Health Care Systems

Health Care Health Care SystemsSystems

Nevada Health ScienceNevada Health Science

History of Health CareHistory of Health Care

Hippocrates – 400 BCHippocrates – 400 BC Native Americans – herbal therapyNative Americans – herbal therapy Various beliefs:Various beliefs:

– Credited health & illness to moods of Credited health & illness to moods of Gods.Gods.

– Others used reason to attempt to explain Others used reason to attempt to explain diseases.diseases.

– Religion – Greek temple of healing.Religion – Greek temple of healing.– Ancient peoples even performed surgery.Ancient peoples even performed surgery.

•When and how did health care When and how did health care begin?begin?


Manuscripts and books were hand Manuscripts and books were hand copied as medical knowledge increased.copied as medical knowledge increased.

Middle Ages (500 – 1500 AD)Middle Ages (500 – 1500 AD)– Reason began to replace people’s beliefs in Reason began to replace people’s beliefs in

spiritual or superstitious causes for disease.spiritual or superstitious causes for disease.– Doctors began to keep careful notes.Doctors began to keep careful notes.– Development of medicine as a science.Development of medicine as a science.– Regulation of medical care – licensing, Regulation of medical care – licensing,

formal training (no women).formal training (no women).– Religious hospitals.Religious hospitals.


Barber – SurgeonBarber – Surgeon– Middle AgesMiddle Ages– Cut hair, treat cataracts, practice blood-Cut hair, treat cataracts, practice blood-

letting, treat injuries, amputate limbs, letting, treat injuries, amputate limbs, cauterized bleeds.cauterized bleeds.

– Stripped pole – after operation, Stripped pole – after operation, bandages, hung on staff/pole and bandages, hung on staff/pole and placed outside as an advertisement. placed outside as an advertisement. Twirled by the wind, they would form Twirled by the wind, they would form red/white spiral patterns.red/white spiral patterns.


Renaissance (1300 – 1600 AD)Renaissance (1300 – 1600 AD)– Scientific Method came into useScientific Method came into use

Process used to acquire new knowledge Process used to acquire new knowledge instead of guessing or supernatural.instead of guessing or supernatural.

Based on observation, taking careful Based on observation, taking careful notes.notes.

– Microscope inventedMicroscope invented– Study of human anatomyStudy of human anatomy

History of Health CareHistory of Health Care Industrial Revolution (1700 – 1800 AD)Industrial Revolution (1700 – 1800 AD)

– Introduction of machinesIntroduction of machines– Blood carried through body by vessels, Blood carried through body by vessels,

discovery of capillariesdiscovery of capillaries– Stethoscope inventedStethoscope invented– Connection between health & environmentConnection between health & environment– VaccinationsVaccinations– Sterilization of equipment to avoid Sterilization of equipment to avoid

infection (medical asepsis)infection (medical asepsis)– Discovery of pathogens, anesthesiaDiscovery of pathogens, anesthesia


• Modern times (1900 – present)Modern times (1900 – present)– Hospitals were places for people to go Hospitals were places for people to go

to dieto die– Advances in engineering, chemistry, Advances in engineering, chemistry,

physicsphysics– Antibiotics & other medications Antibiotics & other medications

inventedinvented– X-raysX-rays– Organ transplants, artificial organsOrgan transplants, artificial organs– In vitro fertilizationIn vitro fertilization– Research, technology, and computersResearch, technology, and computers

The CaduceusThe Caduceus• Greek God of Healing – Greek God of Healing –

AsclepiusAsclepius• His symbol was the His symbol was the

snakesnake• Priest healers later Priest healers later

adopted the symbol adopted the symbol and has now become and has now become the symbol for the symbol for physiciansphysicians

• Angel of healingAngel of healing

Medical MilestonesMedical Milestones

• 1518 – College of Physicians is established in 1518 – College of Physicians is established in London.London.

• 1628 – William Harvey describes the 1628 – William Harvey describes the circulation of blood.circulation of blood.

• 1816 – Rene Laennec invents the stethoscope.1816 – Rene Laennec invents the stethoscope.• 1839 – First dental school founded in 1839 – First dental school founded in

Baltimore.Baltimore.• 1842 – Crawford Lang develops ether 1842 – Crawford Lang develops ether

anesthesia.anesthesia.• 1869 – Gregor Mendel develops the laws of 1869 – Gregor Mendel develops the laws of

heredity.heredity.• 1893 – Aspirin is developed.1893 – Aspirin is developed.


• 1910 – Marie Curie isolates radium, later 1910 – Marie Curie isolates radium, later used to treat cancer.used to treat cancer.

• 1922 – Frederick Banting treats diabetes 1922 – Frederick Banting treats diabetes with insulin.with insulin.

• 1928 – Sir Alexander Fleming discovers 1928 – Sir Alexander Fleming discovers penicillin.penicillin.

• 1944 – First kidney dialysis machine.1944 – First kidney dialysis machine.• 1953 – First heart-lung machine is used for 1953 – First heart-lung machine is used for

successful open-heart surgery.successful open-heart surgery.• 1953 – First successful kidney transplant 1953 – First successful kidney transplant

performed.performed.


• 1963 – First human liver transplantation.1963 – First human liver transplantation.• 1964 – First human lung transplantation.1964 – First human lung transplantation.• 1967 – Christian Barnard performs the first 1967 – Christian Barnard performs the first

successful heart transplantation.successful heart transplantation.• 1967 – First hospice founded in England.1967 – First hospice founded in England.• 1969 – Denton Cooley implants the first 1969 – Denton Cooley implants the first

temporary artificial heart.temporary artificial heart.• 1972 – CT scan introduced.1972 – CT scan introduced.• 1975 – Lyme disease reported for first 1975 – Lyme disease reported for first

time.time.


• 1978 – First test tube baby born in 1978 – First test tube baby born in England.England.

• 1981 – AIDS is identified as a disease.1981 – AIDS is identified as a disease.• 1981 – First successful surgery on a 1981 – First successful surgery on a

fetus.fetus.• 1998 – Stem cells isolated from fetal 1998 – Stem cells isolated from fetal

tissues.tissues.• 2000 - Human genome mapping 2000 - Human genome mapping

project is completed.project is completed.

Pioneers in MedicinePioneers in Medicine

Without medical pioneers, there would Without medical pioneers, there would be no medical advances, no technology be no medical advances, no technology evolution, no progress at all.evolution, no progress at all.

The theories or conclusions of the The theories or conclusions of the medical pioneers aren’t always popular. medical pioneers aren’t always popular. – New and different ideas are often met with New and different ideas are often met with

hostility, distrust, and contempt.hostility, distrust, and contempt.– Medical pioneers often deal with opposition Medical pioneers often deal with opposition

and conflict, but they move forward with and conflict, but they move forward with determination.determination.

Pioneers in MedicinePioneers in Medicine We literally owe our lives to those that make We literally owe our lives to those that make

the tough decisions affecting the medical the tough decisions affecting the medical field and medical practices.field and medical practices.

Here are just a few:Here are just a few:– Alexander Fleming: penicillin.Alexander Fleming: penicillin.– Joseph Lister: aseptic technique in surgery.Joseph Lister: aseptic technique in surgery.– Jane Addams: first social worker in US.Jane Addams: first social worker in US.– Elizabeth Blackwell: First female physician.Elizabeth Blackwell: First female physician.– Clara Barton: Civil war nurse.Clara Barton: Civil war nurse.– Anthon van Leeuwenhook: invented microscope.Anthon van Leeuwenhook: invented microscope.– Florence Nightingale: founded modern nursing.Florence Nightingale: founded modern nursing.– Harry Heimlich: Heimlich maneuver.Harry Heimlich: Heimlich maneuver.

Trends in Health CareTrends in Health Care ““Explosive” development of Explosive” development of

technologytechnology– Non-invasive diagnosis of soft tissue Non-invasive diagnosis of soft tissue

diseases/injuriesdiseases/injuries– Ultrasound technologyUltrasound technology– RadiologyRadiology– Cancer treatmentsCancer treatments– Mobile telephonesMobile telephones– Cameras – scopesCameras – scopes– Digital imagingDigital imaging– VERY EXPENSIVEVERY EXPENSIVE

Trends in Health CareTrends in Health Care

Preventive Medicine – WellnessPreventive Medicine – Wellness– Link between diet, exercise, & good Link between diet, exercise, & good

healthhealth– Health care wellness centers for patients Health care wellness centers for patients

with chronic diseases (arthritis, diabetes, with chronic diseases (arthritis, diabetes, osteoporosis, etc.)osteoporosis, etc.)

– Complimentary therapy, Holistic medicineComplimentary therapy, Holistic medicine– Disease screeningsDisease screenings– Helps control costs, encourage positive Helps control costs, encourage positive

choiceschoices


Aging PopulationAging Population– By 2005, one of every two adults will By 2005, one of every two adults will

be 45 years or olderbe 45 years or older– Baby Boom (1946 – 1964)Baby Boom (1946 – 1964)– The elderly require moreThe elderly require more

health serviceshealth services


Underinsured & UninsuredUnderinsured & Uninsured– 16% (42 million) of US population do 16% (42 million) of US population do

not have health insurancenot have health insurance– Many citizens have health insurance Many citizens have health insurance

but the coverage is limited or the co-but the coverage is limited or the co-payments or deductibles are very highpayments or deductibles are very high

– 74% of the uninsured are in families 74% of the uninsured are in families with at least 1 full-time workerwith at least 1 full-time worker

– Among low-wage workers (<$7/hr), Among low-wage workers (<$7/hr), 45% are not even offered medical 45% are not even offered medical benefitsbenefits


Underinsured & Uninsured, cont.Underinsured & Uninsured, cont.– County hospitals, tax-supported hospitals County hospitals, tax-supported hospitals – Cost absorption Cost absorption – Lack of careLack of care– Underinsured – small companies have Underinsured – small companies have

greater overhead costs for providing greater overhead costs for providing insurance and generally only offer a insurance and generally only offer a “one-size-fits-all” medical plan to “one-size-fits-all” medical plan to employeesemployees


Ambulatory/Outpatient SurgeryAmbulatory/Outpatient Surgery– Many procedures, from diagnosis to Many procedures, from diagnosis to

treatment can now be done without treatment can now be done without overnight hospitalizationovernight hospitalization

– Technology, research, new Technology, research, new medicationsmedications

– Influenced by limits on insurance Influenced by limits on insurance reimbursements (DRG’s)reimbursements (DRG’s)

– Overall cost of procedures is reducedOverall cost of procedures is reduced

DRG’sDRG’s

Diagnostic Related Diagnostic Related GroupsGroups– Groups of Groups of

procedures or tests procedures or tests related to a specific related to a specific diagnosis diagnosis

– Now a flat fee is Now a flat fee is paid based upon the paid based upon the diagnosis regardless diagnosis regardless of how long the of how long the patient stays or the patient stays or the services providedservices provided


Home Health CareHome Health Care– Common during late 1980’sCommon during late 1980’s– Nurse or other skilled professional visits Nurse or other skilled professional visits

the home to assess patient’s condition the home to assess patient’s condition and provide treatments and educationand provide treatments and education

– Families and patients have to learn how Families and patients have to learn how to self-administer treatments or to self-administer treatments or perform procedures done in the perform procedures done in the hospital in the pasthospital in the past

– Health care workers evolved to become Health care workers evolved to become teachers and coachesteachers and coaches


Home Health Care, cont.Home Health Care, cont.– Benefits:Benefits:

Exposed to fewer Exposed to fewer pathogens and germspathogens and germs

Reduced stress/anxiety in Reduced stress/anxiety in familiar surroundingsfamiliar surroundings

Lesser skilled workers can Lesser skilled workers can assist with personal assist with personal activities leaving skilled activities leaving skilled workers to provide workers to provide assessment, treatment & assessment, treatment & education – decreases costseducation – decreases costs

Health Care FacilitiesHealth Care Facilities

Places that provide care or make it possible for Places that provide care or make it possible for some type of care to be delivered to patientssome type of care to be delivered to patients

HospitalsHospitals– ReligiousReligious– Private (generally for profit)Private (generally for profit)– Nonprofit – any profit returned to the institution to Nonprofit – any profit returned to the institution to

pay for updates, expansionpay for updates, expansion– Government - funded by taxes (Military, Veterans)Government - funded by taxes (Military, Veterans)– Specialized – specialize in groups of patients or Specialized – specialize in groups of patients or

specific diseases/treatments (cancer, children, etc.)specific diseases/treatments (cancer, children, etc.)


Long-Term CareLong-Term Care– Provide nursing or other professional Provide nursing or other professional

health care services on a regular basishealth care services on a regular basis– Patients may not be safe to live alone or Patients may not be safe to live alone or

may have needs their family cannot meetmay have needs their family cannot meet– Generally see doctors on a monthly basisGenerally see doctors on a monthly basis– Private, non-profit, state/federally fundedPrivate, non-profit, state/federally funded

Assisted-Living CenterAssisted-Living Center Skilled Nursing FacilitiesSkilled Nursing Facilities


Private OfficesPrivate Offices– Individual and group practicesIndividual and group practices

ClinicsClinics– Share office and support staff but have Share office and support staff but have

their own patientstheir own patients– May specialize or combine different May specialize or combine different

specialties – medical care plus allied specialties – medical care plus allied health carehealth care

– Mobile clinicsMobile clinics


LaboratoriesLaboratories– Specimen testingSpecimen testing– May be part of a hospital or independentMay be part of a hospital or independent

Emergency Medical ServicesEmergency Medical Services– Provide care to ill and injured people as Provide care to ill and injured people as

quickly as possiblequickly as possible– Moving out in to the communities (ex: Moving out in to the communities (ex:

Instacare, etc)Instacare, etc)


HospiceHospice– Multidisciplinary care for patients who Multidisciplinary care for patients who

have a terminal illness – generally have a terminal illness – generally fewer than six months to livefewer than six months to live

– Focuses on the ill person & family, not Focuses on the ill person & family, not the diseasethe disease

– Goal is to reduce pain and other Goal is to reduce pain and other symptoms and provide emotional symptoms and provide emotional supportsupport

– Generally provided in patient’s homeGenerally provided in patient’s home– Hospice centers are availableHospice centers are available

Health Care AgenciesHealth Care Agencies

Government AgenciesGovernment Agencies– Mainly conduct research, oversee Mainly conduct research, oversee

programs and establish health care programs and establish health care policiespolicies

– ExamplesExamples National Institutes of HealthNational Institutes of Health U.S. Department of Health & Human ServicesU.S. Department of Health & Human Services World Health OrganizationWorld Health Organization Local Health DepartmentsLocal Health Departments Center for Disease Control & PreventionCenter for Disease Control & Prevention Food & Drug AdministrationFood & Drug Administration

Local Health Local Health DepartmentsDepartments

Provide immunizations, inspect Provide immunizations, inspect restaurants, oversee protection of restaurants, oversee protection of the environmentthe environment

Collect statistics about Collect statistics about communicable diseasescommunicable diseases

Health education, community Health education, community health-related serviceshealth-related services

U.S. Dept of Health & U.S. Dept of Health & Human Services (DHHS)Human Services (DHHS) President appoints Secretary of President appoints Secretary of

Health & Human Services – advises Health & Human Services – advises on matters of health and welfareon matters of health and welfare

Provide services to needy children Provide services to needy children & families, at-home services to & families, at-home services to elderlyelderly

Reduce medical errors & costs, Reduce medical errors & costs, and improve quality of health careand improve quality of health care

Centers for Disease Centers for Disease Control & Prevention Control & Prevention

(CDC)(CDC) Agency of DHHSAgency of DHHS Monitors and prevents the Monitors and prevents the

outbreak of diseasesoutbreak of diseases International disease transmission, International disease transmission,

national health statistics, researchnational health statistics, research Ensure health and safety of the Ensure health and safety of the

nationnation

Food & Drug Food & Drug Administration (FDA)Administration (FDA)

Agency of DHHSAgency of DHHS Ensure the safety Ensure the safety

of foods and of foods and cosmetics, and cosmetics, and the safety and the safety and usefulness of usefulness of medications and medications and medical devicesmedical devices

National Institutes National Institutes of Health (NIH)of Health (NIH)

Agency of DHHSAgency of DHHS World’s premier World’s premier

medical research medical research organizationorganization

Cancer, Cancer, Alzheimer’s, Alzheimer’s, diabetes, arthritis, diabetes, arthritis, heart disease, heart disease, and AIDSand AIDS

World Health World Health Organization (WHO)Organization (WHO)

International agency International agency sponsored by the United sponsored by the United NationsNations

Directing & coordinating Directing & coordinating authority on international authority on international healthhealth

Goal is to help all people Goal is to help all people attain the highest possible attain the highest possible levels of healthlevels of health

International health International health statisticsstatistics

Volunteer & Non-Profit Volunteer & Non-Profit Health AgenciesHealth Agencies

Supported by Supported by private private contributions & contributions & fund-raisingfund-raising

Most deal with a Most deal with a specific disease or specific disease or group of diseasesgroup of diseases

Provide funding for Provide funding for research and research and promote educationpromote education

May also provide May also provide services to patientsservices to patients

Great influence on Great influence on laws & standardslaws & standards

Examples:Examples:– American Lung American Lung

AssocAssoc– March of DimesMarch of Dimes– American Heart American Heart

AssocAssoc

Current World Health Current World Health IssuesIssues

AIDS/HIVAIDS/HIV TuberculosisTuberculosis Severe Acute Respiratory Severe Acute Respiratory

Syndrome (SARS) Syndrome (SARS) Tobacco controlTobacco control Traveler’s healthTraveler’s health PolioPolio Maternal healthMaternal health Road SafetyRoad Safety

Utah Health IssuesUtah Health Issues Influenza & “Ask For A Influenza & “Ask For A

Mask”Mask” Affordable prescriptionsAffordable prescriptions Children’s health Children’s health

insuranceinsurance Smoking cessation Smoking cessation

programsprograms Student injuries at Student injuries at

schoolschool DiabetesDiabetes Maternal & infant healthMaternal & infant health

National Health CareNational Health Care

The U.S. health care system is a The U.S. health care system is a mix of public and private programs mix of public and private programs with many people falling between with many people falling between the cracks.the cracks.

There are enormous gaps in the There are enormous gaps in the insurance coverage available and insurance coverage available and level of benefits to people of level of benefits to people of similar circumstances.similar circumstances.


Is health care a right or a privilege?Is health care a right or a privilege? We assure a free, public education to all We assure a free, public education to all

children – how about affordable access children – how about affordable access to at least basic health care?to at least basic health care?

Canada ,United Kingdom, Singapore Canada ,United Kingdom, Singapore guarantee all citizens universal health guarantee all citizens universal health care – “medically necessary” services.care – “medically necessary” services.

Health care services are available on the Health care services are available on the basis of need, not on the ability to pay basis of need, not on the ability to pay for services.for services.


Canada - ProsCanada - Pros– 30 million citizens (comparable to Calif).30 million citizens (comparable to Calif).– Patient goes to physician of choice; no Patient goes to physician of choice; no

deductibles, co-payments, limits, or deductibles, co-payments, limits, or forms.forms.

– *80 billion spent annually and 70% is *80 billion spent annually and 70% is publicly funded – no private insurance.publicly funded – no private insurance.

– Providers/facilities receive global Providers/facilities receive global operating budgets.operating budgets.

– No public awareness of actual costs.No public awareness of actual costs.

National Health CareNational Health Care Canada – ConsCanada – Cons

– No limits on demand, patients seek as No limits on demand, patients seek as much health care as desired.much health care as desired.

– No physician pay raises since 1993.No physician pay raises since 1993.– Sharp decline in quality of services.Sharp decline in quality of services.– Huge wait time for specialist care.Huge wait time for specialist care.

Heart bypass = 18.2 week wait.Heart bypass = 18.2 week wait. Gynecologist = 11.6 week wait.Gynecologist = 11.6 week wait. Orthopedic Surgery = 20.7 week wait.Orthopedic Surgery = 20.7 week wait. General Surgery = 7.1 week wait.General Surgery = 7.1 week wait.

– Rationing of care.Rationing of care.


Is national health care the answer?Is national health care the answer? Other options?Other options?

– Medical savings account.Medical savings account.– Soft mandate that if you don’t take Soft mandate that if you don’t take

advantage of available insurance you lose advantage of available insurance you lose tax benefits and other gov’t entitlements.tax benefits and other gov’t entitlements.

– ““Pooling” to decrease insurance Pooling” to decrease insurance premiums and overhead.premiums and overhead.

– Sponsor “creative federalism” – Sponsor “creative federalism” – experiment with strategies for providing experiment with strategies for providing health care.health care.

Federal Initiatives – Federal Initiatives – Pres. BushPres. Bush

Health Care InitiativesHealth Care Initiatives– Health Savings AccountsHealth Savings Accounts

Out of pocket medical expenses, premiums Out of pocket medical expenses, premiums during unemployment.during unemployment.

Earn tax-free interest, rolled over year to Earn tax-free interest, rolled over year to year.year.

$2600/individual, $5150/family.$2600/individual, $5150/family.

– Health Care Tax CreditHealth Care Tax Credit Tax credit to individuals without access to Tax credit to individuals without access to

employer-based coverage.employer-based coverage. $1000/individual, $3000/family.$1000/individual, $3000/family.


Association Health Plans (AHPs)Association Health Plans (AHPs)– Allow individuals and groups to purchase Allow individuals and groups to purchase

health insurance from an association of health insurance from an association of which they are a member.which they are a member.

– Leverage volume through membership, Leverage volume through membership, similar to how large employers operate similar to how large employers operate their health benefits programs.their health benefits programs.

– Goal is to offer small employers an Goal is to offer small employers an alternative to costly insurance programs.alternative to costly insurance programs.


Medical Malpractice ReformMedical Malpractice Reform– The lawsuit crisis in many states has The lawsuit crisis in many states has

little or nothing to do with increases in little or nothing to do with increases in bad medical practices, but often results bad medical practices, but often results from exotic theories of legal liability, from exotic theories of legal liability, runaway juries, and absurd state tort runaway juries, and absurd state tort rulings.rulings.

– Congress should strongly encourage Congress should strongly encourage states to reform their destructive states to reform their destructive medical malpractice system in ways that medical malpractice system in ways that are consistent with the Constitutional are consistent with the Constitutional principle of federalism.principle of federalism.


MedicareMedicare– New Medicare law: Provision of a drug New Medicare law: Provision of a drug

discount card, help for low income discount card, help for low income seniors, and an improvement of seniors, and an improvement of private plan competition.private plan competition.

– The coming Medicare crisis: Explosion The coming Medicare crisis: Explosion of Medicare costs and un-funded of Medicare costs and un-funded liabilities, loss of retiree drug liabilities, loss of retiree drug coverage (7 years).coverage (7 years).

Future of Health CareFuture of Health Care

The two areas of advancement The two areas of advancement that will have the greatest impact that will have the greatest impact on the future of health care are:on the future of health care are:– Digital TechnologyDigital Technology– GeneticsGenetics


Digital TechnologiesDigital Technologies– Diagnostics/Imaging.Diagnostics/Imaging.– Remote medical care.Remote medical care.– Even shorter hospital stays.Even shorter hospital stays.

Home monitoring.Home monitoring.

– Robotic medicine.Robotic medicine.– Injectable chips and computers.Injectable chips and computers.

Remote control by thought alone.Remote control by thought alone. Restore hearing, sight.Restore hearing, sight. Movement for paralyzed.Movement for paralyzed.


GeneticsGenetics– Most illnesses are influenced by our Most illnesses are influenced by our

genes.genes.– Predicting disease & response to meds.Predicting disease & response to meds.– New vaccines.New vaccines.– Human cloning, stem cells for Human cloning, stem cells for

replacement tissues.replacement tissues.– Universal code of life.Universal code of life.

Mix & match – scorpion into cabbage, etc.Mix & match – scorpion into cabbage, etc.

– Designer babies.Designer babies.


Get ready for the biggest shift in Get ready for the biggest shift in values as people ask profound values as people ask profound questions about the meaning of life.questions about the meaning of life.– We are more than just complex We are more than just complex

machines.machines.– Emphasis on quality of life.Emphasis on quality of life.– Emphasis on the unique value of every Emphasis on the unique value of every

person.person.

Health Care Systems

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