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Week 1 Class Notes

by: Cara Macdonald

Week 1 Class Notes SPHU 3010

Cara Macdonald
GPA 3.86
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About this Document

These are the class notes from the first week of lectures. Textbook notes will be uploaded separately.
Foundations of Health Care Systems
Arthur Mora
Class Notes
Healthcare, Systems, Foundations




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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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