3. Jesse D. Ibarra Jr. M.D. Lectureship in International Health Lectureship in International Health

4. Jesse D. Ibarra Jr. M.D. Native of Leon, Mexico National University of Mexico Internship & Residency - S&W Senior Staff S&W - 1950 Endocrinology Clinic Board of Directors 1973-1984 VP Clinic Board for 5 years Special Projects Committee Native of Leon, Mexico National University of Mexico Internship & Residency - S&W Senior Staff S&W - 1950 Endocrinology Clinic Board of Directors 1973-1984 VP Clinic Board for 5 years Special Projects Committee

5. Jesse D. Ibarra Jr. M.D. President S&W Health Plan 1984-1989 Member State Board of Medical Examiners 1977 - 1988 Retired from S&W 1988 Latin American Task Force until 1999 President S&W Health Plan 1984-1989 Member State Board of Medical Examiners 1977 - 1988 Retired from S&W 1988 Latin American Task Force until 1999

6. TECHNOLOGY and the FUTURE of HEALTHCARE Ronald R. Blanck, D.O. LTG, USA (Retired) President University of North Texas Health Science Center

7. Medicine Today Unprecedented Growth in ● Technology ● Choices in Treatment Modalities ● Evidence – Based Medicine ● Diagnostic Tools

8. Healthcare Today Technology ● Procedures ● Pharmaceuticals ● Blood Products ● Imaging ● Information

15. ... And Unprecedented Growth In: ● Medical Costs (e.g. Meds, Procedures, Liability) ● Regulations (e.g. HIPPA, Multiple Payor Forms) ● Prescriptions per Patient ● Aging Population ● Under or Uninsured ● Emerging Diseases (e.g. Asthma, AIDS, TB)

17. Healthcare Expenditures ●Up 7.8% in 2002 to 1.674 Trillion (CMS) ● 14.9% of GDP in 2002 ● At 1% over economic growth - 38% of GDP in 2075

18. Healthcare Today ● Best Disease Care ● Complex ● Expensive ● Error - Prone ● Regulated ● Inaccessible to Many

19. GOLDEN AGE OF MEDICINE... for Some

20. Person with Public and Private Coverage, and the Uninsured, 1990-1999 Uninsured Public coverage Private coverage Source: HIAA, 1990-2000 Millions of persons

21. The number of uninsured lives is on the rise again. Number and Percent Uninsured 1985 - 2002 Source: US Census Bureau. Number of Uninsured in Millions Percent of Total Population The Uninsured

22. MEDICAL CARE IS... DISEASE CARE RATHER THEN HEALTH CARE

23. Healthcare Today Our Health System is a NON-System Emphasizing Disease By: ● Education ● Research ● Payment

24. Today’s preventive care allows longer life, but more illness- requiring more costly care

25. Health Care Cost Focus on cost of reduction is piecemeal and may be short-sighted: e.g. reduced payments may be counter-productive, potentially reduces early care and access

26. Healthcare Cost (cont.) Instead of only looking at cost reduction, look at distribution... and efficiencies... and what medical/health care is about: ● To heal ● To maintain health/quality of life

27. Healthcare Costs (cont.) Question Is - How Best To Do: ● Medical (disease) care ● Preventive and early detection care ● Both Efficiently

28. Goal is to Rationalize and systematize medical and healthcare for efficiency and quality of life

29. There is no system of medical care in the U.S.

30. There is a System of Healthcare - PUBLIC HEALTH ● Water Purification ● Food Safety ● Sanitation ● Immunizations

31. Biological Warfare The intentional use of microorganisms or toxins derived from living organisms to produce death or disease in humans, animals or plants

33. BW Agreements ● 1925 Geneva Protocol ● 1969 Nixon renounces BW ● 1972 Biological Weapons Convention ● 1975 Geneva Conventions Ratified

34. Biological Weapons Policy ● No use under any circumstance ● Research limited to defensive measures ● We possess NO weaponized biologicals ● Previous weapons stocks destroyed ● Destruction supervised: - USDA - Dept of HEW - DNR of AR, CO, MD

35. The Sverdlovsk Incident ● April - May 1979 - 66 Anthrax fatalities ● 1988 - Soviets present data: ○ 96 cases ○ 79 gastrointestinal ● May 1992 - Yeltsin admits “military developments”

38. Advantages of BW: Are Biologicals the Ultimate Weapons? ● Agent easy to procure ● Inexpensive to produce ● Can disseminate at great distance ● Agent clouds invisible ● Detection quite difficult ● First sign is illness ● Overwhelms medical capabilities ● Simple threat creates panic ● Perpetrators escape before effects ● Ideal terrorist weapon

39. Acquisition of Etiologic Agents ● Multiple Culture Collections ● Universities ● Commercial Supply Houses ● Foreign Laboratories ● Field Samples or Clinical Specimens

40. Hazardous Biological Material ● Letters ● Packages ● Cultures ● Person-to-person ● Airborne

41. Response ● Not Typical First Responders ● BIO First Responders - Physician’s Office - ER - Clinics - Public Health ● All Organizations Involved

42. Issues ● Rapid Detection ● Public Health ● Hospital Capacity ● Stockpiling ● Vaccine Production

45. ... BIOTERRORISM HAS CHANGED THE FOCUS OF OUR APPROACH TO PUBLIC HEALTH

46. Public Health In the Forefront ● Population Health ● Education ● Early Detection ● Immunizations

47. Steps to a System of Care ● Tort Reform ● Single Payor ● Linked Information Systems ● Lifetime Electronic Patient Records ● Change in Priorities for - Education - Research - Payment

48. Future... ● Public Health; Prevention/Health Promotion ● New Paradigm of Care Based on Linking: Technology Prevention Efficiency ● Best use of $ Systematically

49. The end Please continue to the post test Download the post test Complete the post test Send the post test to: –Dr. Sandra Oliver –407 I TAMUII

50. Post Test Question 1 1. Which of the following statement regarding health care expenditures is incorrect A. Up 7.8% in 2002 to 1.674 Trillion (CMS) B. 14.9% of GDP in 2002 C. Approximately 55 percent of Medicaid is financed by state funds D. At 1% over economic growth - 38% of GDP in 2075

51. Post test Question 2 2. Over the decade of the 90’s the number of persons with private health care coverage has: A. Increased B. Decreased C. Remained upchanged

52. Post test question 3 3. Powers and duties of public health officers include all of the following except: A. Tertiary health care programs B. Water Purification C. Food Safety D. Sanitation E. Immunizations

53. Post test Question 4 4. According to R.R. Blanck, the first responders to biological warfare will be: A. Infectious disease physicians B. Firemen/EMT C. Primary care providers D. Toxicologists