Introduction to Healthcare and Public Health in the US: Introduction and History
of Modern Healthcare in the US
Discussion Questions
Lecture a
1. What is health? What is healthcare?
Expected outcomes of discussion:
Elicit appropriate definition of “health” – often thought of as the absence of disease
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”.
Elicit appropriate definition of “illness” - a state of poor health
Elicit appropriate definition of “healthcare” -- the prevention and treatment of illness
Objective(s): 1
Slide(s): 3, 4
2. Who delivers healthcare services?
Expected outcomes of discussion:
Healthcare is delivered by different people from different disciplines. Encourage
students to come up with different disciplines associated with healthcare, including
Medicine
Dentistry
Nursing
Laboratory Science
Pharmacy
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
This material (Comp1_Unit1) 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.
1
Other allied health professions
Discuss the concept of “interdisciplinary teams” where health care workers collaborate
to deliver care
Objective(s): 1
Slide(s): 4
3. Compare and contrast inpatient and outpatient facilities?
Expected outcomes of discussion:
Compare inpatient and outpatient facilities, focus discussion in the context of patient
volumes, cost, presence of ancillary services
Inpatient facilities - hospitals and other residential care settings
Outpatient facilities - patient care in the community
Objective(s): 1
Slide(s): 6, 7, 8, 9
4. What are hospitals? What are the different pathways by which patients can be
admitted to a hospital?
Expected outcomes of discussion:
Institutions for treating sick or injured people
Admissions via ED or as direct admits
Objective(s): 1
Slide(s): 6
5. What type of nursing/residential care facilities would be most appropriate for:
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
This material (Comp1_Unit1) 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.
2
(a) a patient who has recently undergone hip replacement surgery whose orthopedic
surgeon thinks he can go back to living at home in a few months, and
(b) a patient with advanced Alzheimer’s dementia?
Expected outcomes of discussion:
(a) short term nursing/residential care
(b) long term nursing/residential care
Objective(s): 1, 2
Slide(s): 7, 8
6. Can you name different types of ambulatory health care services?
Expected outcomes of discussion:
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
Objective(s): 1
Slide(s): 9
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
This material (Comp1_Unit1) 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.
3
7. Consider the statement: “although hospitals constitute only 1 percent of all
healthcare establishments, they employ 35 percent of all healthcare workers”?
What is it about hospitals that make them employ such a large percentage of healthcare
workers?
Expected outcomes of discussion:
Healthcare is labor intensive, and there are many roles for workers in hospitals
associated with direct and indirect patient care. A hospital is a high volume
concentrated area of patients as compared to other healthcare establishments. A
hospital has many departments and sections.
Objective(s): 2, 3, 5
Slide(s): 10, 11
8. What is a healthcare system? Describe different models of healthcare systems.
Expected outcomes of discussion:
A healthcare system is an organization to deliver health care.
Models of healthcare systems include:
Purely public (care conducted by the state)
Purely private (care conducted by independent, privately funded organizations)
Often a mixed model
Objective(s) 1, 2
Slide(s): 12, 13
9. Can you suggest some benchmarks to measure healthcare systems? Defend
your choices.
Expected outcomes of discussion:
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
This material (Comp1_Unit1) 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.
4
Different sets of benchmarks can be discussed based on clinical, financial, social,
economic, and outcome-based factors. One example of a set of benchmarks includes
attention to:
Patient assessed value
Performance on clinical interventions
Efficiency
Objective(s): 2
Slide(s): 16
Lecture b
1. What is public health?
Expected outcomes of discussion:
Public health is "the science and art of preventing disease, prolonging life and
promoting health through the organized efforts and informed choices of society,
organizations, public and private, communities and individuals."
Objective(s): 1
Slide(s): 3
2. Name some of the significant public health achievements in the US in the 20th
century.
Pick an example of a public health achievement that you consider to be impressive, and
present your findings to your class.
Expected outcomes of discussion:
Significant public health achievements in the US in the 20th century include:
Vaccination
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
This material (Comp1_Unit1) 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.
5
Motor-vehicle safety
Safer workplaces
Control of infectious diseases
Decline in deaths from coronary heart disease and stroke
Safer and healthier foods
Healthier mothers and babies
Family planning
Fluoridation of drinking water
Recognition of tobacco use as a health hazard
There are many other achievements that can be detailed.
Objective(s): 4
Slide(s): 4
3. What is epidemiology? How does it help medicine?
Expected outcomes of discussion:
Epidemiology is a quantitative basic science, a method of causal reasoning based on
developing and testing hypotheses pertaining to occurrence and prevention of morbidity
and mortality, and a tool for public health action to promote and protect the public’s
health. Epidemiology allows the use of reasoning and deductive skills to reduce
morbidity and mortality.
Objective(s): 1, 4
Slide(s): 9
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
This material (Comp1_Unit1) 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.
6
4. There have been multiple confirmed cases of Disease X in your community.
You suspect that the disease is caused by long-term consumption of a particular food
item. How would you begin to collect data that would help you prove your hypothesis?
How would you want to analyze this data?
Expected outcomes of discussion:
Methods for data collection – surveys, prospective and retrospective studies.
Randomization of subjects and the establishment of a control differentiates a true
experiment from quasi-experiments. Data analysis using proven statistical methods.
Objective(s): 2, 4
Slide(s): 11, 12
Lecture c
1. Do you think that health care expenditure in the US is high? If so, why? If not,
defend your position.
Expected outcomes of discussion:
Health care expenditure is $2.3 trillion in 2008 (16.2% of GDP, $7681 per resident) -definitely high!
Objective(s): 5
Slide(s): 3
2. What are the options for financing healthcare in the US? Which do you think is
the most effective when considering the entire population of the US?
Expected outcomes of discussion:
Healthcare can be financed using:
general revenue
social health insurance
voluntary or private health insurance
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
This material (Comp1_Unit1) 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.
7
out-of-pocket payments
internal donations
Objective(s): 5
Slide(s): 3
3. Discuss the cultural shift in medicine that led from physician-centric to patientcentric care – from paternalism to patient autonomy. Which model of care
delivery would you prefer your own physician to use? Why?
Expected outcomes of discussion:
A majority of patients prefer patient-centricity and autonomy to make their own
decisions.
Objective(s): 5
Slide(s): 5
4. Discuss the reasons why care of patients has shifted from an individual to a
team-based approach.
Expected outcomes of discussion:
Shift driven predominantly by the increasing complexity of healthcare delivery, and
patient disease patterns.
Objective(s): 5
Slide(s): 6
5. What is a patient centered medical home? Why do you think that this model of
care is finding increasing acceptance by clinicians?
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
This material (Comp1_Unit1) 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.
8
Expected outcomes of discussion:
Increasing acceptance due primarily to the ability of the model to address the care of
complex patients with multiple diseases.
Objective(s): 5
Slide(s): 7
6. Discuss some of the advantages and disadvantages of the dominance of
technology in healthcare delivery.
Expected outcomes of discussion:
Advantages: improvements in care, patient safety, outcomes, diagnosis, and
management. Disadvantages: increasing technology increases cost, complexity of
healthcare delivery.
Objective(s): 5
Slide(s): 9
7. What is the structure of public health services in your town/city and state?
Expected outcomes of discussion:
Students can discuss their own state and local public health departments.
Objective(s): 1, 2
Slide(s): 6-10
Lecture d
1. What, in your opinion, are the advantages and disadvantages of maintaining
patient medical records in an electronic, as opposed to a paper-based format?
Expected outcomes of discussion:
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
This material (Comp1_Unit1) 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.
9
Advantages:
Remote access to patient data
Record is legible
Confidentiality is better handled than paper records
Improves patient safety
Integration with other resources and data
Integration with decision support and knowledge-base resources
Disadvantages:
Cost of installation, maintenance and upgrading
Requires training and changes in clinical workflows
Lack of interoperability
Depersonalizes the doctor-patient relationship
Objective(s): 4
Slide(s): 3, 4
2. What is a personal health record?
Consider personal health products – take a tour of Microsoft HealthVault at
http://www.healthvault.com/Personal/websites-overview.aspx . Do you think that
use of personal health records will become universal, or will they become unfashionable
and extinct over time? (web site accessed on 12/8/2011)
Expected outcomes of discussion:
Personal health records - patients keep their own medical records. Despite some
concerns, there has been a steady increase in the number of patients who use PHRs.
Objective(s): 1, 4
Slide(s): 5,6
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
10
This material (Comp1_Unit1) 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.
3. Give examples of the use of technology in the inpatient and the outpatient
settings.
How do they help (a) patients, and (b) clinicians?
Expected outcomes of discussion:
Technology in the medical office (billing, claims processing, scheduling, EHR)
Technology in the hospital (pharmacy informatics, diagnostic imaging, robotic surgery)
Telemedicine and telecare
Technology to improve information retrieval and education
Objective(s): 4
Slide(s): 5,6,7,8,9,10,11,12
4. How can clinical decision support improve patient safety?
Expected outcomes of discussion:
Reminders and alerts help clinicians avoid errors
Checks for drug-drug interactions
Reviews orders, scans for inconsistencies
Objective(s): 1, 4
Slide(s): 9
5. Consider that you inhabit an alternate universe where radiology does not exist
as a medical specialty. Discuss the disadvantages of not having this technology
both from the perspective of the physician and the patient.
Expected outcomes of discussion:
Radiology has become an essential tool for diagnosis, greatly benefiting both patients
and physicians.
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
11
This material (Comp1_Unit1) 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.
Objective(s): 4, 5
Slide(s): 11
6. What is assistive technology? Can you give some examples of assistive
devices?
Expected outcomes of discussion:
Examples of assistive technology
Audio books and text-to-speech
Voice recognition software
Prosthetics
Wheelchairs and ambulatory devices
Objective(s): 1, 4
Slide(s): 12
7. List some of the online resources that can be used in the practice of medicine.
How do you think online resources have helped advance medical education?
Expected outcomes of discussion:
Expert systems help in developing diagnostic reasoning skills
Online resources provide a readily available knowledge base that can be accessed ondemand
Simulation technology helps in training
Objective(s): 4
Slide(s): 13
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
12
This material (Comp1_Unit1) 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.