overview of healthcare services

Overview of Healthcare Services

Nawanan Theera-Ampornpunt, M.D., Ph.D.Health Informatics Division

Faculty of Medicine Ramathibodi HospitalMahidol University

TMHG 541: Fundamentals of Health Care and Medical Terminology

January 8, 2013

A Few Words About Me...

2003 Doctor of Medicine (1st-Class Honors), Ramathibodi2009 M.S. (Health Informatics), University of Minnesota2011 Ph.D. (Health Informatics), University of Minnesota

Currently• Deputy Chief, Health Informatics Division, Ramathibodi

Contacts@Nawanan @ThaiHealthITnawanan.the@mahidol.ac.thSlideShare.net/Nawananwww.tc.umn.edu/~theer002groups.google.com/group/ThaiHealthIT

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TMHG 541Course Overview

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Course Outline• Health Care Delivery

• Overview of Healthcare Services• Operations in the Clinical Settings• Quality in Healthcare Organizations• Clinical Processes and Judgment• Case Studies

• Medical Terminology• Basic Word Structure• Prefixes/Suffixes• Terminologies in Specific Areas

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Aims• To introduce basic concepts of healthcare services and medical terminologies

• To familiarize non-healthcare students to healthcare context for their further study in the curriculum

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Grading• Class Attendance 10%

• Class Participation 30%

• Assignments 60%

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Outline• Health• Health Systems & Healthcare Systems• Functions & Components• Characteristics of a Desirable Health System• Models of Healthcare Systems• Healthcare Professionals• Determinants of Health• Major Issues in Health Care

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“Health”

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Class Discussion:

What Is Health?

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Health• Health vs. Illness and Disease

• Medical Model:Health = Absence of Illness or Disease

• So what’s the problem with this model?

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Problems with the Medical Model• Emphasis on treatment of illness/disease

• Promotion and Prevention deemphasized

• Not true sense of the word “Health” but rather just “Lack of ill health”

• So what’s a better model of health?

Shi & Singh (2004)

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The WHO Model & Definition

• “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

WHO Constitution (1948)

• Also known as biopsychosocial model of health

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Holistic Health• The well-being of every aspect of what makes a person whole and complete

Shi & Singh (2004)

Holistic Health

Physical

Mental

Social

Spiritual

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Health Systems & Healthcare Systems

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Health Systems• A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health.

• Includes efforts to influence determinants of health as well as more direct health-improving activities.

• More than the pyramid of publicly owned facilities that deliver personal health services.

WHO (2007)

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Health Systems• Includes

• A mother caring for a sick child at home• Private providers• Behavior change program• Vector-control campaigns• Health insurance organizations• Occupational health and safety legislation.• Inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well known determinant of better health. WHO (2007)

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Health Care• Health care: Activities and services performed to improve a person’s health and well-being, through prevention and treatment of illness.

• Similar terms• Healthcare services• Healthcare delivery

Adapted from Shi & Singh (2004)

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Healthcare Systems• An organization that delivers healthcare • In general, healthcare systems

• promote good health in populations• balance levels of actual care provided with the expectations of the population they serve

• Narrower definition than WHO’s “Health Systems”

18Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Systems• 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

19Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Systems

• 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)

20Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Systems

• Healthcare systems can be measured using benchmarks• One framework for assessment:

• Patient assessed value• Performance on clinical interventions• Efficiency

21Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Public Health

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“is the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.“

(Winslow, C.E.A. 1920)

Adapted from materials developed by Oregon Health & Science University, funded by the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human 

Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

What is Public Health?• Private Health

• Clinicians, Health Practitioners

• Treat Individual Health Problems

• Action usually taken after illness/injury occurs

• Public Health• Agencies• Treat/Maintain Health of

Populations• Actions include

Education, Policy, Research, Monitoring

23Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 7a).

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10 Great Public Health Achievements –US, 1900-1999

• Vaccination• Motor-vehicle safety• Safe workplaces• Control of infectious diseases• Decline in deaths from coronary heart disease and stroke• Safer and healthier foods• Healthier mothers and babies• Family planning• Fluoridation of drinking water• Recognition of tobacco use as a health hazard

24Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

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How Has Public Health Improved Healthcare?• Improvements in understanding disease

• Epidemiology is considered the basic science of public health and is• a quantitative basic science• a method of causal reasoning based on developing

and testing hypotheses pertaining to occurrence and prevention of morbidity and mortality

• a tool for public health action to promote and protect the public’s health

25Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

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• An example of epidemiology at work: • In 1854: epidemic of cholera in London, England• Cholera is a bacterial disease• Lack of sanitation and overcrowding led to the spread

of disease• Dr. John Snow linked the spread of disease to a

contaminated public water pump• Snow’s hypothesis: cholera was spread by

contaminated water

26Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

How Has Public Health Improved Healthcare?

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• Improvements in data collection • Original methods of data collection were crude• progressive improvement in methodology led to the use

of sophisticated scientific methods to collect data• cohort studies • randomized controlled trials

27Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

How Has Public Health Improved Healthcare?

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• Improvements in data analysis (use of tools such as multivariate analysis and meta-analysis)

• Improvement in disease surveillance • Example: the Real-Time Outbreak and Disease

Surveillance (RODS) Laboratory at the University of Pittsburgh, Department of Biomedical Informatics

28Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

How Has Public Health Improved Healthcare?

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• Improvement in training • Establishment of many schools of public health in the

early 20th century• Professional degrees such as Master of Public Health

(M.P.H.)• Improvements in infrastructure

• Federal• State• Local health departments

29Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1b).

How Has Public Health Improved Healthcare?

Functions & Components of Health Systems

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Functions of Healthcare Systems

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Healthcare Service Delivery

Health Insurance

Adapted from Shi & Singh (2004) by Theera‐Ampornpunt

Healthcare Payment

Healthcare Financing

Access

FundingFunding

Claims & Reimbursements

Governance, Policy &

Administration

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Components of Health Systems

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WHO (2009)

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Key Stakeholders in Health Care (4Ps)

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Public/Population

Providers

Policy-Makers

Patients

Payers & Purchasers

Adapted from Parchariyanon (2012) by Theera‐Ampornpunt

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Healthcare Delivery

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• Healthcare is delivered in different places• Inpatient facilities

• Hospitals• Institutions for treating sick or injured people• Historically places for shelter, almshouses

• Different types of hospitals• General medical and surgical hospitals• Specialty hospitals (orthopedic, pediatrics, women’s

services, psychiatric, neurological, infectious disease)

Adapted from materials developed by Oregon Health & Science University, funded by the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human 

Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Delivery

• Hospitals may be publicly or privately owned• Patients can be admitted to a hospital through

• Emergency room• An internal outpatient clinic• Directly admitted from an external physician’s office

• Depends on local practices

35Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Delivery

• Nursing and residential care facilities• Can be short term facilities or long term facilities

• Long term care classified by level of care• Nursing homes gradually shifted from being part of the welfare system to being a part of the healthcare system

36Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Delivery• Outpatient facilities • Hospitals in some countries provide ambulatory care through internal outpatient clinics

• Physicians offices (also known as private clinics)

• Primary care offices• Specialty care offices• Single specialty or multispecialty offices

37Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

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Healthcare Delivery• Dental offices

• General dentists or specialists• Medical and diagnostic laboratories• Pharmacies

• Internal pharmacies of hospitals• Private pharmacies

• Community health centers• Other ambulatory health services

38Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

U.S. Healthcare IndustryIndustry segment Employment Establishments

Total 100.0 100.0

Ambulatory healthcare services 42.6 87.3

Offices of physicians 17.0 36.0

Home healthcare services 7.2 3.7

Offices of dentists 6.2 20.4

Offices of other health practitioners 4.7 19.6

Outpatient care centers 4.0 3.6

Other ambulatory healthcare services 1.8 1.4

Medical and diagnostic laboratories 1.6 2.4

Hospitals 34.6 1.3

General medical and surgical hospitals 32.5 1.0

Other specialty hospitals 1.4 0.2

Psychiatric and substance abuse hospitals 0.7 0.1

Nursing and residential care facilities 22.8 11.4

Community care facilities for the elderly 5.2 3.5

Residential mental health facilities 4.1 4.0

Other residential care facilities 1.3 1.1

1.1 Table: Percent distribution of employment and establishments in health services by detailed industry sector, 2008.

39Adapted from materials developed by Oregon Health & Science University, funded by the Office of the 

National Coordinator for Health Information Technology, U.S. Department of Health and Human Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1a).

Characteristics of a Desirable Health System

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WHO Framework

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WHO (2009)

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EQESAR Framework

• E - Equity• Q - Quality• E - Efficiency• SA - Social Accountability• R - Relevance

42Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

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Equity

• Equal services for equal needs• Unequal services for unequal needs• Accessibility

• Physical• Psychological• Financial• Information

43Leerapan B. Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Quality• Safety• Timeliness• Effectiveness• Patient-centeredness

Adapted from IOM (2001)

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Efficiency

• Cost-effectiveness• Output or outcome versus cost• Technical/operational efficiency• Allocative efficiency

45Adapted from Leerapan B. Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

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Social Accountability

• Good governance• Adequate oversight and monitoring• Transparency

46Adapted from Leerapan B. Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

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Relevancy

• Relevant to issues/problems in the context of interest

• Context-dependent

47Adapted from Leerapan B. Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Models of Healthcare Systems

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Models of Healthcare Systems

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Model Financing ProviderOwnership

Example of Countries

Employer-based(market-based)

private insurance

Multipayer, voluntary

Private United States

National health insurance

Single-payer (general taxes)

Public/Private Canada

National health system

Single-pyaer(general taxes)

Public United Kingdom

Socialized health insurance

Employer-employee,mandatory

Private Germany

Hybrid Multiple models Public/Private Thailand

Adapted from Shi & Singh (2004)

Healthcare Professionals

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Healthcare Professionals

• Physicians• Doctor of Medicine (M.D.)

• Allopathic medicine - views medical treatment as active intervention to produce a counteracting reaction in an attempt to neutralize effects of disease

• Doctor of Osteopathic Medicine (D.O.)• Osteopathic medicine - emphasizes musculoskeletal system, stresses preventive medicine as factors that might influence natural resistance

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Adapted from Shi & Singh (2004)

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Healthcare Professionals

• Physicians• Generalists

• General practitioners (GP)• Primary care physicians (PCP)

• Specialists• Certified in an area of medical specialization• Residency: graduate medical education in a specialty in the form of paid on-the-job training (trainees called residents)

• Fellowship: subspecialty training after residency (trainees called fellows) 52

Adapted from Shi & Singh (2004)

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Healthcare Professionals

• The following are often considered generalists working as primary care physicians (but they typically underwent residency training after medical school, i.e. not just GPs)• Family medicine physicians• General internal medicine physicians (internists)• General pediatricians

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Adapted from Shi & Singh (2004)

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Healthcare Professionals

• Dental Professionals• Dentists• Dental hygienists• Dental assistants

• Pharmacists

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Adapted from Shi & Singh (2004)

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Healthcare Professionals

• Nurses• Practical nurses (PN)• Registered nurses (RN)• Advanced practice nurses (APN)

• Clinical nurse specialists (CNSs)• Certified registered nurse anesthetists (CRNAs)• Nurse practitioners (NPs)• Certified nurse midwives (CNMs)

• Physician Assistants55

Adapted from Shi & Singh (2004)

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Healthcare Professionals• Allied Health Professionals

• Physical therapists• Occupational therapists• Respiratory therapists• Medical records technicians• Medical technologists• Radiology technicians• Dietitians• Social workers• Speech therapists• Public health practitioners• etc.

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Adapted from Shi & Singh (2004)

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Healthcare Professionals

• Other health professions• Optometrists• Psychologists• Podiatrists• Chiropractors

• Presence, numbers and authorized practices vary by location

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Adapted from Shi & Singh (2004)

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Other Roles & Professions• Alternative and traditional medicine practitioners• Health services administrators• Researchers• Educators• Informaticians• Engineers• Other administrative staff

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Adapted from Shi & Singh (2004)

Determinants of Health

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The Epidemiology Triangle

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Host

EnvironmentAgent

Disease

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Determinants of Health

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Individual

Adapted from Leerapan B. Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand

Environment

Health

Healthcare Systems

- Genetics- Attitudes- Behaviors- Lifestyles

- Physical- Biological- Social, cultural, economic, political, technological

Major Issues in Health Care

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Major Issues in Health Care

• Public Policy & Healthcare Reform• Universal Healthcare Coverage• Cost Containment• Quality & Patient Safety• Innovative Models of Healthcare Delivery & Financing

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Major Issues in Health Care

• Evidence-Based Practice• Increased Expectations & Patient Volumes• Prevention vs. Treatment• Rise of Aging Population & Chronic Diseases• Legal Issues (e.g. Malpractice)• Patient engagement• Workforce: Shortages, maldistributions & evolving competency requirements

• Technological Advances 64

Paradigm Shifts in Medicine

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• Physician-centric to patient-centric care• Individual to team-based care• Paper-based to electronic-based management of medical records

• Provider-kept to personal health records

Adapted from materials developed by Oregon Health & Science University, funded by the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human 

Services (Health IT Workforce Curriculum v.3.0/Spring 2012, Component 1/Unit 1c).

References• Centers for Disease Control and Prevention (CDC). Ten great public

health achievements--United States, 1900–1999. MMWR MorbMortal Wkly Rep. 1999 Apr 2;48(12):241-3.

• Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001. 337 p.

• McKee M. Measuring the efficiency of health systems. The world health report sets the agenda, but there’s still a long way to go.BMJ. 2001 Aug 11;323(7308):295-6.

• Shi L, Singh DA. Delivering health care in America: a systems approach. 3rd ed. Sudbury (MA): Jones and Bartlett Publishers; 2004. 652 p.

• Winslow CE. The untilled fields of public health. Science. 1920 Jan 9;51(1306):23-33.

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References• Constitution of the World Health Organization. Geneva,

Switzerland: World Health Organization; 1948. Available from: http://apps.who.int/gb/bd/PDF/bd47/EN/constitution-en.pdf

• Everybody’s business. Strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva, Switzerland: World Health Organization; 2007. Available from: http://www.who.int/healthsystems/strategy/everybodys_business.pdf

• Systems thinking for health systems strengthening. Geneva, Switzerland: World Health Organization; 2009. Available from: http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf

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