Introduction to Healthcare and
Public Health in the US
Introduction and History of
Modern Healthcare in the US
Lecture a
This material (Comp1_Unit1a) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Introduction and History of Modern
Healthcare in the US
Learning Objectives
• Delineate key definitions in the healthcare domain
(Lectures a, b, c, d)
• Explore components of healthcare delivery and
healthcare systems (Lecture a)
• Define public health and review examples of
improvements in public health (Lecture b)
• Discuss core values and paradigm shifts in US
healthcare (Lecture c)
• Describe in overview terms, the technology used in the
delivery and administration of healthcare (Lecture d)
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
2
Some Definitions: Health
• Health – often thought of as the absence of
disease
• World Health Organization (WHO) - specialized
agency of the United Nations 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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
3
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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
4
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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
5
Healthcare Delivery (continued)
• 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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
6
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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
7
Healthcare Delivery (continued)
• Nursing and residential care facilities
– In 1969, "Intermediary Letter 371" drastically reduced
coverage for nursing homes
– In 1970, the Miller Amendment established a new
standard - "intermediate-care” facilities
– In the 1990s another standard was defined: “subacute
care” – that provided 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”.
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
8
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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
9
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
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
10
Organization of the Healthcare Industry
Industry segment
Employment
Total
Establishments
100.0
100.0
42.6
87.3
17.0
36.0
Home healthcare services
7.2
3.7
Offices of dentists
6.2
20.4
Offices of other health practitioners
4.7
19.6
Outpatient care centers
4.0
3.6
Other ambulatory healthcare services
1.8
1.4
Medical and diagnostic laboratories
1.6
2.4
34.6
1.3
32.5
1.0
Other specialty hospitals
1.4
0.2
Psychiatric and substance abuse hospitals
0.7
0.1
22.8
11.4
Community care facilities for the elderly
5.2
3.5
Residential mental health facilities
4.1
4.0
Other residential care facilities
1.3
1.1
Ambulatory healthcare services
Offices of physicians
Hospitals
General medical and surgical hospitals
Nursing and residential care facilities
1.1 Table: Percent distribution of employment and establishments in health services by detailed industry sector, 2008.
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
11
Healthcare Systems
• A healthcare system is an organization
that delivers healthcare
• Many variations and iterations of
healthcare systems worldwide, but in
general, healthcare systems
– promote good health in populations
– balance the levels of actual care
provided with the expectations of the
population they serve
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
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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 healthcare
system, a private system may coexist in
parallel or offer services not available
under the public system
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
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Healthcare Systems (continued)
• There is no universal healthcare 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 level
Health IT Workforce Curriculum
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Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
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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)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
15
Healthcare Systems (continued)
• Healthcare systems can be measured
using benchmarks
– One framework for assessment:
• Patient assessed value
• Performance on clinical interventions
• Efficiency
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
16
Introduction and History of Modern
Healthcare in the US
Summary – Lecture a
• Important definitions:
– Health – not just the absence of disease or illness
– Healthcare – prevention and treatment of illness
– Healthcare System – an organization that delivers healthcare
• There are different types of healthcare delivery:
– Inpatient (hospitals, short and long term care facilities)
– Outpatient (speciality care facilities, laboratories)
• There are different healthcare system models that range from
private to public funding; most systems fall somewhere between
these two extremes.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
17
Introduction and History of Modern
Healthcare in the US
References – Lecture a
References
•
2002 NAICS Definitions - 621 Ambulatory Health Care Services. (2002). Retrieved December 6, 2011, from US
Census Bureau website: http://www.census.gov/epcd/naics02/def/NDEF621.HTM.
•
Career Guide to Industries, 2010-11 Edition. (2011). Retrieved December 6, 2011, from Bureau of Labor Statistics,
U.S. Department of Labor website: http://www.bls.gov/oco/cg/.
•
Definition of Healthcare. Preamble to the Constitution of the World Health Organization as adopted by the
International Health Conference, New York, 19 June - 22 July 1946; signed on 22 July 1946 by the representatives
of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April
1948.
•
Duckett, S. J., & Ward, M. (2008). Developing ‘robust performance benchmarks’ for the next Australian healthcare
Agreement: The need for a new framework. Aust New Zealand Health Policy , 5(1).
•
Health Care Careers Directory - Allied Health . (2011). Retrieved December 6, 2011, from American Medical
Association website: http://www.ama-assn.org/ama/pub/education-careers/careers-health-care/directory.shtml.
•
Hospital. (2011). In Encyclopædia Britannica. Retrieved from
http://www.britannica.com/EBchecked/topic/272626/hospital .
•
Subacute care definition . (2011). Retrieved December 6, 2011, from Ca.gov Department of Healthcare Services
website: http://www.dhcs.ca.gov/provgovpart/Pages/SubacuteCare.aspx.
•
World Health Report 2000 - Health systems: improving performance. (2000). Retrieved December 6, 2011, from
WHO website: http://www.who.int/whr/2000/en/.
Charts, Tables, Figures
1.1 Table: BLS Quarterly Census of Employment and Wages, 2008. (2008). Retrieved December 6, 2011, from US
Bureau of Labor Statistics website: http://www.bls.gov/cew/.
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture a
18