 5.5 and 5.3. Greece’s rate decreased slightly to 5.4 but Iceland’s increased slightly to 5.9 in 2006.
Life expectancy
- at birth and age 65 and by gender is the average number of years that a person at that age and by gender can be expected to live, assuming that age specific mortality levels remain constant
Life expectancy at birth for males and females:
- In 2000, U.S. the female life expectancy at birth was 79.5 years of age which was ranked 22nd out of the 30 countries. By 2006, it had increased to 80.4 which is nearly another year of life.
- The number one nation was Japan at 84.6 in 2000-their country increased its rate to 85.5 in year 2005. The second country was France with 83 in 2000 which increased to 83.7 by 2005.
- These are interesting statistics for the U.S. because they spend so much of their gross domestic product on health care expenditures. The statistics could also reflect the sedentary lifestyle and poor diet in the U.S.
- U.S. males’ life expectancy at birth was lower than females but ranked slightly higher—20th out of the 30 countries. In 2000, the male expectancy was 74.1 with an increase of nearly 12 months to 75.2.
- The highest life expectancy of males was Iceland at 78.4 which increased to 79.2 by 2006. These gender projections are typical of other data analyses from the Centers for Disease Control, the World Health Organization, etc.
Total life expectancy at birth (males and females together):
- Japan continues leading the life expectancy at birth with 81.2 in 2000 which increased to 82.0 by 2005. Iceland was second with 80.1 in 2000 with an increase to 81.2 by 2005.
- The U.S. remains in 10th place with 76.8 in 2000 with an increase to 77.8 by 2005.
- These statistics are reflection of the gender life expectancy statistics. These statistics are often used as a comparison of countries worldwide to assess their health status.
Life expectancy at 65 for males and females:
• These statistics address the quality of health care for the elderly. Although there is statistics that address life expectancy at birth and by gender, this statistic focuses on life after age 65 years of age.
- In 2000, Japan was the top country at 22.4 years of life expectancy for females age 65 which increased to 23.2 years in 2006.
- In 2000, the top nine countries which included Japan, France, Switzerland, Spain, Italy, Austria, Canada and Luxembourg had life expectancies of 20 years or greater for women at 65 years old.
- All of them increased their life expectancy by 2006. The bottom country was Turkey with an expectancy rate of 14. 6 in 2000 which did marginally increase to 15 years by 2006.
- The U.S. was ranked higher than previous statistics at 18th with a life expectancy of 19.2 which did increase to 20 by 2006.
- Iceland was the lead country for male’s life expectancy at age 65 with 18.1 years which did decrease to 18 years of age by 2006.
- The U.S. ranked 12th in this category. In 2000, the male expectancy after age 65 was 16.3 years which increased to 17.2 years by 2006.
- The lowest ranked countries were Turkey and Hungary which had 12.9 years and 12.7 years respectively.
- These statistics support the general international statistics of female life expectancy that are longer than males.
- These statistics further support the quality of care provided to the elderly.
Bad debt:
efforts to secure payment from patient has failed
Charitable care
provider gives care but does not expect payment because of inability to pay
Healthcare Industry Stakeholders
Consumers – The main group of stakeholders and the most important stakeholder in the industry.
Employers – Hospitals, nursing and residential care facilities, physicians, dentists, home health care, outpatient and ambulatory care centers, laboratories and other health care practitioners.
Government – Federal, state and local levels all participate
Educational and training organizations- Medical schools, nursing schools, public health schools and allied health programs
Research organizations- government and private
Professional associations- represent physicians, nurses, hospitals, and other health care stakeholders to protect their interests. American Hospital Association (AHA) and Pharmaceutical Research and Manufacturers of America (PhRMA) are examples of professional organizations
Pharmaceutical industry- responsible for developing drugs used for medication to treat diseases and conditions
OECD- Organization for Economic Cooperation and Development
; a membership organization with their mission of providing comparable statistics of economic and social data worldwide
- Comprised of 30 countries; the US being one of them
- Outpatient care
Outpatient care describes medical care or treatment that does not require an overnight stay in a hospital or medical facility. Outpatient care may be administered in a medical office or a hospital, but most commonly, it is provided in a medical office or outpatient surgery center.
Ambulatory care:
personal health care consultation, treatment or intervention using advanced medical technology or procedures delivered on an outpatient basis (i.e. where the patient’s stay at the hospital or clinic, from the time of registration to discharge, occurs on the same calendar day).
- Many medical investigations and treatments for acute illness and preventive health care can be performed on an ambulatory basis, including minor surgical and medical procedures, most types of dental services, dermatology services, and many types of diagnostic procedures (e.g. blood tests, x rays, endoscopy, and biopsy procedures of superficial organs). Other types of ambulatory care services include emergency visits, rehabilitation visits, and in some cases telephone consultations.
Hazard Communication Standard: (HCS)
ensures that all hazardous chemicals are properly labeled and that companies are informed of these risks.
Administration on Aging: (AOA)
Was established in 1965 as part of the Older Americans Act (OAA). One of the largest providers of home and community based care for older persons.
- Their mission is to develop a cost effective and efficient system of long term care that helps the elderly to maintain dignity in their homes and communities.
- The AOA is a partnership of the federal, state, and local networks called the National Network on Aging which services 7 million elderly and their caregivers in the US.
- Services provided the AOA include: supportive community services such as transportation to medical appointments, etc., nutritional services, preventative health services and caregiver services.
- In 2000, the National Family Caregiver Support Program was funded which assists caregivers with education and additional services to care for their elderly. The AOA also protects the rights of the elderly and provides services to Native Americans.
US Public Health Service Commissioned Corps:
Consists of over 6,000 public health professionals that are stationed within federal agencies and programs. These commissioned employees include many professionals such as dentists, nurses, physicians, mental health specialists, veterinarians, and therapists. Overseen by the Surgeon General. Provides support to the Surgeon General
National Incident Management System: (NIMS)
developed by the department of homeland security to provide a systematic, proactive approach to all levels of government and private sector agencies to collaborate to ensure there is a seamless plan to manage any major incidents. Housed in the Department for Homeland Security’s National Management System Resource Center.