component 1: introduction to health care and public health in the u.s. 1.1: unit 1: introduction to...

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

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 1 2Health IT Workforce Curriculum

Version 1.0/Fall 2010

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



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



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



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



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




• 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”.




• 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



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



Organization of the healthcare industry



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



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




• 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 levelComponent 1 / Unit 1 14

Health IT Workforce Curriculum Version 1.0/Fall 2010


• 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)




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

• Patient assessed value• Performance on clinical interventions• Efficiency



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