1. HSM 200 SUMMER 2016

2. Chapter 1  Affordable Care Act : developed due to rising costs, questionable quality, lack of healthcare system access for large numbers of population.  Projected cost of implementation of ACA is $1.1 trillion!  US is 8 th in the world for healthcare behind UK, Germany, Sweden, Canada, France, Australia, Japan  ACA provides to 30 million Americans access to healthcare.  Danger to automatically link insurance to healthcare; does not equal quality healthcare.  Private sector picks up the slack the government creates.  Primary Goal : Contain costs and realize profits.

3. Chapter 1  Providers have lost the monopoly on healthcare decisions & actions.  Now we answer to: consumers, payers, managers and quality assurers.  Natural History of Disease: a) Prepathogenesis – individual is at risk for disease but is not yet affected. B) Period of Pathogenesis – Course of diseases.  Levels of Prevention : a) primary prevention – prevention of disease occurrence b) secondary prevention – early detection and prompt treatment to achieve an early cure c ) Tertiary prevention – rehabilitation and maximizing remaining functional capacity.

4. Chapter 1  Major Stakeholders in US Healthcare:  A. The Public  B. Employers  C. Providers  D. Hospitals  E. Governments  F. Alternative Therapies  G. Health Insurers  H. Long-Term Care  I. Volunteer Facilities  J. Education and Training Institutions  K. Professional Associations  L. Research Communities

5. Chapter 1  Priorities of Healthcare : Heroic medicine over more mundane and far less costly preventative care  Tyranny of Technology : with advancement of technology and introduction of electronic health records, numerous questions remain unanswered about these advances.  Aging Population : chronic illness increases as we live longer, requires more long-term care; financial gaps for the aging.  Access to healthcare limited with 49 million people uninsured or underinsured.  Quality of care a problem with variations in quality and appropriateness of medical care.

6. Chapter 1  Conflicts of interest arise when physicians invest in other healthcare business, e.g. labs, imaging centers, medical supply companies.  ACA requires all financial transactions and transfers of value to be reported; fine for violation is up to $1 million / year.  Ethical Dilemmas : physician –assisted suicide, living wills and advanced directives, terminal care

7. Chapter 2  3 major healthcare concerns: cost, quality, access  Medicare & Medicaid introduced in 1966-1969 to finance healthcare.  1973 brought Health Maintenance Organizations or HMO’s. (managed care)  2001 brought Preferred Providers Organizations or PPO’s. (managed care)  Hi-Tech Medicine in the second half of the 20 th century brought the polio vaccine, Librium and valium, the birth control pill, the heart- lung machine, CAT scans.

8. Chapter 2  Increased use of high and new technology has contributed to rising costs in healthcare.  Special interest groups from providers, insurers, consumers, business and labor, have created pressure on legislators to fund health service and changes to the healthcare system.  The Public Health lobby focuses on health promotion and disease prevention.  HIPPA or the Health Insurance Portability and Accountability Act was passed in 1996. It was intended to address the problem of the increasing number of uninsured.  The Affordable Care Act (ACA) was enacted in 2010.

9. Reference  Sultz, H.A. & Young, K.M. (2014). Health Care USA: Understanding Its Organization and Delivery (8 th ed.). Jones & Bartlett Learning: Burlington, MA.