Health Care Systems

Historical Events In Health Care Hippocrates (400 BC) --- father of medicine Created high standards of ethics Ancient Greek 18th Century Edward Jenner (1796) --- first vaccination; smallpox 19th Century Ignaz Semmelweis (1840) – wash hands Florence Nightingale (1860) – founder of modern nursing Gregory Mendel (1870) --- father of genetics & inheritance Robert Koch (1890) --- father of microbiology William Roentgen (1895) – discovered X-rays

20th Century 1920’s --- health insurance plans first appeared Sir Alexander Fleming(1928) – discovered penicillin Dr Papanicolaou (1940) --- exfoliative cytology Dr Jonas Salk (1955) --- polio vaccine 1960 – birth control pills 1960’s – organ transplants 1970’s – HMO concept appeared 1978 – IVF 1980’s– AIDS pandemic 1997 – sheep cloned

Health Care Facilities Hospitals Private (proprietary) Nonprofit Government General care hospitals Specialty care hospitals Long Term Care Facilities(LTC) Nursing homes Geriatric homes Extended care facilities Independent/assisted Living Facilities Medical offices Dental Offices Optical Centers Clinics Multispecialty Single specialty Surgicenters Urgent/emergency care Mental health Substance abuse Home Health Care Hospice Rehabilitation centers HMO organizations Industrial care centers School health services

Government Agencies WHO USDHHS FDA OSHA NIH CDC FDA OSHA State & local health departments

Voluntary/Nonprofit Agencies American Cancer Society American Red Cross March of Dimes American Diabetes Association National Association of Mental Health These agencies provide: Special services to victims of disease Research into the disease

Health Insurance Plans 1960’s = all covered (subscriber & beneficiaries); no exclusions; no co-payment 1970’s = coverage limited ; exclusion of pre-existing conditions; no co-payment 1980’s = coverage limited; exclusions; co-payments 1990’s = HMO’s with all covered; private plans as in 1980’s but larger co-payments Managed care plans emerge(HMO’s, PPO’s, etc) Develop lists of “what is medically necessary” (see next slide)

Health Insurance Plans Health Insurance Terminology Deductibles Co-insurance ( usually in percentages) Co-payment (usually in dollar amounts) HMO Private fee-for-service plans PPO Medicare Type A -- the facilities Type B – the health deliverer Medicaid Worker’s Compensation

Organizational Structure This refers to the chain of command It indicates areas of responsibility Shows one their immediate supervisor

Trends in Health Care Cost Containment Methods DRG’s (diagnostic related groups) Combination of services Outpatient services Mass purchasing Preventive services Energy conservation Home Health Care Can involve all aspects of health care

Trends in Health Care Geriatric care Telemedicine Adult day care centers Retirement communities Assisted living facilities Long term care facilities OBRA = omnibus budget reconciliation act (1987& 1989) Established regulations for nursing assistants Develop measures of health care quality Compliance with patient’s rights Regulations regarding long-term & home health care Key = to ensure certain “standards of care” Telemedicine

Trends in Health Care Wellness Holistic Health Care = promotes physical, emotional, social, intellectual, by treating the whole body, mind and spirit and spiritual well being Physical wellness Emotional wellness (e.g. stress management) (cup half full) Social wellness --- tolerance Mental & intellectual wellness --- open-minded, continual education Spiritual wellness --- ethics & morals Wellness is determined by lifestyle choices

Alternative Methods of Health Care Acupressure (Shiatsu)---- use of hands to apply pressure to specific points of the body to stimulate the flow of energy Acupuncture---------------- use of needles to stimulate the flow of energy Antioxidants --------------- inhibit oxidation of free radicals Aromatherapy------------- use of aromas to alter mood & restore spirit Biofeedback---------------- use of devices to show pts their response to stress Healing touch (Reiki) ---- use of hand pressure to energy centers of body to stimulate healing Homeopathy--------------- use of chemicals to stimulate disease to encourage ones immune system to go into action Hydrotherapy Hypnosis -------------------- use of trance-like state to make pt more receptive to suggestion Imagery --------------------- images to induce soothing Ionization therapy -------- use of ionizers to make negatively charged air particles to treat respiratory illness

Alternative Methods of Health Care Macrobiotic diet ------ use of diet to balance “yin & yang” Yin= dark; yang = light/ everything has its opposite Meditation ---------- use of breathing & muscle relaxation to quiet the mind (reduce stress) Pet therapy ------------- use of animals to stimulate interest in life Phytochemicals ------ use of plant chemicals to treat disease Play therapy------------- use of toys to stimulate children to “come out of their shells” Positive thought------- develop self esteem & self-love to allow the body to heal Reflexology -------------- uses foot pressure to send energy to an affected body part Spiritual therapies--- use of prayer to get spiritual guidance to produce a sense of well-being Tai Chi ---------------use of slow, graceful body movements & breathing to improve energy flow Therapeutic massage (Swedish) Therapeutic touch ----- use of hands to locate changes in body’s energy field Yoga --------------------- use concentration & positions to balance energy flow