Introduction to Healthcare and

Public Health in the US

Introduction and History of
Modern Healthcare in the US
Lecture c
This material (Comp1_Unit1c) 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
2
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
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Introduction and History of Modern Healthcare in the US
Lecture c
Core Values in US Healthcare
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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 c
Patient centricity and individual choice
Interdisciplinary care
Technology and innovation drive healthcare
Cost of healthcare
Options for financing healthcare
Taxation or general revenue
Social health insurance
Voluntary or private health insurance
Out-of-pocket payments
Internal donations
Healthcare expenditure
$253 billion in 1980
$714 billion in 1990
$2.3 trillion in 2008 (16.2% of GDP, $7681 per resident)
Need for cost containment!
Paradigm Shifts in Medicine:
Physician-Centric to Patient-Centric Care
The old model: patient care options were
determined by the provider -- patients were
offered few opportunities to make decisions
The new model: cultural shift towards giving
patients greater responsibility in their care
Shift from paternalism to patient autonomy

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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 c
Paradigm Shifts in Medicine:
Physician-Centric to Patient-Centric Care
(continued)
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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 c
Patient Self-Determination Act,1990
Requires healthcare organizations to give adult individuals
certain information about their rights including
the right to participate in and direct their own
healthcare decisions
the right to accept or refuse medical or surgical
treatment
the right to prepare an advance directive
information on the providers policies that govern the
utilization of these rights
Providers, organizations and healthcare systems have
become more responsive to patient needs
Paradigm Shifts in Medicine:
Individual to Team-Based Care
Historically, patient care was provided by an individual
clinician
With the increasing complexity of healthcare and
patients, there has been an evolution towards
collaboration between clinicians
An interdisciplinary team is a group of individuals with
diverse training and backgrounds who work together as
an identified unit or system
Examples: intensive care units, hospice care, primary
care outpatient settings

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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 c
Paradigm Shifts in Medicine:
Individual to Team-Based Care (continued)
The Patient Centered Medical Home - term introduced
by the American Academy of Pediatrics in 1967, now
endorsed by numerous organization including the AAFP,
ACP, and the AOA
Hallmarks of the patient centered medical home include:
Personal physician
Physician directed medical care
Care is coordinated
Emphasis on quality and safety
Enhanced access to care

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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 c
Paradigm Shifts in Medicine:
Physician-Kept Records to Personal
Health Records
The first medical records were maintained by physicians
as notes
First individual patient medical records - 1907, at the
Mayo Clinic in Rochester, Minnesota
Advances in technology have led to the electronic
medical record, but these are still usually created,
maintained and updated by the provider or the system
Current trend is towards the personal health record,
which is created and maintained by the patient

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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 c
Paradigm Shifts in Medicine:
Dominance of Technology in
Healthcare Delivery
Health information technology (HIT) allows comprehensive
management of medical information and its secure
exchange between healthcare consumers and providers
HIT can:
improve healthcare quality and prevent medical errors
increase the efficiency of care provision
reduce unnecessary healthcare costs
increase administrative efficiencies and decrease
paperwork
expand access to affordable care
improve population health
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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 c
Paradigm shifts in medicine:
Use of the ED for primary care
Emergency Department, ED, visits have
increased from 90.3 million visits in 1996
to 119 million in 2006
This may be related to a shortage of
primary care physicians
Patients with Medicaid are more likely to
visit ED than patients with private
insurance


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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 c
Introduction and History of Modern
Healthcare in the US
Summary Lecture c
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The core values in US Healthcare
Paradigm shifts in Medicine
Physician-centric to patient-centric care
Individual to team-based care
Physician-kept to personal health records
Paper-based to electronic-based
management of medical records
Primary care to emergency department use
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 c
Introduction and History of Modern
Healthcare in the US
References Lecture c
References
Arvantes, J. (2008). Emergency Room Visits Climb Amid Primary Care Shortages, Study Results Show. Retrieved
December 6, 2011, from American Academy of Family Physicians website:
http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20080827er-visits.html.
The electronic medical record at Mayo Clinic . (2011). Retrieved December 6, 2011, from Mayo Clinic website:
http://www.mayoclinic.org/emr/.
Health Policy Explained: US Health Care Costs Background Brief. (2010, March). Retrieved December 6, 2011,
from Kaiser EDU website: http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx.
JAMA Special Communication Uninsured Adults Presenting to US Emergency Departments. Assumptions vs.
Data. (2008). Journal of the American Medical Association, 300(16), 1914-1924. Retrieved from http://jama.ama-
assn.org/content/300/16/1914.abstract.
Joint Principles of the Patient Centered Medical Home. (2007). Retrieved December 6, 2011, from Patient-
centered Primary Care Collaborative - American Academy of Family Physicians (AAFP); American Academy of
Pediatrics (AAP); American College of Physicians (ACP); American Osteopathic Association (AOA) website:
http://www.pcpcc.net/node/14.
Overview of Healthcare Financing, from Regional Overview of Social Health Insurance in South East Asia. (2004).
Retrieved December 6, 2011, from World Health Organization SEARO website:
http://www.searo.who.int/LinkFiles/Social_Health_Insurance_HSD-274.pdf.





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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 c