Healthcare
An Enormous Industry….
U.S. health care:
• $ 3.5 trillion
• 16 million+ workers
• 11% of U.S. employment
• 17% of GDP
Where Do We Spend Our Health Care
Dollars?
International Comparisons
• Among 7 other developed nations, (U.K.,
Germany, Sweden, Canada, France, Australia,
Japan), U.S. health status ranks 8th on important
health status indicators:
– Life expectancy at birth
– Infant mortality rate
– Probability of dying between ages 15 and 60
• U.S. health expenses are triple those of Japan
and more than double of the 7 other nations.
Health Indicators
•
•
•
•
•
•
•
Chronic lung disease
Drug-related deaths
General disability
Heart disease
Injuries and homicides
Low birth weight
Teen pregnancy and sexually transmitted
infections
• Obesity and diabetes
System Complexity
• A vast array of “players” and “payers”
– Mosaic of business relationships range from
individual “doctor-patient” to multi-billion
dollar hospital, healthcare and insurance
systems
– Public (government) and private payment
sources with differing rules, regulations
– Poorly aligned infrastructure, medical
specialization result in a confusing labyrinth
for patients and providers
Enduring Challenges
• Size and complexity contribute to problems of:
– Limited access, inconsistent quality,
high costs
– Unnecessary and wasteful service
duplications
• How to make the world’s finest technical medical
capabilities available and accessible to U.S.
population in effective and efficient ways?
Problems of Health Care
• Inexplicable contradictions of objectives
(treatment “after the fact” vs. prevention)
Problems of Health Care
• Variations in performance, quality, effectiveness
and efficiency
Problems of Health Care
• Long-standing discord between population
needs reflected by government policies vs.
market goals to contain costs and realize profits
• American people fearful of risks entailed by
change
Understanding U.S. Health Care
• The public has inadequate understanding of the
health care system
– Practitioners fostered mystique to establish
and maintain authority
– Tradition of “highly educated” health care
professionals daunted patients’ involvement
– Treatments and outcomes have remained
opaque to consumers with no accessible
information to inform about provider choices
and quality
Understanding U.S. Health Care (2)
• Ongoing changes include:
– Increasing scrutiny by purchasers (employers
and government ) about quality of outcomes
vs. costs
– Medical entrepreneurship
– More public data about quality, e.g. “Hospital
and Physician Compare”
– “Shared decision-making”
– Internet resources available to all
Tyranny of Technology
• As technology advanced, more people denied of
its benefits due to costs
• Historical emphasis on sophisticated curative
medicine over highly cost-effective preventive
services
• Technology assessment questions: Patient
benefit?; Worth the cost?; New better than
previous methods with improved outcomes?
Social Choices of Health Care
• Health care system has failed to lead prevention
– Difficult intervention for behavioral
issues, e.g. tobacco, other substances;
risky sexual behaviors
– Health professionals’ training
emphasizes illness detection and
treatment; poorly prepared (and
compensated) for counseling on health
behaviors
Aging Population
• By 2030, ~ 20% U.S population 65+; by 2050,
~ 21% 85+
– Increased longevity, immigration, culturally
diverse aged
– Major gaps in traditional system for care of
older, culturally diverse Americans
– Financial gaps in Medicare and Medicaid
payment for older adult basic needs; state
burden of nursing home care
Explain why it is important to be a responsible
health care consumer
.
Health Insurance
• The fundamental principle of health insurance is
that the cost of health care can be predicted for
large populations.
• Depending on circumstances, you may never
pay for what your medical care costs, or you
may pay much more than what your medical bills
total.
Health Insurance
• Approximately 9 million Americans are not
covered under any insurance plan.
• This results in delayed health care and
increased mortality.
• Underinsurance may also result in adverse
health consequences, and millions more
Americans are in this group.
Health Insurance
• Private health insurance
– This may involve deductibles, copayments,
coinsurance, exclusions, "preexisting condition"
clauses, waiting periods, and upper limits on
payments.
• Managed care
– Health maintenance organizations
– Preferred provider organizations
• Medicare and Medicaid
Issues Facing Today's Health Care System
• In 2010, Congress passed the Patient Protection and
Affordable Care Act (ACA) to provide a means for all
Americans to obtain affordable heath care. Three key
issues outlined are access, cost, and quality of health
care.
• Access—this is determined by the supply of providers
and facilities, proximity to care, ability to maneuver the
system, health status, and insurance.
• Cost—we spend more on health care that any other
nation, yet we do not provide universal access.
Issues Facing Today's Health Care System
• Quality
– Quality is ensured by education,
certification/registration, accreditation, peer
review, and malpractice litigation.
– Some of these measures are mandatory,
whereas others are voluntary.
– Most insurance plans now require prior
authorization and/or second opinions in order
to reduce costs and improve quality.
Points of View: National Health Care—
Is It a Government Responsibility?
Taking Responsibility for Your Health Care
• Self-Care
– Diagnosing symptoms or conditions that occur
frequently but may not require a physician
– Using over-the-counter (OTC) remedies to
treat mild, infrequent and unambiguous pain
and other symptoms
– Performing first aid for common,
uncomplicated injuries and conditions
Taking Responsibility for Your Health Care
– Checking blood pressure, pulse, and
temperature
– Performing monthly breast or testicular selfexaminations
– Doing periodic checks for blood glucose,
cholesterol, or other levels as prescribed by a
physician
– Maintaining a healthful diet, getting adequate
rest, and exercising
When to Seek Help
• Know that home health care and home health
tests are not a substitute for regular, complete
examinations by a trained physician.
• You should consult a physician if you
experience:
– A serious accident or injury
– Sudden or severe chest pains, especially if
they cause breathing difficulties
– Trauma to the head or spine with headache,
blurred vision, loss of consciousness,
vomiting, convulsions, or paralysis
When to Seek Help
– Sudden high fever or
recurring temperature
(over 102º F for children
and 103º F for adults)
and/or sweating
– Tingling sensation in the
arm accompanied by
slurred speech or impaired
thought processes
– Adverse reactions to a
drug or insect bite
(shortness of breath,
severe swelling, dizziness)
When to Seek Help
– Unexplained weight loss
– Persistent or recurrent diarrhea or vomiting
– Blue-colored lips, eyelids, or nail beds
– Any lump, swelling, or thickness or a sore that
does not subside or that grows for over a
month
– Any blood in the stool or urine, or significant
pain or marked, persistent change in bowel or
bladder habits
– Yellowing of the skin or the whites of the eyes
– Any symptom that is unusual and recurs over
time
– Pregnancy
Assessing Health Professionals
• Consider the following:
– Do they listen to you, respect you and give
you time to ask questions? Do they return
phone calls?
– What are their credentials?
– Are they affiliated with an accredited
institution?
– Are they open to complementary or
alternative medical strategies?
Assessing Health Professionals
– Do they indicate how long a given treatment
may last and what side effects and problems
to expect?
– Who will be responsible for your care if your
physician is unavailable?
– Are there any professional reviews of your
physicians online and/or data regarding
malpractice claims against them?
What questions should I ask my health care
provider?
It's important to understand
recommendations that your
health care provider makes.
Questions to ask include how
often the practitioner has
performed a procedure, the
proportion of successful
outcomes for the treatment or
procedure, any side effects and
whether they can be treated or
reduced, whether a hospital stay
will be required, and why a test
has been ordered.
Assessing Health Professionals
• Your Rights as a Patient
– You have the right to informed consent
– You have the right to know if your treatment is
standard or experimental
– You have the right to privacy
– You have the right to receive care
– You have the right to access all your medical
records
– You have the right to seek second opinions
Conventional Health Care
• Conventional health care is also called allopathic
medicine.
• It is based on the premise that illness is a result
of exposure to pathogens. Therefore, the
prevention of disease and restoration of health
involves the use of vaccines, drugs, surgery, and
other treatments.
Complementary and Alternative Medicine
(CAM)
• Complementary medicine is used together with
conventional medicine.
• Alternative medicine is used in place of
conventional medicine.
• About 36% of a 18–29 year olds use some form
of CAM.
• The list of practices considered to be CAM
changes continuously.
Diseases and Conditions for Which CAM is
Most Frequently Used Among Adults, 2007
The 10 Most Common CAM Therapies
Among U.S. Adults
© 2014 Pearson Education, Inc.
Do Herbal Remedies Pose Any Risks or
Have Any Side Effects?
Herbal Remedies and Other Dietary
Supplements
• Herbal remedies are not to be taken lightly.
• Something that is "natural" is not necessarily
safe.
• Even rigorously tested products can be risky.
• Herbal supplements and functional foods can be
sold without FDA approval.
Consumer Protection
• Although many CAM products appear promising,
most are not currently regulated in the United
States.
• It is important to have as much information as
possible in evaluating a CAM product so that
you can make an informed decision.
Older Adults: A Growing Population
• Today, there are 40.4 million people age 65 or
older in the United States.
• The older population is expected to be twice as
large in 2030, growing to 72.1 million.
• The needs of this generation will have a major
impact on the economy, housing market, health
care system, and Social Security.
Number of Americans 65 and Older
(in millions), Years 1900–2008, and
Projected 2010–2050
Health Issues for an Aging Society
• As the number of older Americans increases,
their financial and medical needs become
issues.
• More people will be drawing from Social Security
while fewer people contribute to the system.
• Health care costs to the individual will rise as
Medicare coverage becomes less adequate.
Health Issues for an Aging Society
• Housing and living arrangements will be a
problem for low-income elderly.
• A shortage of donor organs will present difficult
ethical questions.
Living Arrangements of Americans Age 65
and Older
Normal Effects of Aging on the Body
Life-and-Death Decision Making
• The right to die: Some states legally allow
certain life-support techniques to be refused by
competent patients.
– Electrical or mechanical heart resuscitation
– Mechanical respiration
– Feeding via nasogastric tube
– Intravenous nutrition
– Gastrostomy
– Medication
The Right to Die
• As long as a person is conscious and
competent, he or she has the right to refuse
treatment.
• The living will and other advance directives are
designed to allow people to make decisions
about their care in advance of becoming
incapacitated.