Chapter 2
Current Health Care Systems and Trends
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Today’s Health Care Industry
• Largest service employer in U.S.
• Americans spent $2.5 trillion on health care
in 2009
– May increase to $4.4 trillion by 2018
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Technological Advancements
• Health care changed very gradually until
beginning of 20th century
• Progress now increases rapidly
• Infectious diseases previously major
causes of death
– Now largely under control
– Due to the discovery of penicillin and antibiotics
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Technological Advancements
• Recent advancements:
– Organ transplants
– Microscopic and robotic surgery
– Gene therapy
– Targeted drug therapy aimed a specific
cancers
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Robotic Surgery
spectrum.ieee.org
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Highlights of Health Care History
• Ancient Egyptian (average life span 20 to 30 years)
– The earliest people know to maintain accurate
health records
– Called upon gods to heal them when disease
occurred
– Physicians were priest
– Used magic and medicinal plants to treat
disease
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ancient-egypt-online.com
Highlights of Health Care History
• Ancient Chinese (average life span 20 to 35 years)
– Believed in the need to treat the whole body by
curing the spirit and nourishing the body
– Medication use based on herbs
– Used acupuncture of the skin to relieve pain
and congestion
wilshirewestacupuncture.com
medicalacupuncturefacts.com
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Highlights of Health Care History
• Ancient Greeks
– Early beliefs in supernatural causes
– Hippocrates
• Physician in ancient Greece
• Considered “Father of Medicine”
http://www.sjsu.edu/depts/Museum/hippoc.html
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Highlights of Health Care History
• Ancient Romans (average life span 25 to 35 years)
– Began public health and sanitation systems
– First to organize medical care by providing care
for injured soldiers
– Diet, exercise, and medications were used to
treat disease
en.wikipedia.org
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Highlights of Health Care History
• Dark Ages (400 AD – 800 AD)
– Emphasis was placed on saving the soul
– The study of medicine was prohibited
– Monks and priest provided custodial care for
sick people, emphasis on saving the soul
– Medications were mainly herbal mixtures
– Plague killed large percentage
of people
xtimeline.com
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Question
• Chronic illnesses were rare in ancient times because
_____ .
A. The average person did not live longer than 35 years
B. The environment did not contain synthetic chemicals
as it does today
C. Physicians were unable to diagnose most diseases
A. The average person did not live longer than 35 years
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Highlights of Health Care History
• Renaissance (average life span 30-40 years)
– Was the rebirth of science in medicine
– Experiments and observation
– Leonardo da Vinci used dissections to draw the
human body
winkersworld.com
leonardo.net
– Andrea Veralius published the first
anatomy book
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science.kukuchew.com
Highlights of Health Care History
• 17th Century (average life span 35 to 45 years)
– Surgery became respected form of treatment
– Body functions still poorly understood
– Anton van Leeuwenhoek invented the
microscope.
findingdulcinea.com
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Highlights of Health Care History
• 18th Century
– Technique of vaccination discovered by
Edward Jenner who developed a vaccine for
smallpox
bizarremedical.com
– William Harvey described the circulation of
blood to and from the heart
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library.thinkquest.org
Highlights of Health Care History
• 18th Century (average life span was 40-50 years)
– Gabriel Fahrenheit created the first mercury
thermometer
coolcosmos.ipac.caltech.edu
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Highlights of Health Care History
misabioamigo.com
• 19th Century
– Building of large hospitals
– Dentists introduced anesthesia
– Louis Pasteur proved that bacteria caused
certain diseases
– Began pasteurizing milk to Kill bacteria
– Advancements in public health and preventive
medicine
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Highlights of Health Care History
• 19th Century
– Florence Nightingale founder of modern
nursing
edhird.wordpress.com
– Joseph Lister began using disinfectants and
antiseptics during surgery
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chemistryexplained.com
Highlights of Health Care History
• In the 19th Century medical education
opened for the first time to female.
• The first nursing school was opened 1860
was opened by a MD, Elizabeth Blackwell
americanenglishdoctor.com
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Highlights of Health Care History
• 20th Century
– Jonas Salk developed the polio vaccine using a
dead virus (inactive or killed virus)
– Sir Alexander Fleming discovered
penicillin
biologycorner.com
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poliofreeindia.org
Highlights of Health Care History
• 20th Century (average life span 60 to 70 years)
– Many discoveries
• E.g., blood groups, vitamins, penicillin and
antibiotics, synthetic drugs to treat specific problems
– Health care specialties developed
• E.g., physical and occupational therapy
– Emphasis on scientific approach to medicine
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Highlights of Health Care History
• 20th Century
– Great advances in surgical techniques
– Christian Barnard performed the first
successful heart transplant
hola.com
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Hopes for the 21st Century
• Vaccine to prevent human
immunodeficiency virus (HIV)
• Cure for acquired immune deficiency
syndrome (AIDS)
• Cure for obesity
• Organ cloning
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Hopes for the 21st Century
•
•
•
•
Cures for cancer and heart disease
More effective treatment for mental illness
Less invasive treatments
Drugs with fewer side effects
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Less Invasive Treatment
Abdominal Surgery
Laparotomy surgery
buzzle.com
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nature.com
Specialization
• Effects on health care:
– Improved diagnosis and treatment
– More technical and fragmented medical
practice
– Increased health care costs
– Break down of patient-provider relationships
– Increased job opportunities for health care
professionals
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Aging Population
• Life expectancy increase
– 1900
• 47 years
– Today
• 75 to 80 years
• Large number of “baby boomers”
becoming older adults
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boomerslife.org
Aging Population
• Older adults
– Heaviest users of health care services
• Needs of older adults:
– Long-term care facilities
– Home care services
– Treatment for chronic conditions
us-seniorcare.com
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Question
• True or False:
– “Chronic” describes a health condition
experienced as a result of aging.
• False - Chronic conditions and illnesses
that cannot be cured quickly
• Persist over period of time
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Increasing Costs of Health Care
• Costs increasing dramatically
– Technological advances
– Increased use of services due to aging
population
– Rising costs of pharmaceutical products
– Increased use of expensive diagnostic tests
– Lack of competition in some areas
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Increasing Costs of Health Care
• Costs increasing dramatically
– Rising expectations of patients
– More effective treatments
• Therefore, more patients seeking care
– Poor geographic distribution of health care
providers
bedandbreakfastcenter.com
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Increasing Costs of Health Care
Retrieved 10/11/2016 from: http://tinyurl.com/jzqchvx
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Costs of Health Care
Sources of health care dollars, 2004
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Costs of Health Care
Uses of health care dollars, 2004
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Health Care Facilities and Services
• Wide variety of health care facilities
• Many patient services for different needs
• Range in size from private individual office
to national organizations
• Many options available for today’s health
care professionals
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Where Do We Go for Care?
•
•
•
•
•
Hospitals
Outpatient Care Centers
Long term care services
Home health agencies
Hospice programs
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Hospitals
• Traditional health care setting
– Now high-tech facility limited to patients who
need sophisticated treatment and 24-hour care
• Costs have increased dramatically
– Major challenge:
• Controlling expenses
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Hospitals
• Various levels of care provided
– Trauma center
– Emergency room (ER)
– Intensive care unit (ICU)
– Cardiac care unit (CCU)
– General unit
– Transitional care unit (TCU)
– Rehabilitation unit
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Accreditation of Health Care Facilities
• The Joint Commission
– Private, non-profit organization
– Encourages high standards
– Provides guidelines
– Performs on-site inspections
– Accreditation voluntary
bronxgastro.com
• But may be required to qualify for Medicare
reimbursement
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Ambulatory/Outpatient Services
• Patients do not require hospitalization
• Most surgeries today outpatient
• Majority of ambulatory services performed
in physicians’ offices
henricodoctors.com
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Ambulatory/Outpatient Services
• Facilities that offer outpatient services:
– Adult day care
– Dental offices
– Diagnostic centers
– Emergency and urgent care centers
– Health care services in companies, schools,
and prisons
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Ambulatory/Outpatient Services
• Facilities that offer outpatient services:
– Medical offices
– Rehabilitation centers
– Specialty clinics and offices
– Surgical centers
– Wellness centers
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Long-Term Care Facilities
• Individuals do not need hospital
– But unable to live at home
• Fastest growing area of health care services
pinemedicalcenter.org
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Long-Term Care Facilities
• Nursing home
– Skilled nursing facility
– Intermediate nursing facility
• Adult foster home
• Assisted living residence
• Continuing care community
eldercarechoice.net
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Home Health Care Services
• Provide care to patients in their homes
• Tremendous growth in need for services
• Factors contributing to its growth:
– Shorter hospital stays
– Increase in older population
– Medical equipment that can be used at home
– Desire of individuals to stay at home
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bocahomecareservices.com
Home Health Care Providers
• Examples of professionals who provide
care at home:
– Nurses
– Physical therapists and assistants
– Occupational therapists and assistants
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Home Health Care Providers
• Examples of professionals who provide
care at home:
– Speech therapists
– Medical social workers
– Nursing assistants and home health aides
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Hospice
• Palliative care and support for dying
patients and their families
• Team of professionals and volunteers
• Medical, emotional, and spiritual support
• Make patient’s last days as pain-free and
meaningful as possible
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pancan.org
Question
• True or False:
– Palliative care provides comfort and pain relief,
but does not offer a cure.
True
- Palliative care relieves
– But does not cure
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Government Health Services
• Examples of federal agencies:
– National Institutes of Health (NIH)
medcitynews.com
– Centers for Disease Control and Prevention
(CDC)
stanford.edu
– Occupational Safety and Health Administration
(OSHA)
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askaboutsafetyonline.com
Question
• Which of the following service is provided
by the National Institutes of Health?
A. Make health care available for the uninsured
B. Control the spread of diseases
C. Conduct medical research
C. Conduct medical research
• Role of National Institutes of Health:
– Conduct medical research
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Government Health Services
• Examples of state services:
– License personnel and facilities
– Provide laboratory services
– Establish health data systems
– Conduct public health planning
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Government Health Services
• Examples of local government services:
– Collect vital statistics
– Conduct sanitary inspections
– Screen for diseases
– Provide immunizations
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New Approaches to Health Care
• Reasons for interest:
– Search for alternatives to surgery and drugs
– Desire to use natural products
– Belief in mind-body connection
– Focus on prevention rather than cure
– More personal responsibility for health
– Patient access to information
– Desire for humanization of medicine
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Wellness
• Promotion of health through preventive
measures and practice of good habits
• Leading causes of death influenced by
lifestyle habits
wellness.ucsd.edu
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Wellness
• Wellness centers
– Routine physicals
– Immunizations
– Exercise and nutrition classes
healblog.net
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Complementary and Alternative
Medicine
• Complementary medicine
– Used together with conventional medicine
• Alternative medicine
– Used instead of conventional medicine
iaph2008.org
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Complementary and Alternative
Medicine
• Integrative medicine
– Conventional used with nonconventional
practices for which there is scientific evidence
of effectiveness
collinge.org
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Complementary and Alternative
Medicine
• Whole medical systems
– Homeopathic
• disorders treated with very small amounts natural substances
that cause the disorder
– Naturopathic
• Belief that the human body has its own natural healing activity.
– Traditional Chinese
• Including acupuncture
– Ayurveda
• Traditional medicine in India looking at
balance in life
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peacefulmind.com
Complementary and Alternative
Medicine
• Mind-body medicine
– Patient support groups
– Meditation
– Prayer
– Creative activities
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Complementary and Alternative
Medicine
• Biologically-based practices
– Aromatherapy
– Herbs
– Dietary supplements
– Natural products
sinaata.com
• E.g., shark cartilage believed to be used for some
cancers
© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied,
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Complementary and Alternative
Medicine
• Manipulative and body-based practices
– Chiropractic
• Based on belief pressure on the nerves can cause dysfunction of the
body
– Osteopathic
chiropracticcareobx.com
• Body can heal self if musculoskeletal system in good order
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osteopathy.org.uk
Complementary and Alternative
Medicine
• Manipulative and body-based practices
– Massage
• Enables body to relax and promoting
improved circulation
disabilitynews.org
– Reflexology
• Pressure points relate to different parts of the
body
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redmondreflexology.com
Question
• Which of the following health care practices
involves manipulating the spine to relieve
pain or correct dysfunction?
A. Naturopathy
B. Acupuncture
C. Chiropractic
C. Chiropractic
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Complementary and Alternative
Medicine
• Energy therapies
– Biofield
• Qi gong
dahab.net
– practice of aligning breath, movement, health of mind,
body, and spirit (Chinese)
• Reiki
– Japanese technique for stress reduction and relaxation
that also promotes healing. The "laying on hands" and is
based on the idea that an unseen "life force energy" flows
through us and is what causes us to be alive.
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adeeperunderstanding.com
Complementary and Alternative
Medicine
• Susceptible to fraud
• Signs of fraudulent products:
– Claims to cure variety of problems
– Claims to be miraculous and/or secret
– Uses terms for which no definitions exist
– Provides undocumented case histories
– Requires payment in advance
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Holistic Medicine
• Expanded view of traditional medicine
• Emphasizes prevention of disease and
personal responsibility for health
• All aspects contribute to health
– Physical
– Mental
– Emotional
– Spiritual
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Challenges in Health Care Today
• Access to health care
– Unemployed or underemployed
– Preexisting conditions
– Recent federal legislation may alleviate
problems
– Concerns about cost of providing health care
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Challenges in Health Care Today
• Social conditions
– Poverty
– Homelessness
– Violence
– Substance abuse
– Spousal, child, and elder abuse
– Malnutrition
© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied,
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Challenges in Health Care Today
• Maintaining quality of care
– High costs encourage cutting expenses
– Amount of care may be decreased
– Decisions made by insurance companies
rather than health care providers
• Preauthorization
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Challenges in Health Care Today
• Public health concerns
– Antibiotic resistance
equidblog.com
• Bacterial infections difficult or impossible to treat
• Considered by some to be most serious public
health problem
– Pandemics
• Rapidly spreading disease that attacks many people at one time
– Immunizations and treatments for cancer
© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied,
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Challenges in Health Care Today
• Public health concerns
– Reduction in rate of infant mortality
– Addressing substance abuse issues
• Personal responsibility for health
– Lifestyle choices influence incidence of heart
disease, cancer, and stroke
– Healthy habits should be encouraged
© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied,
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