Week 1 health and health care system

Health and the Health Care System

Week 1

BNURS 323 Healthcare Politics and Policy

Summer 2009

Health

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

• Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 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.

Retrieved Nov/2008 from http://www.thewellspring.com/wellspring/introduction-to-wellness/357/key-concept-1-the-illnesswellness-continuum.cfm

Jean Watson’s 10 carative factors

• The formation of a humanistic-altruistic system of values

• The instillation of faith-hope• The cultivation of sensitivity to one’s self and to

others• The development of a helping-trusting

relationship• The promotion and acceptance of the

expression of positive and negative feelings

Jean Watson’s 10 carative factors cont’d

• The systematic use of the scientific problem-solving method for decision making

• The promotion of interpersonal teaching-learning• The provision for a supportive, protective, and

(or) corrective mental, physical, sociocultural, and spiritual environment

• Assistance with the gratification of human needs• The allowance for existential-phenomenological

forces (Watson, 1985, p. 9-10)

Non-caring

1986 study by Riemen found three themes emerging from patients descriptions of non-caring nurse behaviors:

1. Physically present—emotionally distant2. Belittling and inhumane actions3. Devaluation of the patient as a unique

individual

Patient satisfaction

• Care is the human service quality that makes health consumers either satisfied or dissatisfied with health services and it is the care not the cure that consumers really value.

• Question for Class: Do we value (health care provider) professional satisfaction? Where does it come in?

Health Services versus Health Care

• Service: Work done by one person or group that benefits another (Retrieved 6/22/09 from wordnet.princeton.edu/perl/webwn)

• Health care: Implies enactment of caring theory, patient satisfaction

• Health care services: implies combination of services and caring

Health care system

• Illness industry: a capitalist institution• Focus on illness and injury versus prevention

of problems and maintenance and promotion of health

• Care versus service versus profit• Non-profit out-of-date term, now not-for-

profit because business management same as for-profit

Health Maintenance

• =Health Protection• Activities that preserve present health• Primary prevention• Health supervision• Monitoring and surveillance

Health Promotion

• Risk Reduction– Health Education: nutrition, physical activity, injury

prevention, sleep, OTC medications, when to call MD and use of health care system, immunizations• Anticipatory Guidance– Physical G&D– Psychological and emotional G&D– Socialization, interactions, behavior

Public Health

• (One) Definition of public health: effort organized by society as a whole to protect, promote, and restore health

• Focus is on what requires group effort to accomplish as opposed to individual effort

• In U.S., mixed knowledge, attitudes, and beliefs about government, role of society in individual life

Economics, Politics, and Policy

• Economics: Study of distribution of scarce resources

• Politics: Study of power over the distribution of scarce resources; social relations involving authority or power

• Policy: A policy is typically described as a deliberate plan of action to guide decisions and achieve rational outcome(s). Retrieved 6/22/09 from http://en.wikipedia.org/wiki/Policy

Public Health Policy

• http://www.cdc.gov/nceh/ehs/EPHLI/core_ess.htm

• Policy Development as one of the Core Functions of Public Health: Assessment, Policy Development, Assurance

Public Health Core and Essential Functions (from webpage previous slide)

• Assessment– Monitor environmental and health status to identify community environmental health problems– Diagnose and investigate environmental health problems and health hazards in the community

• Policy Development– Inform, educate and empower people about environmental health issues– Mobilize community partnerships to identify and solve environmental health problems– Develop policies and plans that support individual and community environmental health efforts

• Assurance– Enforce laws and regulations that protect health and ensure safety– Link people to needed environmental health services and assure the provision of environmental

health services when otherwise unavailable– Assure a competent environmental health workforce– Evaluate the effectiveness, accessibility and quality of personal and population-based

environmental health services– Conduct research for new insights and innovative solutions to environmental health problems

and issues

Questions for Class

• Given the definitions of politics and policy, what is the relationship between them?

Health Care System

• Providers: Hospitals, physicians (those who can bill third party payers directly for their services)

• In-patient/Out-patient: Hospital as basis of orientation; where does ED fall?

• Clinic, out-patient surgery, free-standing birth center

• Urgent care center, doc-in-the-box

Hospitals

• Public: Federal, state, county, city• Community=voluntary=not-for-profit• Proprietary=for profit

Questions for Class

• What is missing from this consideration of the health care system? (hint—who are we?)

• What/who makes the decision for in-patient care/admission to the hospital?

Medical therapeutics

• MDs: Diagnose and treat. How treat?–Prescription of medications: Drugs and herbs• Drug categories: Legend (scheduled and

non-scheduled); OTC– Surgery: historically done by barbers until

discoveries of anesthesia and antisepsis–Counseling: lifestyle advice and

recommendations

Prevention

• Primary Prevention: prevention of occurrence of disease or injury. Code word—prevention.

• Secondary Prevention: prevention of progression of disease to symptoms. Code word—screening. Also early diagnosis and treatment.

• Tertiary Prevention: prevention of sequelae or severe consequences of disease. Prevent disability and death. Code word—rehab.

Public Health Allegory• A man, walking along a riverbank, suddenly sees a person flailing

his arms and hears him pleading for help as he bobs in the water while being pushed downstream. The man on the bank dives into the water, swims to the victim and rescues him by pulling him ashore. When the man turns toward the river, once again he hears someone screaming for help. Then another. And another. One after the other, the man pulls victims from the river.

Exhausted, and pulling yet another victim to shore, he notices a woman walking by. “Help me!” he pleads. “All these people are drowning and I have to do something to save them. More people are falling in and need help. Look!” he says, pointing to the river where more victims are in the water and needing help.

Allegory cont’d

• Immediately, the woman starts to run upstream along the bank.

“Where are you going?” he screams at the woman. “I need help now!”

“I am helping right now,” says the woman. “I’m going upstream to find out how they’re falling into the river and to prevent that!” (Retrieved 6/22/09 from http://www.miph.org/blog/upstream-thinking)

Health and Health Care

• Given the definitions of health care and health, how are they connected?

• What does the research show is the connection between health care and health?

• Social and economic determinants of health: standard of living

Example: Tuberculosis

• http://ajrccm.atsjournals.org/cgi/content-nw/full/169/11/1181/FIG1

Historical Trends in Mortality

• From infectious disease and injury• To chronic diseases• Length of life has increased, quality of life now

a concern for the old-old (> 85 y. o.)• Premature death now more of a concern

Primary causes of death in U.S.

• 0-28 days: congenital anomalies• 29-365 days: SIDS• 1 year – 45 years: unintentional injuries, esp

MVA (MVC)• 45-65 years: 1. Cancer 2. unintentional injuries• 65+: 1. cardiovascular disease 2. cancer