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Week 12, Health Care Org notes

by: Loretta Hellmann

Week 12, Health Care Org notes HCA 340 -002

Loretta Hellmann
GPA 3.75

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Week 12, chapter 11
Steven W. Maddox
Class Notes
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This 7 page Class Notes was uploaded by Loretta Hellmann on Sunday April 24, 2016. The Class Notes belongs to HCA 340 -002 at Western Kentucky University taught by Steven W. Maddox in Spring 2016. Since its upload, it has received 22 views. For similar materials see HEALTH CARE ORG/MGT in Nursing and Health Sciences at Western Kentucky University.

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Date Created: 04/24/16
Week 12 notes Tuesday, April 19, 2016 9:35 AM Chapter 11 Public Health and the Role of Government in Health Care Tuesday  Public health defined "Efforts made by communities to cope with health problems arising from people living in groups… the need to control transmission of disease, maintain a sanitary environment, provide safe water and food, and sustain people with disabilities and low income populations." Public health concepts reflect:  Current knowledge of the nature and causes of disease  Practices of disease control and treatment  Dominant social ideologies of communities Grounded in social justice, applies medicine, epidemiology, statistics, social, behavioral, environmental, other disciplines  Public health defined: ecological models  These incorporate numerous "determinants" that impact health status of groups, e.g. physical environments, political conditions, human biology, socio-economic factors, behavioral choices, cultural norms Explain "healthy state" or its absence, facilitate development of effective interventions  Early Origins of Public Health Hebrews: spiritual cleanliness and community responsibility Greeks: personal hygiene to achieve mind/body balance Romans: water systems, sewage disposal and swamp drainage; infirmaries for the sick and poor were first "public hospitals" Medieval period: overpopulated, filthy walled town spawned epidemics, superstitious, demonic and theological theories of disease displaced earlier attention to personal hygiene and sanitary environment Renaissance Period- rebirth of art, literature, and science; production and world trade demanded healthy laborers and soldiers; centralized government public health measures  Public Health in England Poverty, illness, disability common; support for medical care in private homes and public infirmaries Elizabethan Poor Laws of 1601: Government provisions for the "lame, week, old, blind and such other among them being poor and unable to work." 17th century: began first collection and analysis of national data on industrial production and demographics; population and disease-specific mortality rates linked social factors with health and disease 18th century: John Ballers (philanthropist) argues that health of people is responsibility of the state  Should maintain hospitals, labs, and create a national health institute; saying population health should be a national concern  Poor Law Amendment Act of 1834: intent reduce public dependency and spur productivity; aid only to able bodies in exchange for labor in workhouses  Poor Law Commission 1834: linked poor health conditions to the poor economy; his data linked population characteristics, environmental conditions with incidence of disease  After years of debate, 1848 Public Health Act passed creating General Board of Health, led to a model of national public health service  Development of U.S. Public Health and Government- Supported Services  Colonial Period-> 1800s: Strong influences of the British model: NY Poor Law (1788) established almshouses  Epidemics stimulated sanitary reforms  Almshouses and town-employed physicians was the mainstay until the 1930s.  1850s: Lemuel Shattuck, statistician: conducted U.S. sanitary surveys of morbidity, mortality rates related to environmental conditions; advocated city, state responsibility for environment  Sanitary commission report: first ignored, now most influential document in evolution of U.S. public health  1865: NYC Council of Hygiene and Public Health published shocking expose' of unsanitary city conditions, helped created board of health, this became U.S. turning point for public health  Early U.S. public health initiatives motivated more by economic than humanitarian concern  USPHS est. 1798 as Marine Hospital Service (component of Treasury Dept.) to care for ill sailors in seaport cities; 1870-Mairne Hospital system reorganized a national hospital system with "surgeon General" as supervisor  1889: Congress est. Public Health Service Commissioned Corps, a mobile physician corps to assist with disease control and health protection  1891: Staten Island Marine Hospital lab moved to DC; forerunner of the National Institute of Health (NIH)  1912: Marine Hospital Service renamed US Public Health Service; became major agency of DHHS  1933: Federal Emergency Relief Act; made optional federal aid to states for acute and chronic medical and nursing care, obstetrics, drugs and supplies  Social Security Act of 1935 was instrumental PH  1953 Public Health Service became part of the new Department of Health, Education and Welfare (HEW) dealing with issues of population expansion, public expectations, technology, supply of health professionals  1970s: National Institutes of Health created for disease, occupational health and safety research  1979: Dept. of HEW renamed Dept. of Health and Human Services; education moved to its own department  2013: DHHS budget $941 B; health protection, promotion, provision of health, other human services to vulnerable populations; 300 programs through 10 operating divisions (65,000 employees)  DHHS Operating Divisions  National Institutes of Health (NIH): 18 health institute, National Library of Medicine, National Center for Complementary and Alternative Medicine; 30,000 research projects  Food and Drug Administration (FDA): food, cosmetic, drug, biological product safety  Centers of Disease Control and Preventions (CDC): monitors disease trend, disease, injury investigations and control measures  Indian Health Service (IHS): operates hospitals, health centers, health stations serving 1.5 M of 500+ tribes Health Resource and Services Administration (HRSA): multiple programs serving needy; FGHCs; health professional training for underserved areas Substance Abuse and Mental Health Services Administration (SAMHSA): quality and access to substance abuse prevention, addiction treatment, mental health services, HIV/AAIDS services Agency for Healthcare Research and Quality (AHRQ): research to improve quality, reduce costs, improve patient safety; evidence-based research Centers for Medicare and Medicaid Services (CMS): administers these and Children's Health Insurance Program Administration of Children and Families (ACF): 60+ programs, e.g. Head Smart, child support enforcement, Temp asst. needy families, domestic violence, adoption, foster care Administration on Aging (AoA): administers federal programs under the Older Americans Act, e.g. meals on wheels, community level programs to support older persons and their caregivers  Veterans Administration (VA) First established for disabled, indigent Civil War veterans under Department of Defense One of world's largest delivery systems  155 medical centers  900+ ambulatory care and outpatient clinics  135 nursing homes  47 residential rehabilitation treatment programs  232 veterans' centers  Department of Defense Military Health Service Program Federal support for direct care and support services for 8.1 M military personnel and dependents, military retirees, families and others entitled Worldwide: 98 hospitals, 480 clinics TRICARE (managed care program): civilian workers of military care is covered under managed care  States' Roles in Public Health Contribute 14% of total national health care expenditures  Operate or support hospitals, support medical schools,, operate mental institutions; health departments that conduct infectious disease monitoring and control, support primary and preventive health services at state and local levels  City and County Roles in Public Health Health departments: direct services, primary prevention, epidemic surveillance and control 1000+ public hospitals and health systems provide "safety nets" and services unattractive to other hospitals Crisis response of public health emergencies Special services for medically needy and low income populations  Decline in Influence of Public Health Service Despite impressive contributions, finding always competed for more highly valued demands of health sector 1960s: professionals, political leaders, media criticized grants to state, local agencies as ineffective  New, important programs assigned to non- public health agencies: Medicare, Medicaid, Head Start, others assigned outside of public health service  1970s: ended "Creative Federalism": Nixon opposed federal, state, local public health systems; federal responsibilities moved to states  1980s: Regan continued more extreme measures; block granted Federal funds; decline of government's organized system of public health accelerated  1985: Institute of Medicine study on status of public health: 1988 reported failures of policy development; politicization of public health agencies; ambiguous responsibilities among levels of government  Responsibilities of the Public Health Sector  DHHS Published- Health People 2000, National Health Promotion and Disease Prevention Objectives  Document called for 90% of population to be served by local health departments that carry out three core public health functions: Assessment, Policy Development, Assurance  3 Core Functions  Assessment: collect, analyze data to define population health status, quantifying existing ir emerging health problems  Policy development: general recommendations from data to intervene, mobilize public and community organizations  Assurance: government public health agencies ensure basis health delivery components are in place


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