examples of each. - Fundamentals of U.S. Health Care Chapter 1 Page 3

  © 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.Fundamentals of U.S. Health Care Chapter 1 Page 3 Learning Objectives • Describe an overview of the U.S. health care system, including the relationships among quality, cost, and access; stakeholders; and types of health care services.• Discuss key medical care and health care designations and definitions.• Identify and discuss the principle problems in the U.S. health care system.• Describe the major forces that have shaped the delivery of health care services, and cite examples of each.Overview of Your Opinion Matters

Your Opinion Matters: Should the Health Care System Be Responsible

for Treating Social Problems?Yes • Health includes social and psychological health as well as physical health.• If child abuse is suspected, health care providers are required to notify authorities.• It is in the patients’ and public’s interest to prevent abuse and crimes when possible.• All patients must provide informed consent for treatment.• By law, health care providers have to provide translators for those who do not speak English and informed consent forms written in other languages.• To treat the whole person, providers have to be prepared to address patients’ entire needs: medical, social, psychological, and spiritual.No • The U.S. health care system is truly a medical care, or illness-driven, system.• Doctors are not trained to deal with a host of social issues.• Social services exist and should be used in conjunction with the health care system.• For translation and literacy issues, patients should bring someone to translate.• Placing translation burden on providers drives up costs, resulting in higher premiums and taxes.(Fundamentals of US Health Care Principles and Perspectives, 1e Charles Yesalis, Robert Politzer, Harry Holt) (Instructor Manual) 1 / 4

  © 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.Fundamentals of U.S. Health Care Chapter 1 Page 4 Instructor Talking Points

• What role should the health care system play in addressing social issues?

• YOM addresses the “medicalization” of social issues and the role the health care system should or should not play in addressing them. Students should appreciate that there is always a cost for placing a medical label on a social issue. Costs may include shifting resources that are dedicated to treatment and rehabilitation to “heal” the person who is “sick.” • However, there are real societal issues that place patients in danger, such as child abuse, child endangerment, eating disorders, drug and alcohol abuse, and prescription drug misuse. Many of these conditions have a social component, but place the health of patients in substantial danger.

• Can the health care system effectively engage in the holistic assessment and

treatment of patients to address such issues as lack of employment, domestic abuse, and spiritual needs?• Emphasize tension between the high cost and the appropriateness of dedicating resources to holistic assessment and treatment of patients to address a litany of contributing factors such as lack of employment, domestic abuse, and spiritual needs.• Students should appreciate that many societal issues, such as unemployment and underemployment, may be root causes of lack of health insurance. Lack of insurance and usual source of care may lead to poorer health status for patients and society as a whole.• However, it is not the responsibility of the health care system to treat employment status and unmet spiritual needs.

• Where does the health care system draw the line between treating a condition or

episode of care and dedicating resources to address other societal issues?• Societal issues may include poverty, child abuse, alcoholism, illiteracy, and domestic abuse.• The U.S. health care system focuses on curative treatments and interventions because the reimbursement structure focuses on payment for the delivery of tests and procedures.• These other societal issues, such as poverty, child abuse, and illiteracy, require much broader societal initiatives and strategies to combat. 2 / 4

  © 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.Fundamentals of U.S. Health Care Chapter 1 Page 5

• What are the unintended consequences of diagnosing societal issues as medical

conditions?• Resources may be diverted to treat conditions that have nonmedical origins as their root cause. As a result, clinicians may only be addressing the symptoms rather than the underlying causes. For instance, lack of education and training may be the root causes of unemployment and lack of health insurance and the underlying cause of tobacco addiction for a patient. Treating the addiction does not get to the root of the problem and may waste health care resources.

• Does the health care system have sufficient resources to treat patients holistically or

should clinicians concentrate on the physical “disease”?• Students should appreciate that the answer may be dependent on severity of symptoms and diagnosis of the patient. In other words, if the patient presents with an immediate life-threatening condition, the priority is on stabilization, not necessarily the holistic approach.• Ultimately, it may depend on whether there are sufficient sources of reimbursement to compensate for the time and expertise that holistic therapies entail.• In the best possible circumstances, holistic treatment is preferable, but it does require resources to train clinicians to recognize the nonphysical human dimensions and incorporate alternative therapeutic interventions.

Your Opinion Matters: Should We Have a Right to Health Care

in the United States?Yes • The U.S. Constitution does not enumerate all personal rights, only minimal rights that the Founding Fathers sought to protect at the time.• Human and civil rights have evolved from liberty rights to include the right to vote, the right to education, rights of disabled persons to education, and the right to health care.• When the Constitution was ratified in 1789, only property-holding white men over the age of 21 were permitted to vote.• Other barriers such as religious tests, racial restrictions, literacy tests, and poll taxes were implemented and then abolished over time.• In 1920, women were also given the right to vote, and in 1921, adults between 18 and 21 years old were afforded this right. 3 / 4

  © 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.Fundamentals of U.S. Health Care Chapter 1 Page 6 • Almost all other industrialized nations have established a right to health care and provided systems for universal access to health care.• As a founding nation and member of the United Nations, the United States should do the same. No one should be deprived of basic necessities such as food, housing, and health care.No • There is no explicit right to health care in the U.S. Constitution.• Citizens have the rights of life, liberty, property, and the pursuit of happiness, but such rights do not translate into government providing food, clothing, or housing.• Similarly, we have the right to pursue health, but it is our responsibility to maintain our health by engaging in healthy behaviors.• Conversely, we also have the right to be destructive toward our own health. It is the government’s duty to protect those choices.• As part of the right to pursue health, we can choose to purchase health care services.• When government does for individuals what individuals should do for themselves, a dependent class is created that only widens socioeconomic inequalities and inhibits some from pursuing the American dream.Instructor Talking Points

• Why does the right to health care fall into the category of the right to vote, free

speech, speedy trial, and assembly?• It has been included in the Economic Bill of Rights and the Universal Declaration of Human Rights, and other economically developed countries have identified health care as a basic right.• However, it has never been included in the U.S. Constitution or Declaration of Independence and was never passed as a piece of legislation by the U.S. Congress.

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