Introduction to Health Care and

Public Health in the U.S.

Introduction to and History of
Modern Health Care in the U.S.
Lecture c
This material (Comp 1 Unit 1) 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://creativecommons.org/licenses/by-nc-sa/4.0/.
 Introduction to and History of
Modern Health Care in the U.S.
Learning Objectives - 1
• Define key terms in health care and public
health (Lectures a, b, c, d)
• Describe components of health care
delivery and health care systems
(Lecture a)
• Discuss examples of improvements in
public health (Lecture b)

2
 Introduction to and History of
Modern Health Care in the U.S.
Learning Objectives - 2
• Define core values and paradigm shifts in
U.S. health care (Lecture c)
• Describe the technology used in the
delivery and administration of health care
(Lecture d)

3
 Core Values in U.S. Health Care

• Patient centricity
• Individual choice
• Interdisciplinary care
• Technology and innovation drive health
care
• Technology drives health care spending

4
 Cost of Health Care

• Options for financing health care

– Taxation or general revenue
– Social health insurance
– Voluntary or private health insurance
– Out-of-pocket payments
– Internal donations
• Health care expenditure
– 1980: $253 billion
– 1990: $714 billion
– 2015: $3.2 trillion

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 Paradigm Shifts in Medicine:
Physician-Centric to
Patient-Centric Care - 1
• Old model
– Patient care options were determined by the
provided
– Patients were offered few opportunities to
make decisions
• New model
– Cultural shift towards giving patients greater
responsibility in their care
• Shift from paternalism to patient autonomy
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 Paradigm Shifts in Medicine:
Physician-Centric to
Patient-Centric Care - 2
• Patient Self-Determination Act,1990
– Requires organizations to give individuals
information about their rights
o Participate in and direct their own health care decisions
o Accept or refuse medical or surgical treatment
o Prepare an advance directive
o Information on the provider’s policies that govern the
utilization of these rights
• Providers, organizations and health care
systems have become more responsive to
patient needs
7
 Paradigm Shifts in Medicine:
Individual to Team-Based Care - 1
• Patient care was provided by an individual
clinician
• Increasing complexity caused an evolution
towards collaboration between clinicians
• Interdisciplinary team
– “…group of individuals with diverse training and
backgrounds who work together as an identified
unit or system” (Drinka, 2000)
– Intensive care units, hospice care, primary care
outpatient settings
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 Paradigm Shifts in Medicine:
Individual to Team-Based Care - 2
• Patient Centered Medical Home
– Introduced by the American Academy of
Pediatrics in 1967
– Endorsed by numerous organizations
• Features include
– Personal physician
– Physician-directed medical care
– Care is coordinated
– Emphasis on quality and safety
– Enhanced access to care
9
 Paradigm Shifts in Medicine:
Team-Based Care to
Accountable Care
• Accountable Care Organizations (ACOs)
– Groups of physicians, hospitals, and other health
care providers who provide coordinated, high-
quality care
– Goal is to ensure that patients get the right care
at the right time, avoid having unnecessary
duplication of services, and aim to prevent
medical errors
– Some ACOs may share in the savings achieved

10
 Paradigm Shifts in Medicine:
Physician-Kept Records to Personal
Health Records
• First medical records were maintained by
physicians as notes
• 1907 – first individual records developed
and centrally located in Mayo Clinic
• Advances in technology led to the
electronic medical records
• Current trend is towards the personal
health record, which is created and
maintained by the patient
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 Paradigm Shifts in Medicine:
Dominance of Technology in
Health Care Delivery
• Health information technology (HIT)
– Allows comprehensive management of information
– Secure exchange between patients and providers
• HIT can
– Improve quality and prevent medical errors
– Increase efficiency of care
– Reduce unnecessary health care costs
– Increase administrative efficiencies
– Expand access to affordable care
– Improve population health

12
 Introduction to and History of
Modern Health Care in the U.S.
Summary – Lecture c
• The core values in U.S. Health Care
• Paradigm shifts in Medicine
– Physician-centric to patient-centric care
– Individual to team-based to accountable care
– Physician-kept to personal health records
– Paper-based to electronic-based
management of medical records

13
 Introduction to and History of
Modern Health Care in the U.S.
References – 1 – Lecture c
References
Accountable Care Organizations. Retrieved January 19, 2017, from Center for Medicare
and Medicaid Services,
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/
Drinka, T.J.K. and Clark, P.G. (2000) Health Care Teamwork. Interdisciplinary Practice
and Teaching. London: Auburn House.
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://
jamanetwork.com/journals/jama/fullarticle/182794.

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 Introduction to and History of
Modern Health Care in the U.S.
References – 2 – Lecture c
References
Joint Principles of the Patient Centered Medical Home. (2007). Retrieved January 19,
2017, from Patient-centered Primary Care Collaborative - American Academy of
Family Physicians (AAFP),
http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PC
MHJoint.pdf
.
Wilson, KB (2016). Health Care Costs 101. Oakland, CA, California Health Care
Foundation. http://www.chcf.org/publications/2016/12/health-care-costs-101

15
 Introduction to Health Care and
Public Health in the U.S.
Introduction to and History of
Modern Health Care in the U.S.
Lecture c
This material 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.
16