Current Trends in Health Care AND health care delivery

• Health care professionals need to ne licensed
• Providers an facilities need to be certified
• Drugs and devices need to be approved and regulalted

• high rate of medical errors
• inadequate/dangerous care
• disparities in access to importnat health care resources
• unisured population
• high health care expenditure
• deficiency of health care workers

• improve quailty of life
• quicker diagnoses and better treatment
• increased life expectancy

• expectations of the best care available
• excess use of technology
• deficient assessment of cost and effectiveness
• disease-centered care instead of patient-centerd care
• unequal access to technology

• long, health and productive lives
• access
• quality 
• efficiency 
• equity
• (under preformance on all of those dimesions

• health :"devine gift"
• disease "divine punishment"

attempted to remove the supernautral as the cause of disease

naturalistic explantion of the health/ disease

• prefected Hippocrates' ideas
• health as a balance of our 4 fluids: blood, yellow bile, black bile, and phlegm

a state of complete, physical, mental, and social well-being, and not merely the abscenece of disease

• Merriam- Webster: The maintaining and restoration of health by the treatment and prevention of disease especiialy by trained and liscensed professionals (as in medicine, dentistry, clinical psychology, and public health)
• prevention, diagnosis, and treatment od disease, condition, and/or injur

a health system consists of all organizations, people, and acions who primary intent is to promote, restore, or maintain health

cause of disease

• Cause of disease: human sin, environmental (miasmic), unhelathy life style
• share values- humoralism "interconnected whole"

• treatment: combo of folklore and magic
• minerals, plants, and herbal remedies
• medications used in Europe: Mercury and opium preparations
• Native American Remedies: cinchona bark  (quinine)

• every part of the body was related inevitably and inextricably with every other. 
• In health the body's system was in balance
• in disease, the body lost its balance and suffered disequilibrium
• if health practitioners were able to treat effectively, the needed the knowledge of individual pts and the body's system of intake and outgo

• drugs had to be seen as adjusting the body's internal equilibrium 
• in addition, the drug's action had, if possible, to alter there visible products of the body's otherwise instructable internal state

• mainstream or regular
• treatment: "heroic medicine" : physicians bled, purged, sweated sweated their patients
• Drugs: listed by the physiological effects: diuretics, emetics, narcotics, diaphoretics

• irregular
• treatment: alternative practice
• drugs: folk, medicines, straightening tonics and astringents, temperance from alcohol, homeopathy, small dose therapeutics, regimens of fresh air, exercise, hydropathy (water cures)

• fast development of commercial manufacture of proprietary medicines
• pharmacists open stores where they would fill the prescriptions and compound drugs
• pharmacists shifted their allegiance from the physicians to the pt (counter prescribing, diagnosing, and treating

• "pt medicine": affordable medicines, manufactured in small factories, advertised in newspapers, home delivered (until 1860)
• new role of the pharmacist retailer

• role of the social reformers and public officials
• production and distribution of pt medicine "quakery"
• efforts to warn the public that the pt medicines are dangerous and to pass the nation legislation regulating the industry

• delivered at home, physician's office, drugstore, and cure establishment from the upper and middle class
• the working class and the lower class when sick will try to avoid seeking service from a physician (orthodox or sectarian) to avoid cost

place to protect the community from the infectious or poor

• were institutions with charitable and welfare function 
• distinguished members of the community served as trustees
• untrained caretakers
• poorhouse or almshouse: places to protect the community from the infectious or poor
• place where pts usually dies
• no aseptic practice 
• physicians from upper-class families provided free care

• lower class
• urban, new immigrant neighborhoods
• outpt services: prescribing medication therapies, dental work, and minor surgeries
• employees: a steward, a house physician (druggist)

• after the Civil War, number of hospitals reached 6000
• mental facilities, children hospitals, tuberculosis sanitariums
• sponsored from religious organizations, ethnic associations, women's groups, physician groups, African- American association

1900

• Modern hospital
• 1946 National Hospital Survey and Construction Act: federal funding
• increase in govnt influence in medical education and research and operation in hospitals
• pt-centered care for customer satisfaction
• multidisciplinary teams
• hospitals are "more pleasant, comfortable, and user friendly"

• 1900: 38,000 drugstores in US (one store per 2,000 people)
• drugstore independent owned store or shop-provided different services and products: soda fountains, perfumes, phone booths, candy
• chain drug store 
• "golden age" reputable profession
• Flexner report, discovery of penicillin, and eradication of typhoid fever, cholera, diptheria

• 1910
• accreditation standards for medical school increased
• admission standards for medical students increased
• number of schools and enrolled students reduced
• Medical education by scientific method
• Hospitals became teaching and research centers

discovery of penicillin by A. Fleming

eradication of typhoid fever, cholera, diphtheria

• production and use of antibiotics change health care 
• occurrence of infectious diseases leading cause of death decreases and occurrence of chronic conditions such as heart disease and cancer increases
• focus on sub-cellular and molecular mechanisms of disease
• biomedical model of care
• 1980: eradication of the smallpox worldwide
• 1981: first cases of AID appear in the US

eradication of the smallpox worldwide

first cases of AIDS appear in the US

• 1906: Pure Food and Drug Act
• 1912: Children's Bureau was established
• 1921: Sheppard- Towner Maternity and Infancy Act
• 1930: National Institutes of Health and the Veteran Administration established
• 1937: National Cancer Act
• 1938: Food, Drug, and Cosmetic Act

• 1906 
• address accurate labeling

• 1921
• federal funding for supporting children's health clinics

• 1914 
• provided cash payments for workplace related injuries or disease

• 1937
• biomedical research

• 1938
• Elixir Sulfanilamide scandal of 1937

• Part A for hospital coverage
• Part B for medical insurance: physicians and other medical services
• 1972: adds people with disabilities from any age and those with permanent kidney failure

federal and state program for the low-income elderly or disabled and families with children

• 1996
• a max of a 12-month waiting period for employee coverage usage and dissemination of health insurance information

• 1997
• health insurance for children without coverage

Medicare part D: voluntary rx drug benefit program

• main focus on pt centered care
• electronic record keeping
• inter-professional education in academic hospitals 
• outcomes

improved health quality and efficiency and reduction of medication errors