Public Health vs Medicine HAS 3150

Myths Medicine equals improved health status More and better equals healthier people The services we call health are directed towards disease

Some services promote health Protect food and water supplies Control communicable diseases Reduce behaviors that result in injury

Public health responsible for… 67% reduction in stroke mortality 49% decline in cardiovascular disease 28% reduction in mortality due to motor vehicle accidents Less than 1% of current health expenditures support these services

Illness care has little effect on… Tobacco Diet and activity Alcohol Toxic agents Firearms Sexual behavior Motor vehicles Illicit drug use

Find it early Reduce pain and suffering Less costly Intervention –Screening tests –Case-finding efforts –Physical exams

Links Public health practice Medical practice –Primary care –Secondary care –Tertiary care Long-term care

Health Services Pyramid Population-based Public Health Primary Health Care Secondary Tertiary

Interfaces Collaboration –Medical practice = disease and injury –Public health = health promotion/protection Conflict –Immunizations –Early case-finding activities

Other issues Same problems at different stages Decades-old issues Emphasis divides Technology emphasizes differences Economics Resources

Which is better?

Economics 15% of GDP Do we spend too much? Sources of financing 3% on prevention-related activities

Managed care History Response to spending Attempts to provide economic incentives How it works… HMOs

Controlling costs Capitation Gatekeepers Withholds

Managed Care Opportunities More structure Framework to serve groups Prevention Specialized providers Data collection

Report Cards Report cards are coming Goal of report cards

HEDIS Quality of care Access to care Patient satisfaction

Physicians Effectiveness questions

Long-Term Care Ombudsman Health and safety Welfare and rights Empowerment Education Advocacy Training Dignity

Do all Americans have the right to medical care when they need it?