Component 1, Unit 2a: Introduction to Health Care and Public Health in the U.S., Delivering Health Care, Part 1, Lecture a
Introduction to Health Care
and Public Health in the U.S.
Delivering Health Care, Part 1
Lecture a
This material (Comp 1 Unit 2) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http:
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y-nc-sa/4.0/.
Welcome to Introduction to Health Care and Public Health in the U.S.: Delivering Health Care, Part 1. This is lecture a.
The component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and how services are delivered in the U.S. It covers public policy, relevant organizations and their inte
elationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S.
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Delivering Health Care, Part 1
Learning Objectives
Describe the organization of health care at the federal, state and local levels
(Lecture a)
Describe the organization of the VA system and Military Health System (Lecture b)
Describe the structure and function of hospital clinical and administrative units (Lecture c)
Describe different types of long term care facilities, with an emphasis on their function (Lecture d)
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The learning objectives for Delivering Health Care, Part 1 are to:
Describe the organization of health care at the federal, state, and local levels
Describe the organization of the VA system and Military Health System
Describe the structure and function of hospital clinical and administrative units
And, describe different types of long-term care facilities, with an emphasis on their function
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Delivering Health Care, Part 1
Learning Objectives – Lecture a
Describe the organization of health care at the federal, state, and local levels
Overview of the U.S. Department of Health and Human Services (HHS)
Role of state governments in health care
Local health care organizations
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This first lecture describes the organization of health care at the federal, state, and local levels, including the U.S. Department of Health and Human Services, or HHS, state governments, and local health care organizations.
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Purpose of the HHS
Provides essential health care for all Americans
Protects the needy or underserved
State, local, and tribal levels
Structure
Office of the Secretary
11 operating divisions
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The HHS is the federal agency that oversees health care for all Americans. It focuses on helping citizens who are needy or underserved. Services are generally provided at the state, local, and Native American tribal levels. The HHS is run by the Office of the Secretary, and includes eleven operating divisions.
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Organization of the HHS
1.1 Chart: (HHS.gov, ND)
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As illustrated in this flowchart, the structure of the HHS is complex.
At the top, outlined in purple, is the Office of the Secretary, which oversees all operations. This lecture focuses on the inner boxes outlined in blue, which represent the eleven HHS operating divisions. Three of these divisions are considered human services agencies: the Administration for Children and Families, the Administration on Aging, and the Centers for Medicare and Medicaid Services. The other eight divisions are part of the U.S. Public Health Service.
The Office of the Inspector General will also be discussed.
Overall, the HHS runs more than 300 health care programs.
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Administration fo
Children and Families (ACF)
Addresses the economic and social well-being of children, families, individuals, communities
Vulnerable populations
Programs are both national and regional
Well-known program: Head Start
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The Administration for Children and Families, or ACF, operates federal programs that encourage economic independence, social well-being, and quality of life. Although this agency targets children and families, it also addresses individuals and entire communities. Vulnerable populations are a special focus, such as people with disabilities, foreign-born individuals, Native Americans, and victims of human trafficking.
One cu
ent initiative, "Let's Move! Child Care”, is an effort to promote child health by encouraging physical activity and healthier nutrition practices in early care and education settings.
Another initiative seeks to build the supply and stability of high quality family child care providers. Head Start, a program of the ACF, promotes school readiness among young children by working to improve health, nutrition, educational attainment, and social development. The Early Head Start program targets pregnant women as well as infants and toddlers.
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Administration on Aging (AoA)
Adults 65 years of age and older will be 21.7% of the U.S. population by 2040
Programs are both home-based and community-based
Funds non-medical programs to prolong health and independence
Multiple needs served: nutritional, logistical, legal, quality of life
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Next is the Administration on Aging, or AoA. According to government census projections, people aged 65 and older will represent 21.7% of the population by the year 2040. Individuals who are cu
ently age 65 can expect to live, on average, about another 18 years. Many older people live alone and have a low income, creating an increased need for national programs that target this group.
The AoA provides funding for nonmedical home-based and community-based services for the elderly, with the goal of prolonging the health and independence of senior citizens. Examples of these services are home delivery of meals, nutrition information, transportation services, adult day care, and legal assistance.
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Agency for Healthcare Research and Quality (AHRQ) - 1
Mission:
produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used
All stakeholders are included
Health care value
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Decision-making about any issue is difficult when people do not have the information they need. In terms of health care, a good resource for information is the Agency for Healthcare Research and Quality, or AHRQ. AHRQ’s mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. The efforts of AHRQ target all stakeholders in the health care system, including patients, individual health care providers, hospitals, insurers, policy makers at all government levels, and medical schools.
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Agency for Healthcare Research and Quality (AHRQ) - 2
Helps organizations adopt new technology
Areas of research:
Effectiveness of treatments
Quality improvement and patient safety
Illness prevention and care management
Health care value
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AHRQ helps organizations adopt new information technology, such as computerized medical records. It researches the effectiveness of treatments, including drugs, devices, diagnostic tests, and surgery, so patients and physicians can make informed decisions. The agency’s other research interests are quality improvement and patient safety, illness prevention and care management, and issues of health care value, such as the affordability of health care.
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Agency for Toxic Substances
and Disease Registry (ATSDR) - 1
Works to prevent illness and disease due to toxic or hazardous substances
Common toxins: arsenic, asbestos, lead, mercury
Locations: environmental pollution, waste sites, disasters
Methods of exposure:
eathing, drinking, food, soil exposure, cut
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The Agency for Toxic Substances and Disease Registry, or ATSDR, works to prevent illness and disease due to toxic or hazardous substances. Among the most common toxic substances are arsenic, asbestos, lead, and mercury. Toxic substances may be found in the environment, in specific areas such as waste sites, or due to sudden disasters. People may be at risk from merely
eathing, or from contact with water, food, soil or through an open sore like a cut.
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Agency for Toxic Substances
and Disease Registry (ATSDR) - 2
Identifies exposures, evaluates risk, recommends action
Prepares for emergencies/disasters
Educates about toxicology, environmental medicine, chemical exposures
Issues public health advisories
Example: 9/11/2001
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The ATSDR identifies potential exposures, quantifies the risk, and makes recommendations for protecting communities. It ensures emergency preparedness for natural or man-made disasters, and it educates health care providers on topics such as toxicology, environmental medicine, and acute chemical exposures. It also issues public health advisories about hazardous materials or physical hazards such as unsafe buildings or abandoned mine shafts.
To give an example, the ATSDR partnered with other government agencies after the te
orist attacks in New York City on September 11, 2001. It provided information about toxin levels and answered questions from residents, first responders, and the media.
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Centers for Disease Control
and Prevention (CDC) - 1
Responsible for public health
Protect America from health, safety and security threats, both foreign and domestic
Activities:
Health promotion
Disease prevention
Reduction of injury and disability
Public Preparedness
Numerous centers, institutes and offices
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The Centers for Disease Control and Prevention, or CDC, is responsible for public health. The CDC’s mission is to protect America from health, safety, and security threats, both foreign and in the U.S. Major activities include health promotion, disease prevention, reduction of injury and disability, and public preparedness for emerging health threats. The CDC accomplishes these goals through numerous centers, institutes, and offices. Just a few examples are the Center for Global Health, the National Institute for Occupational Safety and Health, the Office of Infectious Disease, and the National Center on Birth Defects and Developmental Disabilities.
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Centers for Disease Control
and Prevention (CDC) - 2
Works with partners to monitor and investigate threats to health
Enacts prevention strategies, develops public health policies, advocates for healthy behaviors.
Educates health care providers, consumers
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The CDC works with its partners, both national and international, to monitor cu
ent health and to investigate emerging threats to health, for example swine flu. It also enacts prevention strategies and public health policies, and advocates for healthy behaviors. The CDC monitors new threats to the U.S. public, such as infectious diseases that originate in other countries, like the Zika virus. Finally, the CDC offers a wealth of publications on health care topics, some written for health care providers and some written for the public.
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Centers for Medicare
and Medicaid Services (CMS)
Provides insurance for 1 in 4 Americans
Medicare
Largest health insurer in the U.S.
For people 65+ or disabled people
Insured person pays premiums