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Component 1: Introduction to Health Care and Public Health in
the U.S.1.1: Unit 1: Introduction to modern
healthcare in the US
1.1 a: Introduction and definitions
Objectives Of This Unit
• Delineate key definitions in the healthcare domain
• Distinguish between healthcare systems and healthcare practice
• Outline key paradigm shifts in medicine • Describe in overview terms the technology
used in the delivery and administration of healthcare
• Discuss core values in American healthcare
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Some definitions: Health
• Health – often thought of as the absence of disease
• World Health Organization (WHO) - specialized agency of the United Nations
• WHO definition: Health is defined as the “…state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
• Thus “illness” is a state of poor health
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Healthcare
• Healthcare is the prevention and treatment of illness
• Healthcare is delivered by different people from different disciplines, including– Medicine– Dentistry– Nursing– Laboratory Science– Pharmacy– Other allied health professions
• These people come together as interdisciplinary teams to deliver care
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Healthcare delivery
• Healthcare is delivered in different places
• Inpatient facilities – Hospitals
• Institutions for treating sick or injured people• Historically places for shelter, almshouses• Hospital Survey and Construction Act (also known
as the Hill-Burton Act) passed in 1946 that provided federal grants to improve hospital physical infrastructure
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Healthcare delivery
• Inpatient facilities – Different types of hospitals
• General medical and surgical hospitals• Specialty hospitals (orthopedic, pediatrics, women’s
services)• Psychiatric hospitals
• Hospitals may be publicly or privately owned• Patients can be admitted to a hospital
through the emergency room, or directly admitted from a physician’s office
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Healthcare delivery (continued)
• Nursing and residential care facilities– Can be short term facilities or long term
facilities– Long term care classified by level of care– Nursing homes initially proliferated after
an amendment of the Social Security Act and gradually shifted from being part of the welfare system to being a part of the healthcare system
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Healthcare delivery (continued)
• Nursing and residential care facilities– In 1969 -- "Intermediary Letter 371" drastically
reducing coverage for nursing homes– In 1970 -- the Miller Amendment established a
new standard - "intermediate-care facilities– In the 1990s another standard – “subacute care”
to provide care for patients discharged from hospitals who briefly need a higher level of care “than is provided to the majority of patients in a skilled nursing facility”.
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Healthcare delivery (continued)
• Outpatient facilities – Physicians offices
• Primary care offices• Specialty care offices• Single specialty or multispecialty offices
– Dental offices• General dentists or specialists
– Medical and diagnostic laboratories– Other ambulatory health services
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The healthcare industry
• The healthcare industry is one of the largest industries in the US
• In 2008 – 14.3 million jobs for wage and salary workers
• Industry comprises of 595,800 establishments– about 76 percent of healthcare establishments are
offices of physicians, dentists, or other health practitioners.
– although hospitals constitute only 1 percent of all healthcare establishments, they employ 35 percent of all healthcare workers
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Organization of the healthcare industry
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Healthcare systems
• A healthcare system is an organization to deliver health care.
• Many variations and iterations of health care systems worldwide, but in general health care systems – promote good health in populations– balance the levels of actual care provided with
the expectations of the population they serve
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Healthcare systems (continued)
• Different models of healthcare systems– Purely public (care conducted by the state)– Purely private (care conducted by
independent, privately funded organizations)– Often a mixed model
• In countries with state run health care system, a private system may coexist in parallel or offer services not available under the public system
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Healthcare systems (continued)
• There is no universal health care system in the US
• But there are public and private components
• Public healthcare systems may be organized:– At the federal level (for example, the Veterans
Health Administration)
– As a partnership between federal and state governments (such as Medicaid and the Children’s Health Insurance Program)
– At the local levelComponent 1 / Unit 1 14
Health IT Workforce Curriculum Version 1.0/Fall 2010
Healthcare systems (continued)
• Privately owned, commercial organizations may also act as healthcare systems
• These organizations may serve a single area or multiple geographic locations
• Private healthcare systems may be:– Not-for-profit organizations (governed by
principle of non-distribution) or – For profit organizations (distribute surplus
funds to shareholders or owners)
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Healthcare systems (continued)
• Healthcare systems can be measured using benchmarks– One framework for assessment:
• Patient assessed value• Performance on clinical interventions• Efficiency
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