1. Public Health vs Medicine HAS 3150

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

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

4. 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

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

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

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

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

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

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

11. Which is better?

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

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

14. Controlling costs Capitation Gatekeepers Withholds

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

16. Report Cards Report cards are coming Goal of report cards

17. HEDIS Quality of care Access to care Patient satisfaction

18. Physicians Effectiveness questions

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

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