CHAPTER 1 HEALTH CARE OF THE PAST, PRESENT, AND FUTURE

Health Care of the Past Egyptians, Greeks, and Chinese Ancient treatments Witch doctors Herbalists Use of herbs and plants for medication Hippocrates (460–377 B.C.) Father of modern medicine Plagues caused millions of deaths

Box 1-2 Hippocratic Oath

Health Care of the Present • Focus of health care has shifted from contagious diseases to lifestyle changes Cancer Drug abuse Heart disease Acquired immunodeficiency syndrome Tuberculosis

Health Care of the Present Primary concerns Emergency response and preparedness services Some communicable diseases still a focus AIDS 351,614 persons in United States living with AIDS in 2003 Tuberculosis 14,517 cases of TB in 2004 Avian flu United States established preparation guidelines of a possible H5N1 flu epidemic

Table 1-2 Pandemics and Pandemic Scares in the United States

Table 1-3 Agency Health Care Providers

Federal Agencies That Oversee Nation’s Health Care Public Health Service Part of the Department of Health and Human Services (HHS) Established in 1798 Department of Labor Regulates some health concerns through the Occupational Safety and Health Administration (OSHA)

Health Care in the United States One of the largest industries in the United States Supply of workers is less than demand Job opportunities and job security in many areas Cost of health care continues to increase as a result of: Technological developments Malpractice litigation Increase in longevity Disaster relief expenses

Health Insurance United States only industrialized nation that does not guarantee health care to all citizens Insurance company third party payer assumes most health care costs Medicare and Medicaid were established to provide health care benefits for special needs groups and the elderly

Medicare Federal health care program for: Individuals age 65 years and older Certain younger people with disabilities People with end-stage renal disease (ESRD) DRGs (Diagnosis-related groupings) Reimbursement based on diagnosis rather than services – limits time allowed for treatment

Medicaid Provides health care coverage for people with low income and limited resources Joint program between federal and state governments Programs vary from state to state

Health Insurance Options Managed care insurance plans HMO: Health Maintenance Organizations PPO: Preferred Provider Organizations POS: Point-of-Service Indemnity (fee-for-service) Disability income insurance Long-term care insurance plan Medical Savings Account (MSA)

Figure 1-2 Health Care Insurance Model

Table 1-4 Sample Insurance Cost Comparison

Health Insurance Portability and Accountability Act (HIPAA) Allows employed individuals to maintain insurance coverage if they lose or change jobs Limits exclusion of coverage because of preexisting conditions Prohibits denial of coverage because of prior illness Guarantees right to purchase insurance if unemployed Mandates the format for electronic data interchange (EDI) of information

Factors in Choosing a Career in Health Care Economic security Nature of the duties Good working environment Opportunities for advancement New challenges Respect

Table 1-5 Career Ladder in Health Care

The “Patient” of Today Takes on more responsibility for his or her own care Obtains second opinions Shops for the lowest health care costs Seeks alternative and complementary providers

Patient and Resident Rights American Hospital Association “Patient’s Bill of Rights” – rights of the client to participate in the system of care Nursing Home Reform Law Enacted by Congress in 1987 to protect nursing home residents Places strong emphasis on individual dignity and self-determination

Agencies of Accreditation Training programs must meet acceptable standards Most agencies of accreditation are provided by the professional association of the health care occupation

Credentialing Health care workers may require: Licensure: controlled by the state and is usually based on successful completion of an examination Certification: given by an agency or a training program; indicates successful completion of a particular course Registration: earned through the state or an agency

Health Care of the Future Wellness services To include nutritional advice, stress reduction counseling, habit cessation management, and exercise instruction Focus on care of the elderly Alternative medicine Technology

Health Care Workers of the Future Multicompetent Trained for a broad range of skills Able to adapt to new technologies Highly regulated to ensure quality of care

Figure 1-4 National Health Care Skill Standards Model