1. THE UNITED STATES HEALTH CARE SYSTEM Combining Business, Health, and Delivery CHAPTER Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Cultural Competency, Health Literacy, and Health Care Ethics 13

2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Objectives Define cultural competency. Describe REALM. Explain the ideal of health literacy. Identify the benefits of health and cultural literacy to the country. Assess your own and your family’s health literacy.

3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Objectives (cont.) Discuss and give examples of 4 health literacy strategies. Discuss ethical issues in cultural competency theories. Identify and describe 3 major ethical theories. Identify 4 major ethical principles in health care.

4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Objectives (cont.) Discuss the ethical rational for health care reform.

5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care Culture is learned and shared by group members. What you believe, your values, and much of your behavior are culturally determined.

6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Core values of the American culture: –Individualism –Freedom/Democracy –Equality –Achievement and success –Efficiency and practicality –Progress/Science and technology –Material comfort/Activity and work –Humanitarianism/Group superiority

7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Subcultures are groups that share many of the elements of mainstream culture, but maintain their own distinctive customs, values, norms, and lifestyles.

8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) The U.S. has five ethnic minority groups: –Native Americans/Alaskan Native, Hispanics/Latina, Asian, Native Hawaiian, and African-American Our culture influences the way we see the world.

9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle

10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Ethnocentric: –Evaluating others’ customs according to values of his or her own cultural group; this can lead to misperceptions and conflict. Health literacy: –The degree to which individuals have the capacity to obtain, process, and understand basic information and services needed to make appropriate decisions about their health

11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Cultural competence: –The ability of health organizations and practitioners to recognize the cultural beliefs, values, attitudes, traditions, language preferences, and health practices of specific cultural groups and to apply that knowledge to produce positive health outcomes

12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Culture and language may influence: –Health, healing, and wellness belief systems –How illness, disease, and their causes are perceived, both by the patient/consumer and the health care provider –The behaviors of patients/consumers who are seeking health care and their attitudes toward health care providers

13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Health care providers who are working with specific populations need: –A good orientation to the customs and beliefs of the group –Access to language assistance –A way to rapidly assess health care literacy and appropriate communication tools

14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Culture and Health Care (cont.) Health Literacy: –Health literacy is not the same thing as regular literacy –The health care profession has its own language; medical terminology –Many of the groups are not English language proficient –REALM (Rapid Estimate of Adult Literacy in Medicine): This tool asks patients to read and pronounce common medical terms

15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Ethical Issues in Health Care Health care ethical theories provide a framework to assist patients, health care providers, and policy makers in making ethical decisions. Ethical issues are those issues in which there are competing values or goods. In an ethical dilemma there is always more than one answer.

16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Ethical Issues in Health Care (cont.) Health care ethics addresses large concepts such as: –Respect for autonomy –Nonmaleficency (do no harm) –Beneficence (do good) –Justice –Veracity (truth telling) –Privacy

17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Ethical Issues in Health Care (cont.) Health care ethics addresses large concepts such as: (cont.) –Confidentiality –Professional roles

18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Ethical Issues in Health Care (cont.) Ethical theories –Autonomy  Requires the health care provider to adhere to the patient’s decisions –Nonmaleficency  Requires health care providers not to inflict harm intentionally or to do no harm

19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Ethical Issues in Health Care (cont.) Ethical theories (cont.) –Beneficence  Requires health care providers to contribute positively to the welfare of others – do good/not evil –Codes of ethics  Are based on a combination of the concepts that health care professionals are held to a higher ethical standard than non-professionals

20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Justice and the Health Care System Theories of justice help decide how to distribute fairly the benefits of society. –Access: As many people as possible should be able to receive health care services. –Quality: The health care services should be of the highest possible quality –Cost: The health care services should not cost too much

21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Justice and the Health Care System (cont.) In rights theory –Health care is viewed as a basic human and citizen right The utilitarian theory –The idea that health care resources should be allocated where they will do the most good Kantian theory –Tells people they ought to treat others as they want to be treated themselves

22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Justice and the Health Care System (cont.) John Rawls wrote A Theory of Justice. –His justice as fairness concepts have been the basis of policy on a large-scale societal level  Each person has an equal right to basic liberties  There are natural and social inequalities; give the least advantaged as much benefit as is possible

23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Women and Health Care Justice Health care distribution in the U.S. accounts for 13% of the Gross National Product or over $8,000 per person. Women, who make up over 50% of the population, do not enjoy 50% of its benefits. Women of color are even more disadvantaged.

24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. The United States Health Care System: Combining Business, Health, and Delivery, Second Edition Anne Austin Victoria Wetle Women and Health Care Justice (cont.) Women interact with the health care: –Giving birth –At menopause –In old age