Week 1 Class Notes
Week 1 Class Notes SPHU 3010
Popular in Foundations of Health Care Systems
Popular in Public Health
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This 6 page Class Notes was uploaded by Cara Macdonald on Sunday September 4, 2016. The Class Notes belongs to SPHU 3010 at Tulane University taught by Arthur Mora in Fall 2016. Since its upload, it has received 20 views. For similar materials see Foundations of Health Care Systems in Public Health at Tulane University.
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Date Created: 09/04/16
Arthur M. Mora, PhD. Week 1 Introduction 8/30 ● Health care systems work systematically to close disparities in hospitals ○ Social status ○ Economic status ○ Education attainment ○ Family support structure ○ Positive health behaviors ■ Risky health behaviors include sexual health, drug/tobacco use, etc. ○ Environment ■ Access to clean water ■ Exposure to hazards ■ Access to heat ○ Healthcare system ■ How we deliver, pay for care ● Health care reform ○ Affordability: allows for early detection and treatment The History of the US Healthcare System 9/1 ● Healthcare system: ○ Pieces, parts and fragments cobbled together to address disciplines, organizations, public/individual interest ● How did we get here? ○ Preindustrial era: ■ Practitioners visit houses ● Quacks, faith healers, homeopaths, snakeoilers, midwives, salesmen ● Snake oil, cocaine drops, etc brought by traveling salesmen ■ Wordofmouth and selfprescriptions ■ NO SCIENCE IN MEDICINE TO PROVE OTHER TREATMENTS ● Barbers and surgeons frequently shaved and bled with the same razors ■ Miasma theory of disease: ● If there was an odor, it meant disease was spreading ○ Was coincidentally true ■ Dependant on ones self and family for survival ■ Lack of knowledge ■ No infrastructure for healthcare ● What structure we did have wasn’t real healthcare ● No real hospitals, had alms houses, homes for the poor, asylums ○ All these places ended up being shelters→ institutionalized and removed people from society instead of treating and returning them ○ For those unlucky enough to fall sick without family to take care of them ○ Conditions were crowded, unsanitary, unethical and inhumane ○ Postindustrial Era ■ What changes occured to get us where we are today? ● Science of medicine confirmed what the MDs knew ○ Homeopathic, faith and snakeoil healers fell behind without science to back up their treatments ○ Supreme Court upholds and confirms medical authority in physicians graduating from reputable medical college ■ Highes t court qualifies a legitimate system ■ Medica l colleges advocated for these physicians ■ Enroll ment increased ■ Transition to an Urban Society ● Industrialization shifted the workplace from the home to somewhere other than the home ○ Concentrated areas of population ○ Apartment dwelling, often alone tenantdwelling ■ Lose family support ■ If you got sick, you had no one to care for you ■ Conditi ons were somewhat deplorable ■ BUT this fueled the opportunity for further legitimization in the field of healthcare ● Improvement in hospitals removed the stigma against them ○ Advent of antiseptic surgery ■ Previo usly, 50/50 prospect of surviving a surgery ■ Antise ptics saw this risk drop exponentially ○ Anesthesia ■ Prior to its advent, amputations occurred without anesthesia or painkillers ■ Further reduced the stigma against hospitals ○ Hospitals began to keep records ■ Kept track of effective treatments ■ Statisti cs proved if a treatment was effective or not ■ Saw improvement in the performance of the hospital ● Rise of Insurance ○ Cost of hospital treatments increased, were no longer affordable ○ Black Tuesday stock market crash left hospitals empty ■ Had no cash coming in from lack of patients ○ Baylor University Hospital Insurance Plan: ■ $6/yea r guaranteed up to 21 days of hospitalization ■ $6/yea r gave peace of mind, was worth the small price for the high risk ○ Blue Cross/ Blue Shield began guaranteeing their employees health insurance ○ WWII wage freeze exempts health insurance ■ Wome n were pulled into the workforce ■ Lack of employees to fulfill businessgovernment contracts ■ Factori es took employees from other factories ● G overnment contracts became more expensive, lost money ● I mplemented a wage freeze ■ Compa nies started offering health insurance to incentivize employees ● I nstitutionalized attainment of health care ○ Elderly was major group left out of healthcare ■ Jobles s, had no employee benefits ■ Many presidents have aimed for universal healthcare, but failed ■ Kenne dy insisted on providing healthcare for the elderly ● A fter his assassination, wave of emotion left people obligated and inspired to carry out the tenets of his campaign ■ LBJ: those who have plenty should give to those who have none ● A bundance of wealth in our country had to be shared ● 1965: Social Security Act ○ Medicare: government paid the hospital bills for the elderly ■ Hospitals were on board→ brought in more patients and money ■ 2 parts: ● Hospitalization: government will pay ● Physicians were paid individually to take care of the elderly ○ Brought the conservatives on board ■ System had no limiting factors to its costs ● LBJ grossly underestimated the price of all these services ● 1960: individuals paid about $147 on healthcare ● 2010: individuals paid about $8,000 on healthcare ○ Medicaid: system for the working poor ○ Baby boomers are all hitting medicare age right about now, and the current working class has to pay for it ■ Demands healthcare system reform ■ 2008: access was limited ● 4651 million Americans uninsured ● Another 25 million were underinsured ● Who is bearing the cost? ○ Employers who pay for the insurance ○ Employees who work for the money ○ Government ○ Americans received disparate quality services ● Inflation in health insurance ○ Left workers with less discretionary income ● Why does health matter? ○ Workplace: ■ Countries thrive on efficiency, innovation and services ● Companies supporting workplace health have greater workplace attendance ○ Education: ■ Hunger, physical and emotional abuse and chronic illness lead to poor school performance ■ Health risk behaviors are closely linked to performance as well ○ Society: ■ Reinforces poverty in the community ■ Need to break the cycle of poverty ● Poor health reduces economic welfare that can never be fully overcome ● Negative effects increase the equality gap between whites and minorities ● Healthcare spending; ○ We spend FAR more than any other country on healthcare ■ US: 18% of GDP ■ Next closest is France at ~10% ○ Other sectors have to compete for this money ■ Healthcare services get far more money
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