1. Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a This material (Comp1_Unit1a) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Introduction and History of Modern Healthcare in the US Learning Objectives 2 Delineate key definitions in the healthcare domain (Lectures a, b, c, d) Explore components of healthcare delivery and healthcare systems (Lecture a) Define public health and review examples of improvements in public health (Lecture b) Discuss core values and paradigm shifts in US healthcare (Lecture c) Describe in overview terms, the technology used in the delivery and administration of healthcare (Lecture d) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

3. Some Definitions: Health 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a Health – often thought of as the absence of disease World Health Organization (WHO) - specialized agency of the United Nations 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

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 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

5. Healthcare Delivery 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a 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

6. Healthcare Delivery (continued) 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 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

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 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

8. Healthcare Delivery (continued) Nursing and residential care facilities –In 1969, "Intermediary Letter 371" drastically reduced coverage for nursing homes –In 1970, the Miller Amendment established a new standard - "intermediate-care” facilities –In the 1990s another standard was defined: “subacute care” – that provided 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”. 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

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 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

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 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

11. Organization of the Healthcare Industry Industry segmentEmploymentEstablishments Total100.0 Ambulatory healthcare services42.687.3 Offices of physicians17.036.0 Home healthcare services7.23.7 Offices of dentists6.220.4 Offices of other health practitioners4.719.6 Outpatient care centers4.03.6 Other ambulatory healthcare services1.81.4 Medical and diagnostic laboratories1.62.4 Hospitals34.61.3 General medical and surgical hospitals32.51.0 Other specialty hospitals1.40.2 Psychiatric and substance abuse hospitals0.70.1 Nursing and residential care facilities22.811.4 Community care facilities for the elderly5.23.5 Residential mental health facilities4.14.0 Other residential care facilities1.31.1 1.1 Table: Percent distribution of employment and establishments in health services by detailed industry sector, 2008. 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

12. Healthcare Systems A healthcare system is an organization that delivers healthcare Many variations and iterations of healthcare systems worldwide, but in general, healthcare systems –promote good health in populations –balance the levels of actual care provided with the expectations of the population they serve 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

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 healthcare system, a private system may coexist in parallel or offer services not available under the public system 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

14. Healthcare Systems (continued) There is no universal healthcare 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 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

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) 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

16. Healthcare Systems (continued) Healthcare systems can be measured using benchmarks –One framework for assessment: Patient assessed value Performance on clinical interventions Efficiency 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

17. Introduction and History of Modern Healthcare in the US Summary – Lecture a 17 Important definitions: –Health – not just the absence of disease or illness –Healthcare – prevention and treatment of illness –Healthcare System – an organization that delivers healthcare There are different types of healthcare delivery: –Inpatient (hospitals, short and long term care facilities) –Outpatient (speciality care facilities, laboratories) There are different healthcare system models that range from private to public funding; most systems fall somewhere between these two extremes. Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a

18. Introduction and History of Modern Healthcare in the US References – Lecture a 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Introduction and History of Modern Healthcare in the US Lecture a References 2002 NAICS Definitions - 621 Ambulatory Health Care Services. (2002). Retrieved December 6, 2011, from US Census Bureau website: http://www.census.gov/epcd/naics02/def/NDEF621.HTM.http://www.census.gov/epcd/naics02/def/NDEF621.HTM Career Guide to Industries, 2010-11 Edition. (2011). Retrieved December 6, 2011, from Bureau of Labor Statistics, U.S. Department of Labor website: http://www.bls.gov/oco/cg/.http://www.bls.gov/oco/cg/ Definition of Healthcare. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. Duckett, S. J., & Ward, M. (2008). Developing ‘robust performance benchmarks’ for the next Australian healthcare Agreement: The need for a new framework. Aust New Zealand Health Policy, 5(1). Health Care Careers Directory - Allied Health. (2011). Retrieved December 6, 2011, from American Medical Association website: http://www.ama-assn.org/ama/pub/education-careers/careers-health-care/directory.shtml.http://www.ama-assn.org/ama/pub/education-careers/careers-health-care/directory.shtml Hospital. (2011). In Encyclopædia Britannica. Retrieved from http://www.britannica.com/EBchecked/topic/272626/hospital. http://www.britannica.com/EBchecked/topic/272626/hospital Subacute care definition. (2011). Retrieved December 6, 2011, from Ca.gov Department of Healthcare Services website: http://www.dhcs.ca.gov/provgovpart/Pages/SubacuteCare.aspx.http://www.dhcs.ca.gov/provgovpart/Pages/SubacuteCare.aspx World Health Report 2000 - Health systems: improving performance. (2000). Retrieved December 6, 2011, from WHO website: http://www.who.int/whr/2000/en/.http://www.who.int/whr/2000/en/ Charts, Tables, Figures 1.1Table: BLS Quarterly Census of Employment and Wages, 2008. (2008). Retrieved December 6, 2011, from US Bureau of Labor Statistics website: http://www.bls.gov/cew/.http://www.bls.gov/cew/