Ivan Wima Aditama

18/425499/KU/20548
GROUP B TUTOR 5
PD Internasional 2018

1. Differences between primary care clinics and hospitals

Health care should be effective and safe. Professionals as well as the general public often
over-rate the performance of their health services. The emergence of evidence-based
medicine in the 1980s has helped to bring the power and discipline of scientific evidence to
healthcare decision-making, while still taking into consideration patient values and
preferences. The effectiveness and safety of generalist ambulatory care, where most
interactions between people and health services take place, has been given much less
attention. This is a particularly important issue in the unregulated commercial settings of
many developing countries where people often get poor value for money

(WHO, 2008)

• Clinic
A Clinic is a health care center where you receive routine preventative care when you are
healthy or visit your Doctor/Primary Care Provider when you are sick. A clinic is smaller than
a hospital where patients are less sick and do not stay overnight. You should schedule an
appointment to visit your doctor at the clinic. (California Department of Public Health, 2019)
Some reasons to go to a clinic or Doctor’s office to see your Primary Care
Provider/Doctor are:
o Routine medical appointments
o Appointments when you feel sick
 o Immunizations
• Hospital
Your Doctor /Primary Care Provider will refer you to the Specialist or Hospital. If it is an
Emergency, go directly to the hospital. (California Department of Public Health, 2019)

You may need to go to a Hospital for some of the following health issues:
o Emergencies
o An appointment with a Specialist
o Specific medical treatment (Surgery/Operation)

2. Role and Responsibilities of Doctor in solving health problem

Physicians' desire to intervene with the power of modern medicine, with the diagnostic
and therapeutic armamentarium now at hand, is insufficient. They must also counsel patients
to modify their risk factors, help them quit smoking, help them initiate an appropriate
exercise program, and engage in safer sexual practices. The counseling benefits will be
measured many, many years later—long after patients have forgotten their physician's
involvement. Reducing patients' risk factors poses a particular challenge to physicians
because of two contravening forces within the profession itself. (Lawrence, 1990)
CLINICAL PREVENTIVE SERVICES.
To accomplish this integration of health promotion and disease prevention in the clinical
setting, physicians will have to provide the following services: (Lawrence, 1990)
1. Counseling for behavior change in the context of the specific risk profile of the
individual patient;
2. screening tests to detect early, presymptomatic disease (mammography for
breast cancer) or risk factors (hypertension or elevated cholesterol); and
3. immunizations and chemoprophylaxis.
EDUCATION.
Medical educators have faith that health profession students and graduate clinicians can
improve their health promotion skills, knowledge, and attitudes as a result of effective
teaching and training (Lawrence, 1990)
PRACTICE AUDIT AND FEEDBACK.
Feedback based on audits of physicians' records is limited to the physicians' own reports of
tests ordered and advice given. Direct observations are needed to assess the quality of
counseling skills and other health promotion activities, and few studies have been reported.
(Lawrence, 1990)
REMINDER SYSTEMS.
Most reminder systems in clinical practice are computer-based. First demonstrated at the
Regenstrief Institute, computer reminders about abnormal test results and monitoring of
drug side effects improved adherence to predetermined standards. (Lawrence, 1990)
MULTIPLE INTERVENTIONS.
The combination of educational interventions plus practice setting changes such as reminder
systems or payment for preventive services produced positive changes in mammography
and immunization rates in an internal medicine clinic. (Lawrence, 1990)

3. Components of Health Care System

The health care system consists of all personal medical care services—prevention,
diagnosis, treatment, and rehabilitation (services to restore function and independence)—
plus the institutions and personnel that provide these services and the government, public,
and private organizations and agencies that finance service delivery. (The Nation's Health
Care System, 2012)
The health care system may be viewed as a complex made up of three interrelated
components: people in need of health care services, called health care consumers; people
who deliver health care services—the professionals and practitioners called health care
providers; and the systematic arrangements for delivering health care—the public and
private agencies that organize, plan, regulate, finance, and coordinate services—called the
institutions or organizations of the health care system. The institutional component
includes hospitals, clinics, and home-health agencies; the insurance companies and
programs that pay for services like Blue Cross/Blue Shield, managed-care plans such as
health maintenance organizations (HMOs), and preferred provider organizations (PPOs); and
entitlement programs like Medicare and Medicaid (federal and state government public
assistance programs). Other institutions are the professional schools that train students for
careers in medical, public health, dental, and allied health professions, such as nursing. Also
included are agencies and associations that research and monitor the quality of health care
services; license and accreditation providers and institutions; local, state, and national
professional societies; and the companies that produce medical technology, equipment, and
pharmaceuticals. (The Nation's Health Care System, 2012)
Much of the interaction among the three components of the health care system occurs
directly between individual health care consumers and providers. Other interactions are
indirect and impersonal such as immunization programs or screening to detect disease,
performed by public health agencies for whole populations. All health care delivery does,
however, depend on interactions among all three components. The ability to benefit from
health care depends on an individual's or group's ability to gain entry to the health care
system. The process of gaining entry to the health care system is referred to as access, and
many factors can affect access to health care. This chapter provides an overview of how
Americans access the health care system. (The Nation's Health Care System, 2012)

4. Role of Family in Health Care System

Families provide the support and conditions needed for healthy living, prevention of
disease and opportunities for early diagnosis and treatment to avert or delay complications.
Interventions for health to be effective, must necessarily take into account the social
determinants of health. In addition to sociocultural factors, health is impacted by several
other factors such as nutrition, environment, living and working conditions, urbanization, the
ageing population, globalization and so on. This necessitates a multisectoral approach to
address health issues. (WHO, 2013)
Social support for families needs to be responsive to the dynamics of today’s family
structure and the composition, condition, and challenges faced by families. Family is the
foundation for health development of individuals. Changing family structure, demography,
roles, and responsibilities poses challenges in nurturing healthy behaviours. Intersectoral
interventions to empower families are crucial to build adequate support systems for healthy
family development; to strive towards social inclusiveness increasing family access to public
services; to enable institutions to assess family at-risk before crisis; and, to design family
centred support systems. Active participation of families is crucial for family empowerment.
(WHO, 2013)

5. Principles of early detection, health promotion, and health protection

Health promotion seeks to improve the level of health in a population by preventing
diseases, controlling hazards, improving fitness and well being and enhancing the capacity
or workers to work and to function in society. Health promotion activities are generally
divided into education, health protection (protecting the worker from hazards and ensuring
prompt intervention if something goes wrong) and prevention of disease. Prevention, in turn,
is often divided into primary prevention (the prevention of disease in the first place, for
example through clean water or immunization against infectious disease), secondary
prevention (the early detection of disease at a stage when it can be treated or limited,
through periodic health surveillance) and tertiary prevention (prevention of disability, for
example by providing rehabilitation services after an injury). The workplace is an excellent
place to promote health, to the benefit of all society. For this reason, the World Health
Organization has developed many sophisticated approaches to health promotion based on
education, disease prevention and enhancing fitness in the workplace, based on recognition
of the determinants of health and interventions based on a model of how they work together
known as the health field concept. The Ottawa Charter (1986) is a key document that brought
together WHO’s approach and links it with empowerment of the worker, who is encouraged
to take responsibility for his or her own health. Health promotion activities take many forms
but generally target exercise and activity, diet, cancer prevention, smoking cessation, and
management of chronic diseases through wellness programs. (Mendes & Dias, 2011)

6. Basic epidemiology
Epidemiology is the study and analysis of the distribution (who, when, and where),
patterns and determinants of health and disease conditions in defined populations. (Porta,
2014)
It is a cornerstone of public health, and shapes policy decisions and evidence-based
practice by identifying risk factors for disease and targets for preventive healthcare.
Epidemiologists help with study design, collection, and statistical analysis of data, amend
interpretation and dissemination of results (including peer review and occasional systematic
review). Epidemiology has helped develop methodology used in clinical research, public
health studies, and, to a lesser extent, basic research in the biological sciences. (Porta, 2014)
Epidemiological practice and the results of epidemiological analysis make a significant
contribution to emerging population-based health management frameworks. (Porta, 2014)
Population-based health management encompasses the ability to:

a. Assess the health states and health needs of a target population;

b. Implement and evaluate interventions that are designed to improve the health of that
population; and
c. Efficiently and effectively provide care for members of that population in a way that
is consistent with the community's cultural, policy and health resource values.
Each of these organizations uses a population-based health management framework called
Life at Risk that combines epidemiological quantitative analysis with demographics, health
agency operational research and economics to perform: (Porta, 2014)

a. Population Life Impacts Simulations: Measurement of the future potential impact of

disease upon the population with respect to new disease cases, prevalence,
premature death as well as potential years of life lost from disability and death;
b. Labour Force Life Impacts Simulations: Measurement of the future potential impact
of disease upon the labour force with respect to new disease cases, prevalence,
premature death and potential years of life lost from disability and death;
c. Economic Impacts of Disease Simulations: Measurement of the future potential
impact of disease upon private sector disposable income impacts (wages, corporate
profits, private health care costs) and public sector disposable income impacts
(personal income tax, corporate income tax, consumption taxes, publicly funded
health care costs).

7. Healthcare seeking behaviour (including the factors influencing patient’s

decision) -> Ways for patients to seek for achieving healthcare
Health seeking behavior is the behavior of a person towards seeking health care during
illness. It also defined as a sequence of treatment actions or decisionmaking process or
power that further affect individually or household's behavior or perception during illness
towards health service. [The health-seeking behavior of the mother determined by her
personal health behavior and that behavior influenced by the physical, social-economic,
cultural or political condition of that existing society

References
California Department of Public Health. (2019, February 6). Center for Infectious Disease.
Retrieved from California Department of Public Health Web Site:
https://www.cdph.ca.gov/Programs/CID/ORH/Pages/Difference-between-Hospital-
and-Clinic.aspx
Lawrence, R. S. (1990). The Role Of Physicians In Promoting Health. Chicago: Project
HOPE.
Mendes, R., & Dias, E. C. (2011). Health Protection, Health Promotion, and Disease
Prevention at the Workplace. New York: Oxford Scholarship .
Porta, M. (2014). A Dictionary of Epidemiology. New York: Oxford University Press.
The Nation's Health Care System. (2012, January 8). The Components Of The Health Care
System. Retrieved from Library Index:
https://www.libraryindex.com/pages/1817/Nation-s-Health-Care-System-
COMPONENTS-HEALTH-CARE-SYSTEM.html
WHO. (2008). Primary Care: Putting People First. Geneva: WHO Press.

WHO. (2013). Family as Centre of Health Development. New Delhi : World Health
Organization.