Week 12, Health Care Org notes
Week 12, Health Care Org notes HCA 340 -002
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HCA 340 -002
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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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