1. History of Health Care

2. Objectives Students will: Identify medical/health care milestones that have led to advances in health care. Identify medical/health care milestones that have led to advances in health care. Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models. Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models.

3. Background Health care has developed and changed throughout history. Health care has developed and changed throughout history. The experiences and discoveries of the past has led to the advances of today. The experiences and discoveries of the past has led to the advances of today.

4. 4000 BC – 3000 BC Primitive Times Illness and diseases were a punishment from the Gods Illness and diseases were a punishment from the Gods Tribal witch doctors treated illness with ceremonies Tribal witch doctors treated illness with ceremonies Herbs and plants used as medicines (morphine, digitalis, Quinine, belladonna, atropine, willow bark) Herbs and plants used as medicines (morphine, digitalis, Quinine, belladonna, atropine, willow bark) Trepanation or trephining (surgically removing a piece of bone from the skull) Trepanation or trephining (surgically removing a piece of bone from the skull) Average life span was 20 years Average life span was 20 years

5. 3000 BC – 300 BC Ancient Egyptians Earliest people to keep accurate records. Earliest people to keep accurate records. Superstitious/ called on gods to heal Superstitious/ called on gods to heal Learned to identify certain diseases. Learned to identify certain diseases. Physicians were priests Physicians were priests Splinting Splinting Bloodletting or leeches used as medical treatment Bloodletting or leeches used as medical treatment Average life span was 20-30 years Average life span was 20-30 years

6. 1700 BC – AD 220 Ancient Chinese Believed in the need to treat the whole body by curing the spirit and nourishing the body Believed in the need to treat the whole body by curing the spirit and nourishing the body Recorded a pharmacopoeia of medications based mainly on the use of herbs Recorded a pharmacopoeia of medications based mainly on the use of herbs Used therapies such as acupuncture Used therapies such as acupuncture Began to search for medical reasons for illness Began to search for medical reasons for illness Average life span was 20-30 years Average life span was 20-30 years

7. 1200 BC –200 BC Ancient Greeks First to observe the human body and the effects of disease – led to modern medical sciences. First to observe the human body and the effects of disease – led to modern medical sciences. Believed illness is a result of natural causes Believed illness is a result of natural causes Used therapies such as massage, art therapy, and herbal treatment Used therapies such as massage, art therapy, and herbal treatment Stressed diet and exercise as ways to prevent disease Stressed diet and exercise as ways to prevent disease Average life span was 25-35 years Average life span was 25-35 years

8. Hippocrates (460 – 377 BC) Greek physician known as the “Father of Medicine Greek physician known as the “Father of Medicine Authored code of conduct for doctors known as the “Hippocratic Oath” that is the basis of medical practice today Authored code of conduct for doctors known as the “Hippocratic Oath” that is the basis of medical practice today Believed illness was not caused Believed illness was not caused by evil spirits and stressed by evil spirits and stressed importance of good diet, fresh importance of good diet, fresh air, cleanliness, and exercise air, cleanliness, and exercise

9. 753 BC – AD 410 Ancient Romans First to organize medical care by providing care for injured soldiers First to organize medical care by providing care for injured soldiers Later hospitals were religious and charitable institutions in monasteries and convents Later hospitals were religious and charitable institutions in monasteries and convents First public health and sanitation systems by building sewers and aqueducts First public health and sanitation systems by building sewers and aqueducts Galen established belief that the body was regulated by four body humors; blood, phlegm, black bile, and yellow bile Galen established belief that the body was regulated by four body humors; blood, phlegm, black bile, and yellow bile Life span was 25-35 years Life span was 25-35 years

10. AD 400 – AD 800 Dark Ages Emphasis on saving the soul and study of medicine was prohibited Emphasis on saving the soul and study of medicine was prohibited Prayer and divine intervention were used to treat illness & disease Prayer and divine intervention were used to treat illness & disease Monks and priests provided custodial care for sick people Monks and priests provided custodial care for sick people Medications were mainly herbal mixtures Medications were mainly herbal mixtures Average life span was 20-30 years Average life span was 20-30 years

11. AD 800 – AD 1400 Middle Ages Renewed interest in medical practices of Greek and Romans Renewed interest in medical practices of Greek and Romans Bubonic Plague killed 75% of population in Europe and Asia Bubonic Plague killed 75% of population in Europe and Asia Major diseases included smallpox, diphtheria, tuberculosis, typhoid, the plaque, and malaria Major diseases included smallpox, diphtheria, tuberculosis, typhoid, the plaque, and malaria Arabs began requiring physicians pass examinations and obtain licenses Arabs began requiring physicians pass examinations and obtain licenses Average life span was 20-35 years Average life span was 20-35 years

12. AD 1350 – AD 1650 Renaissance Dissection of body led to increased understanding of anatomy and physiology Dissection of body led to increased understanding of anatomy and physiology Invention of printing press allowed medical knowledge to be shared Invention of printing press allowed medical knowledge to be shared First anatomy book was published by Andreas Vesalius (1514-1564) First anatomy book was published by Andreas Vesalius (1514-1564) Average life span was 30-40 years Average life span was 30-40 years

13. 16 th and 17 th Centuries Cause of disease still not known – many people died from infections Cause of disease still not known – many people died from infections Invention of the microscope allowed physicians to see disease-causing organisms. Invention of the microscope allowed physicians to see disease-causing organisms. Apothecaries (early pharmacists) made, prescribed, and sold medications Apothecaries (early pharmacists) made, prescribed, and sold medications Ambroise Pare (1510-1590), a French surgeon, known as the Father of Modern Surgery established use of ligatures to stop bleeding Ambroise Pare (1510-1590), a French surgeon, known as the Father of Modern Surgery established use of ligatures to stop bleeding Average life span 35-45 years Average life span 35-45 years

14. Anton van Leeuwenhoek (1632-1723) Invented the microscope lens that allowed visualization of organisms Invented the microscope lens that allowed visualization of organisms Scraped his teeth Scraped his teeth and observed the and observed the bacteria that bacteria that causes tooth causes tooth decay decay

15. 18 th Century Gabriel Fahrenheit (1686-1736) created the first mercury thermometer Gabriel Fahrenheit (1686-1736) created the first mercury thermometer Joseph Priestley- discovered the element oxygen. Joseph Priestley- discovered the element oxygen. John Hunter (1728-1793), established scientific surgical procedures and introduced tube feeding John Hunter (1728-1793), established scientific surgical procedures and introduced tube feeding Average life span 40-50 years Average life span 40-50 years

16. Benjamin Franklin (1706-1790) Invented bifocals Invented bifocals Found that colds could Found that colds could be passed from person be passed from person to person to person

17. Edward Jenner (1749-1823) Developed a vaccination for smallpox in 1796 Developed a vaccination for smallpox in 1796

18. Ephraim McDowell (1771 -1830) Surgeon from Danville, Ky. Surgeon from Danville, Ky. Performed the first ovariotomy -(surgical removal of the ovary) - to remove a 22 pound tumor Performed the first ovariotomy -(surgical removal of the ovary) - to remove a 22 pound tumor

19. Rene Laennec (1781-1826) Invented the stethoscope in 1819 Invented the stethoscope in 1819 First stethoscope was made of wood First stethoscope was made of wood

20. 19th Century Rapid advancements due to discoveries of microorganisms, anesthesia, and vaccinations Rapid advancements due to discoveries of microorganisms, anesthesia, and vaccinations Infection control developed once microorganisms were associated with disease Infection control developed once microorganisms were associated with disease Formal training for nurses began Formal training for nurses began Women became active participants in health care Women became active participants in health care Average life span 40-60 years Average life span 40-60 years

21. Florence Nightingale (1820-1910) Known as the “Founder of Modern Nursing” Known as the “Founder of Modern Nursing” Established efficient and sanitary nursing units during the Crimean War in 1854 Established efficient and sanitary nursing units during the Crimean War in 1854 Invented the call bell system and use of dumbwaiters to deliver meals Invented the call bell system and use of dumbwaiters to deliver meals Begin the professional education of nurses Begin the professional education of nurses

22. Elizabeth Blackwell (1821-1910) First female physician in the United States in 1849 First female physician in the United States in 1849

23. Louis Pasteur (1822-1895) Known as the “Father of Microbiology” Known as the “Father of Microbiology” His germ theory proved that microorganisms cause disease His germ theory proved that microorganisms cause disease Proved that heat can be used Proved that heat can be used to destroy germs through a to destroy germs through a process called pasteurization process called pasteurization Created a vaccine for rabies in Created a vaccine for rabies in 1885 1885 Founded the basic rules for Founded the basic rules for sterilization sterilization

24. Joseph Lister (1827-1912) Used carbolic acid on wounds to kill germs Used carbolic acid on wounds to kill germs First doctor to use an antiseptic during surgery First doctor to use an antiseptic during surgery

25. Clara Barton (1821-1912) Volunteer nurse for wounded soldiers during the Civil War Volunteer nurse for wounded soldiers during the Civil War After Civil War, established a bureau of records to search for missing men After Civil War, established a bureau of records to search for missing men Campaigned for the USA to sign Campaigned for the USA to sign the Treaty of Geneva, which the Treaty of Geneva, which provided relief for sick and provided relief for sick and wounded soldiers wounded soldiers Formed American Red Cross Formed American Red Cross in 1881 and served as its first in 1881 and served as its first president president

26. Robert Koch (1843-1910) Developed the culture plate method to identify pathogens Developed the culture plate method to identify pathogens Isolated the bacterium Isolated the bacterium that causes tuberculosis that causes tuberculosis

27. Wilhelm Roentgen (1845-1923) Discovered roentgenograms (X-rays) in 1895 Discovered roentgenograms (X-rays) in 1895 Let doctors see inside the body Let doctors see inside the body X-rayed wife’s hand X-rayed wife’s hand

28. Sigmund Freud (1836-1939) Discovered the conscious and unconscious part of the mind Discovered the conscious and unconscious part of the mind His studies were the basis for psychology and psychiatry His studies were the basis for psychology and psychiatry

29. 20th Century Increased knowledge about the role of blood in the body Increased knowledge about the role of blood in the body ABO blood groups discovered ABO blood groups discovered Found out how white blood cells protect against disease Found out how white blood cells protect against disease New medications were developed New medications were developed Insulin discovered and used to treat diabetes Insulin discovered and used to treat diabetes Antibiotics developed to fight infections Antibiotics developed to fight infections Vaccines were developed Vaccines were developed New machines developed New machines developed Kidney Dialysis Machine Kidney Dialysis Machine Heart Lung Machine Heart Lung Machine Surgical and diagnostic techniques developed to cure once fatal conditions Surgical and diagnostic techniques developed to cure once fatal conditions

30. 20th Century (continued) Organ Transplants Organ Transplants Test tube babies Test tube babies Implanted first artificial heart Implanted first artificial heart Health Care Plans developed to help pay the cost of care Health Care Plans developed to help pay the cost of care Medicare and Medicaid marked the entry of the federal government into the health care arena Medicare and Medicaid marked the entry of the federal government into the health care arena HMOs provided an alternative to private insurance HMOs provided an alternative to private insurance Hospice organized Hospice organized

31. Sir Alexander Fleming (1881-1955) Discovered penicillin in 1928 which is considered one of the most Discovered penicillin in 1928 which is considered one of the most important important discoveries of discoveries of the twentieth the twentieth century century

32. Mary Breckinridge (1881-1965) Born to an influential Kentucky family, she enjoyed a privileged childhood and education in the U.S. and Europe. Her father was the U.S. ambassador to Czar Nicholas II of Russia from 1894 to 1897. Established the Frontier Nursing Service (FNS) in 1925 as a private charitable organization serving an area of about 700 square miles in southeastern Kentucky. The staff was initially composed of nurse- midwives trained in England. They traveled on horseback and on foot to provide quality prenatal and childbirth care in the clients' own homes, functioning as both midwives and family nurses. Since 1925, the FNS has registered over 64,000 patients, and in its first 50 years, it "delivered 17,053 babies with only 11 maternal deaths." An FNS-trained nurse- midwife began the first American school of midwifery in New York in 1932, and the FNS founded its own school in Hyden, Kentucky, in 1939. Breckinridge ran the Frontier Nursing Service until her death in 1965.

33. Jonas Salk (1914-1995) Albert Sabin (1906 – 1993) Discovered polio vaccine Discovered polio vaccine Saved many people from this virus that paralyzed Saved many people from this virus that paralyzed thousands of adults and children each year. thousands of adults and children each year. Dr. Jonas Salk administering the injectable polio vaccine

34. Francis Crick (1916 – 2004) James Watson (1928 - ) Described the structure of DNA and how it carries genetic information in 1953 Described the structure of DNA and how it carries genetic information in 1953 Built a three-dimensional Built a three-dimensional model of the molecules model of the molecules of DNA of DNA Shared the Noble Prize Shared the Noble Prize in 1962 in 1962

35. 21 st Century The first totally implantable artificial heart was placed in a patient in Louisville, Ky. In 2001 The first totally implantable artificial heart was placed in a patient in Louisville, Ky. In 2001 The threat of bioterrorism lead to smallpox vaccination of the military and first responders in 2002 The threat of bioterrorism lead to smallpox vaccination of the military and first responders in 2002 The Netherlands became the first country in the world to legalize euthanasia in 2002 The Netherlands became the first country in the world to legalize euthanasia in 2002 The Human Genome Project to identify all of the approximately 20,000 to 25,000 genes in the human The Human Genome Project to identify all of the approximately 20,000 to 25,000 genes in the human

36. 21 st Century Stem cells were used in the treatments of disease early in the 2000’s and lead to increased research in the treatment of cancer and other diseases Stem cells were used in the treatments of disease early in the 2000’s and lead to increased research in the treatment of cancer and other diseases President George W. Bush approved federal funding for research using only existing lines of embryonic stem cells in 2001 President George W. Bush approved federal funding for research using only existing lines of embryonic stem cells in 2001 Advanced Cell Technology announced it cloned a human embryo in 2001 but the embryo did not survive Advanced Cell Technology announced it cloned a human embryo in 2001 but the embryo did not survive The U.S. FDA approved the use of the abortion pill RU-486 IN 200 The U.S. FDA approved the use of the abortion pill RU-486 IN 200

37. 21 st Century The standards for Privacy of Individually Identifiable Health Information, required under the Health Insurance Portability and Accountability Act (HIPPA) of 1996, went into effect in 2003 The standards for Privacy of Individually Identifiable Health Information, required under the Health Insurance Portability and Accountability Act (HIPPA) of 1996, went into effect in 2003 The Medicare Prescription Drug Improvement and Modernization Act was passed in 2003 The Medicare Prescription Drug Improvement and Modernization Act was passed in 2003 Vaccinations for cervical cancer and herpes zoster (shingles) in 2006 Vaccinations for cervical cancer and herpes zoster (shingles) in 2006

38. Christian Barnard (1922 – 2001) Performed first successful heart transplant in 1968 Performed first successful heart transplant in 1968

39. Robert Jarvik (1946- ) Creator of the first artificial heart Creator of the first artificial heart On December 2, 1982, it was implanted into Barney Clark, who lived for the next 112 days On December 2, 1982, it was implanted into Barney Clark, who lived for the next 112 days The second Jarvik 7 implant took place in Louisville, KY in 1985. The patient, William Schroeder, lived for 620 days The second Jarvik 7 implant took place in Louisville, KY in 1985. The patient, William Schroeder, lived for 620 days

40. Ben Carson (1951 - ) Famous for his surgeries to separate Siamese twins Famous for his surgeries to separate Siamese twins Currently Director of Currently Director of Pediatric Neurosurgery Pediatric Neurosurgery at John Hopkins at John Hopkins He has refined He has refined hemispherectomy, a hemispherectomy, a surgery on the brain surgery on the brain to stop seizures to stop seizures

41. Potential for 21 st Century Cures for AIDS, cancer, and heart disease Cures for AIDS, cancer, and heart disease Genetic manipulation to prevent inherited disease Genetic manipulation to prevent inherited disease Nerves in the brain and spinal cord are regenerated to prevent paralysis Nerves in the brain and spinal cord are regenerated to prevent paralysis Antibiotics are developed that do not allow pathogens to develop resistance Antibiotics are developed that do not allow pathogens to develop resistance Average life span 90-100 years Average life span 90-100 years

42. Current Trends in Health Care

43. Cost Containment Cost of health care began rising due to: Cost of health care began rising due to: Technological advances Technological advances Aging population Aging population Health-related lawsuits Health-related lawsuits Cost Containment measures include: Cost Containment measures include: Diagnostic related groups (DRG) Diagnostic related groups (DRG) Combination of services Combination of services Outpatient services Outpatient services Mass or bulk purchasing Mass or bulk purchasing Early intervention and preventive services Early intervention and preventive services

44. Health care facilities specialized to include: Health care facilities specialized to include: Home health care Home health care Hospice care Hospice care Geriatric care Geriatric care Types of facilities Types of facilities Omnibus Budget Reconciliation Act (OBRA) Omnibus Budget Reconciliation Act (OBRA) Telemedicine Telemedicine

45. Emphasis on promoting wellness of the whole individual: Emphasis on promoting wellness of the whole individual: Physical wellness Physical wellness Emotional wellness Emotional wellness Social wellness Social wellness Mental and intellectual wellness Mental and intellectual wellness Spiritual Wellness Spiritual Wellness Holistic Health Holistic Health

46. Alternative and Complementary Methods of Health Care Alternative and Complementary Methods of Health Care Chinese medicine practitioners Chinese medicine practitioners Chiropractors Chiropractors Homeopaths Homeopaths Hypnotists Hypnotists Naturopaths Naturopaths

47. National Health Care Plan National Health Care Plan Has become a leading topic of debate due to the increasing number of uninsured Americans Has become a leading topic of debate due to the increasing number of uninsured Americans Education and preparation for a potential pandemic Education and preparation for a potential pandemic Due to the high rate international travel, the possibility for a devastating pandemic has increased Due to the high rate international travel, the possibility for a devastating pandemic has increased