1. Component 1: Introduction to Health Care and Public Health in the U.S. 1.1: Unit 1: Introduction to modern healthcare in the US 1.1 a: Introduction and definitions

2. Objectives Of This Unit Delineate key definitions in the healthcare domain Distinguish between healthcare systems and healthcare practice Outline key paradigm shifts in medicine Describe in overview terms the technology used in the delivery and administration of healthcare Discuss core values in American healthcare Component 1 / Unit 12 Health IT Workforce Curriculum Version 1.0/Fall 2010

3. Some definitions: Health Health – often thought of as the absence of disease World Health Organization (WHO) - specialized agency of the United Nations WHO definition: Health is defined as the “…state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” Thus “illness” is a state of poor health Component 1 / Unit 13 Health IT Workforce Curriculum Version 1.0/Fall 2010

4. Healthcare Healthcare is the prevention and treatment of illness Healthcare is delivered by different people from different disciplines, including –Medicine –Dentistry –Nursing –Laboratory Science –Pharmacy –Other allied health professions These people come together as interdisciplinary teams to deliver care Component 1 / Unit 14 Health IT Workforce Curriculum Version 1.0/Fall 2010

5. Healthcare delivery Healthcare is delivered in different places Inpatient facilities –Hospitals Institutions for treating sick or injured people Historically places for shelter, almshouses Hospital Survey and Construction Act (also known as the Hill-Burton Act) passed in 1946 that provided federal grants to improve hospital physical infrastructure Component 1 / Unit 15 Health IT Workforce Curriculum Version 1.0/Fall 2010

6. Healthcare delivery Inpatient facilities –Different types of hospitals General medical and surgical hospitals Specialty hospitals (orthopedic, pediatrics, women’s services) Psychiatric hospitals Hospitals may be publicly or privately owned Patients can be admitted to a hospital through the emergency room, or directly admitted from a physician’s office Component 1 / Unit 16 Health IT Workforce Curriculum Version 1.0/Fall 2010

7. Healthcare delivery (continued) Nursing and residential care facilities –Can be short term facilities or long term facilities –Long term care classified by level of care –Nursing homes initially proliferated after an amendment of the Social Security Act and gradually shifted from being part of the welfare system to being a part of the healthcare system Component 1 / Unit 17 Health IT Workforce Curriculum Version 1.0/Fall 2010

8. Healthcare delivery (continued) Nursing and residential care facilities –In 1969 -- "Intermediary Letter 371" drastically reducing coverage for nursing homes –In 1970 -- the Miller Amendment established a new standard - "intermediate-care facilities –In the 1990s another standard – “subacute care” to provide care for patients discharged from hospitals who briefly need a higher level of care “than is provided to the majority of patients in a skilled nursing facility”. Component 1 / Unit 18 Health IT Workforce Curriculum Version 1.0/Fall 2010

9. Healthcare delivery (continued) Outpatient facilities –Physicians offices Primary care offices Specialty care offices Single specialty or multispecialty offices –Dental offices General dentists or specialists –Medical and diagnostic laboratories –Other ambulatory health services Component 1 / Unit 19 Health IT Workforce Curriculum Version 1.0/Fall 2010

10. The healthcare industry The healthcare industry is one of the largest industries in the US In 2008 – 14.3 million jobs for wage and salary workers Industry comprises of 595,800 establishments –about 76 percent of healthcare establishments are offices of physicians, dentists, or other health practitioners. –although hospitals constitute only 1 percent of all healthcare establishments, they employ 35 percent of all healthcare workers Component 1 / Unit 110 Health IT Workforce Curriculum Version 1.0/Fall 2010

11. Organization of the healthcare industry Component 1 / Unit 111 Health IT Workforce Curriculum Version 1.0/Fall 2010

12. Healthcare systems A healthcare system is an organization to deliver health care. Many variations and iterations of health care systems worldwide, but in general health care systems –promote good health in populations –balance the levels of actual care provided with the expectations of the population they serve Component 1 / Unit 112 Health IT Workforce Curriculum Version 1.0/Fall 2010

13. Healthcare systems (continued) Different models of healthcare systems –Purely public (care conducted by the state) –Purely private (care conducted by independent, privately funded organizations) –Often a mixed model In countries with state run health care system, a private system may coexist in parallel or offer services not available under the public system Component 1 / Unit 113 Health IT Workforce Curriculum Version 1.0/Fall 2010

14. Healthcare systems (continued) There is no universal health care system in the US But there are public and private components Public healthcare systems may be organized: –At the federal level (for example, the Veterans Health Administration) –As a partnership between federal and state governments (such as Medicaid and the Children’s Health Insurance Program) –At the local level Component 1 / Unit 114 Health IT Workforce Curriculum Version 1.0/Fall 2010

15. Healthcare systems (continued) Privately owned, commercial organizations may also act as healthcare systems These organizations may serve a single area or multiple geographic locations Private healthcare systems may be: –Not-for-profit organizations (governed by principle of non-distribution) or –For profit organizations (distribute surplus funds to shareholders or owners) Component 1 / Unit 115 Health IT Workforce Curriculum Version 1.0/Fall 2010

16. Healthcare systems (continued) Healthcare systems can be measured using benchmarks –One framework for assessment: Patient assessed value Performance on clinical interventions Efficiency Component 1 / Unit 116 Health IT Workforce Curriculum Version 1.0/Fall 2010