Consumers
The main group of stakeholders and the most important stakeholder in the industry.
Employers
Hospitals, nursing and residential care facilities, physicians, dentists, home health care, outpatient and ambulatory care centers, laboratories and other health care practitioners.
Government (stockholders)
Federal, state and local levels all participate
Educational and training organizations (stock holders)
Medical schools, nursing schools, public health schools and allied health programs.
Professional Association(stock holders)
Represent physicians, nurses, hospitals and other health care stakeholders to protect their interests. American Hospital Association (AHA) and Pharmaceutical Research and Manufacturers of America (PhRMA) are examples of professional organizations.
Pharmaceutical industry
Responsible for developing drugs used for medication to treat diseases and conditions.
(OECD)
is a membership organization with their mission of providing comparable statistics of economic and social data worldwide. ( Organization for Economic Cooperation and Development )
2000-2006 Health Expenditures as a percentage of the gross domestic product and per capita.
US Spent the Highest.
Who spends the least in Health Care Expenditures (GDP)
Korea and Turkey
Who spends the least in per capita
Mexico andTurkey
What is the main source in funding the OECD
public sector (except the US and Mexico they have some form of universal health care.)
highest public expenditures for health
Czech Republic
Most countries have some form of government health program
True
US Pharmaceutical Expenditures
US spends less than average
Spends the most in Pharmaceutical Expenditures
Slovak Republic, Korea and Turkey
In 2006 US spending on pharmaceuticals per capita
was the highest.
US physicians per capita
there were less per capita then in most Countries.
OCED average of physicians per capita
3.1
US rank per capita with physicians
20th with 2.3 practicing per 1000
Medical Graduates US rank
23rd oced
This lower rate of medical graduates could be reflective of the difficult curriculum followed in U.S. medical schools.
Three highest ranks med graduates
Ireland,Austria and Turkey
Hospital beds US
ranked bottom five
These rates may address that fact that the U.S. has increased their outpatient services as has other countries.
Hospital beds
Japan highest
Female live expectancy at birth (US) and other countries
ranked 22nd
number one nation was Japan
Male life expectancy at birth (US) and other counties
ranked 20th , Iceland 1st
Total life expectancy at birth
Japan has the leading then Iceland, US is 10th
Female life expectancy after 65
Japan, 18th US
Male life expectancy after 65
Iceland 1st, US 12th, The lowest ranked countries were Turkey and Hungary
Infant mortality ratings
The U.S. ranks 6th from the bottom out of the 30
Lowest infant mortality ratings
Iceland, Japan and Sweden
diabetes deaths per 100,000 population
United States ranked 4th, 1st is Mexico
lowest rates of diabetes deaths per 100,000 population
Greece and Iceland
Overweight
a body mass index of 25- and <30
Obese
body mass index > 30
overweight or obese% of total population
US first Mexico Second
Governments role is much of______
Social Regulation
Social Regulation
protecting employees and consumers of health care
How Many accrediting organizations target specific sectors of health care
25
is mainly by the federal, state and local government levels
regulatory oversight
regulatory oversight
...
Healthcare Facilities Accreditation Program
(HFAP)
TJC
The Joint Commission
NCQA
National Committee for Quality Assurance
CHAP
Community Health Accreditation Program
ACHC
Accreditation Commission for Health Care
Exemplary Provider Programs
The Compliance Team
HQAA
Healthcare Quality Association on Accreditation
AAAHC
Accreditation Association for Ambulatory Health Care
HHS (most important federal agency
for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
Collaborates with state and local governments .
11 operating divisions
8 in U.S. Public Health Service and 3 hum
Has more than 300 programs
HHS
CDC
Centers for Disease Control and Prevention:to protect health and promote quality of life through the prevention and control of disease, injury, and disability.
Goals of the CDC
1) healthy people in healthy places,
2) preparing people for emerging health threats,
3) positive international health and
4) healthy people at all stages of their life.
ATSDR
responsible for finding and cleaning up hazardous waste sites in the country (Agency for Toxic Substances and Disease Registry )
ATSDR responsibilities
Protect public against harmful exposures and disease related exposures to toxic substances.
Determining human health effects associated with toxic exposures
Preventing continued exposures
Help reduce associated human health risks.
Administered with the Ce
NIH Goal
- to collect information in an effort to extend healthy life and reduce the burdens of illness and disability.
-There are 27 institutes and centers that focus on different diseases and conditions ex: cancer, heart disease, aging, alcohol and drug abuse, i
NIH (National Institute of Health)
primary federal agency for research towards preventing and curing disease
HRSA
primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable
HRSA
provides funding to organizations, groups, programs which provide health care to vulnerable populations.
Has six bureaus of concentration: primary health care, health professions, health care systems, maternal and child, the HIV/AIDs bureau and the bureau
AHRQ
to improve the quality, safety, efficiency, and effectiveness of health care for all U.S. citizens.
Focuses on the following areas of research: health care costs and utilization, information technology, disaster preparedness, medication safety, health car
AHRQ helps what and who
more informed decisions and improve the quality of health care services
AHRQ advocacy group
Coalition for Health Services Research (volunt. org.)
Coalition for Health Services Research
Comprised of more than 250 non-profit organizations that support the AHRQ through letters to Congress encouraging more funds for research.
IHS
improve the physical, mental, social, and spiritual health of American Indians and Alaska Natives.
SAMHSA (The Substance Abuse and Mental Health Services Administration )
main federal agency for improving access to substance abuse and mental health services by working with state, communities and private organizations.
SAMSHA includes
Center for Mental Health Services (CMHS),
The Center for Substance Abuse Prevention (CSAP), and
the Center for Substance Abuse Treatment (CSAT).
OAS (The office of applied studies)
data collection center to assist policymakers, providers, and the public in making informed decisions regarding the prevention and treatment of mental and substance use disorders
FDA
a result of the Federal Food, Drug and Cosmetic Act
FDA responsibilities
Responsible for ensuring the safety of food, human and veterinary products, biological products, medical devices, cosmetics and electronic products.
Ensuring accurately of product information.
AOA
part of the Older Americans Act (OAA), one of the largest providers of home- and community-based care for older persons and their caregivers..
AOA goal
develop a comprehensive, coordinated and cost-effective system of home and community-based services that helps elderly individuals maintain their health and independence in their homes and communities.
ACF
Federal programs promoting economic and social well-being of families and children.
Fund state, and local organizations such as family support (welfare), child support, child care, Head Start, child welfare, and other programs relating to children and fam
CMS
President Lyndon B. Johnson, as a result of the Social Security Act
-Administers the Medicare program
Works with state governments to administer Medicaid and oversee State Children's Health Insurance Program (SCHIP)
OSHA
to govern safety in workplace environments
1980s implemented the Hazard Communication Standard (HCS) ensures that all hazardous chemicals are properly labeled
1987, The Medical Waste Tracking Act requires medical waste disposal procedures to ensure there
Who appoints the Surgeon General
the President is the U.S. chief health educator
What does the Surgeon General Oversee?
the operations of the U. S. Public Health Service Commissioned Corps
U.S. Public Service Commissioned Corps
6,000 public health professionals stationed within federal agencies and programs
This includes professionals such as dentists, nurses, physicians, mental health specialists, environmental health specialists, veterinarians, and therapists.
DHS
established in 2002 as a result of the 2001 terrorist attack on the United States
FEMA
2003 which is responsible for managing catastrophic events
FEMA & DHS
Work together for coordinating efforts at all government levels to ensure emergency preparedness for any catastrophic events.
Coordinate with the CDC
CSTE
consists of 1,000 public health epidemiologists that work in state and local health departments.
Provide technical assistance to other agencies for research and policy issues.
Provide expertise regarding maternal child health, infectious diseases, environ
States role in government
U.S. constitution gives state government primary role in health care for their citizens
Is there a lead state agency?
a lead state agency directing other agencies that target specific issues (aging, environment, alcoholism and abuse, etc.)
state agency responsibilities
are responsible for implementing different federal acts (Clean Water Act; Clean Air Act; Food, Drug and Cosmetic Act and Safe Drinking Water Act, etc .)
State health departments
collect health data, manage vital statistics, declare health emergencies and conduct health planning
State health departments duties
Manage disease and tumor registries; provide health education and laboratory services.
Vital statistics collected include deaths, births, marriages, and health and disease status of their populations.
These statistics serve as a basis for funding
Do state health departments license health professionals who practice in that state
yes
The inspection and licensing health care facilities are done by who
state health department
State departments technical assistant to local health departments on
1) quality improvement,
2) data management,
3) public health law,
4) human resource management, and
5) policy development
What do states provide prevention services for?
1) tobacco control and prevention, 2) obesity,
3) injury prevention,
4) HIV/AIDs,
5) diabetes, and
6) sexually transmitted diseases
State agencies are funded primarilty by..
by federal sources (45%), with state resources (24%), Medicaid/Medicare (15%) with the remaining sources are fines and fees (4%), indirect federal funding (3%) and other minor sources (9%)
ASTHO
Not for profit organization that provides support for state and territorial health agencies.
They provide research, expertise and guidance for health policy issues
The federal government looks to ASTHO for their expertise in developing health policy.
True
ASTHO advocate for increased public health funding and campaign against any funding reductions
True
Local Health Departments role in health care
Their basic role is to provide direct public health services to their designated areas
Who provide the most direct services to the population
Local health departments
How do local health departments receive funding?
state and federal government
direct funding such as the Centers for Disease Control and reimbursement for services from Medicaid, Medicare, private health insurance, fees for services
Ranking of local health department funding
1)local health departments
2)stat allocations
3)federal Funding
Regionalization of Local Health Departments
smaller local health departments unite as one. Reduces redundancy in services.
Emergency preparedness in Local health departments
local health departments develop plans for bioterrorism attacks.(includes natural disasters or disease outbreaks)
Assess the situation
assess the capability of the community and itself to respond quickly to a threat as well as to assess the impact of the threat.
Epidemiological capability and laboratory analyses
track susceptible populations and get access to laboratory services as needed
Communication:
Communication systems for key health and medical agencies
Community reassurance:
Address requests for assistance and information.
Clinical interventions
Depending on the type of disaster, interventions provided to the population.
Coordination of Health care systems:
Coordinate with federal and state on-site assistance.
Workforce training:
All workers and volunteers need to be trained on how to implement a disaster plan.
Special populations:
Address the needs of the elderly, disabled and young children.
Legal issues:
Stay apprised of any legal issues
NACCHO
is the advocacy organization for local health departments.
Lobby Congress to promote public health and provide support for their members.
Activities included in the NACCHO
1) food safety, 2) sanitation services, 3) waste disposal, 4) pest control, 5) drinking water purification, 6) restaurant inspection and licensing, 7) communicable disease surveillance, 8) control of sexually transmitted diseases, and 9) public health edu
PHAB
Nonprofit organization to administer the voluntary, national accreditation program for state and local health departments: Exploring Accreditation Project
Who developed the standards for state and local health departments. Also created an assessment process for applicants
Public Health Accreditation Board
Physical environment
pollutants, hazardous exposure at work, water contamination, etc.
The social environment
socioeconomic status, education, sociocultural conditions
Individuals with a higher income level are less exposed to environmental risks and increase access to quality health care
true
Lifestyle
diet,exercise,sexual activity, job
Genetic factors or biology
determinants of health
access to health care
determinants of health
policies
determinants of health
Primary prevention:
reducing disease development. Education and early intervention programs
Secondary prevention
early detection and treatment to stop the progression of disease. Cholesterol checks, blood tests, x-ray
Tertiary prevention:
rehabilitation and monitoring of individuals from disease progression.
Public health professionals focus primarily on
primary and secondary preventions
Edwin Chadwick
reported on the relationship between unsanitary condition and disease in England.
Found that the poor had higher rates of illness than upper class
Advocated for more sanitary working conditions
Who helped implement public health act of england
Edwin Chadwick
Dr. John Snow
made the connection between contaminated water and the spread of cholera in England
Who is most noted for the Broad Street Pump incident
Dr. John Snow..(ex epidemiological investigation)
Lemuel Shattuck
reported on the high mortality rates among lower income and unsanitary living conditions in Boston.
Developed a plan to improve unsanitary conditions in 1850. Also considered the American advocate for environmental health (helped start health laws and the present Public Health programs)
Lemuel Shattuck
APHA gave guidelines for basic health functions
Collection of vital statistics
Control of Communicable disease
Sanitation fo the environment
Laboratory sevices
Maternal and Child Health
Health education of the general public
Sanitation fo the environment
including milk, water and dining;
control of communicable disease
tuberculosis, STDs, and malaria;
Collection of Vital statistics
births, deaths, and reportable diseases;
APHA revised the definition of the Core public health functions
Health surveillance, planning and program development;
Health promotion of local health activities;
Development and enforcement of sanitation standards;
Health services provisions
IOM state three core public health functions
Assessment which includes surveillance, identifying problems, data collection and analysis;
Policy development which includes developing policies to address public problems;
Assurance which includes evaluation of policies meeting program goals .
Public Health Steering Committee, identified what the specific functions and services for public health
monitor community health status;
diagnose and investigate community health problems;
education about potential health problems;
enforce laws and regulations protecting community and individual health
link people to needed health services
Is epidomiology the foundation for public health
yes.
Epidemiology
study of disease distribution and patterns among populations.
Host
the population that has the disease
Agent
organism causing the disease
Environment:
where the disease is occurring
surveillance? Why?
: monitoring patterns of disease and outbreaks
Done to develop intervention strategies for diseases
Biosurveillance
monitoring the environment for bacteria, viruses, and other biological agents that cause disease.
Environmental health work
Involves investigating environmental hazards
Monitoring and enforcing environmental regulations
Ensuring work place environments are safe in conjunction with OSHA
Public health emergency preparedness
planning protocols to manage events such as a natural disaster or man-made disaster
Emergency preparedness protocol
usually done with state and local lever but federal agencies may help.
DHS (State)
Some states have created their own homeland security offices that coordinate with the federal DHS
National Response Framework
NRF), (Department of Homeland Security), describes how communities, states, the federal government, private-sectors, and nongovernmental agencies should collaborate and describes "best practices" for managing incidents.
ICS
used by all emergency management agencies when different agencies respond to an event. take control and make decisions on managing emergency
increases effectiveness on event
Bio Terrorism
An attack on a population by deliberately releasing viruses, bacteria or other germs or agents causing illness or death in people
Public Health Security and Bioterrorism Preparedness and Response Act
provided grants to hospitals and public health organizations to prepare for bioterrorism
Food and Drug Administration
also has responsibilities in the detection of food as a threat to community health
Public Health FUnctions
Currently there is no national accrediting body to institute standards
MAPP
CDC + NACCHO
health program needs of a community
A long range plan for community health is developed based on a the health assessment
Effects of IOM
The Future of Public Health"= public health is improving but environment might yield us to epidemic
Core public health functions of IOM
assessment, policy development and assurance.
Healthy People Reports 3 major goals
increase life expectancy, reduce health disparities, and increase access to preventive services
Role of Federal Government in public health
HHS
Responsible for:
data gathering and analysis, and surveillance and control;
conducting and funding research;
providing assistance to state and local government programs;
formulating health policy;
ensuring food and drug safety;
ensuring access to heal
State Government and Health Public Health
Coordinate with their local public health agencies which are responsible for implementing state policy and regulations.
Most states have public health activities distributed across many agencies
State Government and additional activities
licensing health care professionals;
inspecting and licensing health care facilities;
collecting vital statistics;
epidemiological studies;
crisis management of disease outbreaks;
disease registry;
laboratory services;
health policy implementation and ana
Local Government
Directly responsible for performing the majority of community public health services