History and Trends in Health Care

Primitive Times Disease tied to religion: spirits, demons Tx: Herbs and plants Life span: 20 yrs

Ancient Egyptians Illness still connected to religion First to maintain health records Priests were doctors Used leeches which are still used today to help heal wounds and restore circulation in blocked veins Life span: years

Ancient Chinese Holistic approach to health care Acupuncture Searched for cause of disease Used pulse to assess

Ancient Greeks Recorded s/s; illness d/t natural causes Diet/cleanliness for prevention Created standard of ethics Hippocrates: Father of Medicine: organized methods to observe and tx Aristotle: Founder of comparative anatomy; used animal dissection

The Hippocratic Oath is an oath traditionally taken by MDs pertaining to the ethical practice of medicine. It is widely believed that the oath was written by Hippocrates in the 4th Century B.C., or by one of his students Traditionally it is recited upon graduation from med school

Ancient Romans Organized medical care; developed first hospitals Developed sanitation and public health focus Diet, ex, meds to tx illness Life span to 35 years Fall of Roman Empire: study of medicine stopped

Dark Ages Prohibited study of medicine Emphasis on saving soul Priests for custodial care Herbs used to tx disease Life span to 30 years

Middle Ages Renewed practices of Romans and Greeks Started medical universities Began MD licensure/exams Began pharmacology Bubonic plague killed millions Life span to 35 years

Renaissance Rebirth of the science of medicine Printing press: 1 st anatomy text Michelangelo and DaVinci: used dissection for accurate drawings of human body Life span to 40 years

16 th -18 th centuries Many medical discoveries Apothecaries 1600s: microscope developed and Robert Hooke identified the cell 1714: Fahrenheit: thermometer Anthony Leeuwenhoek: "Father of Microscopy” 1796: Jenner: smallpox vaccine Ben Franklin: bifocals, catheters Life span to 50

19 th Century Florence Nightingale: Founder of nursing Joseph Lister: developed disinfectant/antiseptics Louis Pasteur: germ theory and pasteurization

Elizabeth Blackwell: first woman to graduate from medical school in 1849 Clara Barton: Founder of Red Cross X-rays and stethoscopes Virus identified Life span to 60

20 th Century Freud: father of modern psychiatry Sir Alexander Flemming: penicillin in 1928 Jonas Salk: polio vaccine in 1952 Crick and Watson: identified DNA in 1953; Nobel Prize awarded in s: bc pill developed/marketed 1968: 1 st heart transplant Louise Brown: 1 st in-vitro baby in 1978

20 th Century (cntd) 1984: AIDS identified 1990s: gene therapy 1997: sheep cloning Life span to 70s

Health Care Today What are the major trends associated with the health care industry today What contributes to the high cost of health care today?

Current Trends Cost Containment Home Health Care Geriatric Care Telemedicine Emphasis on Prevention/Wellness Alternative/Complimentary Medicine Health Care Reform

A. Cost Containment Focus on max benefit for every $ spent Cause of current high costs: Technology Aging population Litigation

Methods to contain costs 1. DRGs: system to classify hospital cases into one 500 groups that are expected to have similar hospital resource use; developed by Medicare for hospitals, where predetermined payment amounts have been set for listed procedures 2. Combining Services: eliminate duplication 3. Outpatient care whenever possible

4. Preventative care 5. Bulk purchasing/procurement 6. Conservation of supplies, energy

B. Home Health Care Decreased lengths of stay in the hospital; this is actually a trend and a method to contain cost Historically, much care happened in the home and now there is an emphasis on this again Always cheaper than inpatient care

C. Geriatrics Increased life span and large baby boomer population reaching retirement Adult day care, assisted living and LTC all growing industries Omnibus Budget Reconciliation Act: regulates some of LTC/HHC industries

D. Telemedicine Growing trend Used for patient tx and education of med students Availability of technology and less MDs in remote areas

E. Prevention/Wellness Cheaper than treating disease Involves lifestyle choices Holistic care: emphasis on physical, emotional, social, intellectual and spiritual needs Many health ins plans now pay for preventative care and diet/ex programs

F. Alternative/Complimentary Tx Difference between the two? Holistic care may incorporate both approaches; this is also an approach to treating the whole patient NIH: Office of Alt Med (OAM) to research new therapies and est standards Acupuncture: insertion of thin needles to various depths at strategic points. Tx: pain and chemo induced nausea.

Biofeedback: mind-body therapy. Using feedback from a variety of monitoring procedures/equipment to control certain invol body responses, such as vitals, musc tension

Homeopathy: every person has energy called a vital force or self-healing response and when it is disrupted, illness occurs Homeopathy aims to stimulate the body's healing responses and inv giving small doses of subs that produce characteristic symptoms of illness in healthy people when given in larger doses. This approach is called "like cures like."

Herbal Med Play Therapy Why is it important to be aware of alt/comp tx?

G. Health Care Reform Current US system of hc delivery and insurance in need of overhaul Reform nec to address high costs of hc delivery, insurance and the growing # of uninsured Goal is to make hc affordable for all. Cost containment strategies and ins reform will help accomplish this

What can be done to reform the high costs of health insurance and the large # of uninsured in the US?