hes 4503 unit 3 notes

7/26/2019 HES 4503 Unit 3 Notes

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HES 4503 Unit 3 Notes

CHAPTER 13Health Care System of the United States

Introduction• Health Care delivery in U.S. is unlike other developed countries

o Is delivered by an array o providers in a variety o settin!so IS paid or in a variety o "ays

Health Care Structure• Spectru# o health care delivery

o $arious types o care

• %ypes o health care providers

• Health care acilities and their accreditation

Spectru# o Health Care &elivery• 'opulation(based public health practice

o Co##unity hospitalo $accination pro!ra#

• )edical practice

• *on!(ter# practiceo +or people "ith chronic diseases and disabilities

• End(o(lie practiceo Hospice care

'opulation(,ased 'ractice• Interventions ai#ed at disease prevention and health pro#otion

o 'ublic health pro!ra#- usually unded by the !overn#ent

• Health educationo E#po"er#ent and #otivation

• )uch takes place in !overn#ental health a!encieso lso occurs in a variety o other settin!s

/estaurants- schools- churches- other places in theco##unity

)edical 'ractice &i1erentiated by location and di1erence o health careproviders2

Primary medical careo Clinical preventive services rst(contact treat#ent on!oin! care

or co##on conditions Internal #edicine- a#ily doctor- ,678N- e#er!ency

roo#- clinic- school hospital• Co##on Cold- broken bone- cut

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Secondary medical careo Speciali9e attention and on!oin! #ana!e#ent

'roble# is #ore co#ple:- and you need a reerral Hospital- specialist clinic6o;ce oncolo!ist- radiolo!ist- etc.2

• *euke#ia cute Care< e#er!ency roo# Subacute Care<

Tertiary medical care

o Hi!hly speciali9ed and technolo!y sophisticated #edical andsur!ical care

o +or unusual and co#ple: conditions and treat#ents Hi!her level hospital that is able to provide treat#ents-

usually a tea# o doctors nurses = 's- doctors odi1erent speciali9ations2

• ,one #arro" transplant- kidney transplant- bypass

sur!ery o the heart

*on!(%er# 'ractice Restorative care

o 'rovided ater sur!ery or other treat#ent 'ro!ress o disease can be restored to nor#al health

• /ehab care- therapy- ho#e care

• Inpatient and outpatient units- nursin! ho#es- othersettin!s

Long-term Careo Help "ith chronic illnesses and disabilitieso %i#e(intensive skilled care to basic daily taskso Nursin! ho#es and various settin!s

'ro!ress o disease can be postponed

End(o(*ie 'ractice• Services provided shortly beore death

o &i1ers by culture

• Hospice careo %ake care o patients "ho are near death and help their a#ilies

deal "ith loss %er#inal dia!nosis $ariety o settin!s

Spectru# o Health Care &elivery

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%ypes o Health Care 'roviders• >4.5 #illion "orkers in U.S. >0-.4? o population2

o 4>.3? in hospitalso @5.A? in a#bulatory care settin!so >A.3? in nursin!6residential acilities

• ver @00 types o careers in industryo Independent providers

)&s- &s- nonallopathic chiropractors- acupuncturistso *i#ited care providers

&entistso Nurseso Nonphysician practitioners

)id"iveso llied health care proessionals

ccupational therapistso 'ublic health proessionals

Epide#iolo!ists

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nde!endent Providers

• Speciali9ed education and le!al authority to treat any health proble#or disease

o llopathic and osteopathic providers

o Nonallopathic providers

llopathic and steopathic 'roviders Independent2 Allo!athic !roviders

o 'roduce e1ects di1erent ro# those o diseaseso &octors o )edicine )&s2

)ost po"erul de!ree #ost co#prehensive care can "orkindependently trainin! is #uch lon!er

,achelors &e!ree- 4 years o )edical School- board e:a#s-apply or residency pro!ra# 3(5 years2 to beco#elicensed

)ore than @5? o pri#ary care physicians are international)&s ro# abroad2

"steo!athic !roviderso /elationship bet"een body structure B unction

)ore holistic ualityo &octors o steopathic )edicine &s2

• Si#ilar education and trainin!

• )ost &s "ork in pri#ary care

#onallo!athic Providers Independent2

• Non(traditional #eans o health care• Com!lementary and Alternative $edicine C)2

o Used to!ether "ith conventional #edicine- therapy is consideredDco#ple#entary in place o considered Dalternative

Chiropractors- acupuncturists- naturopaths- etc. Natural products- #ind(body #edicine- #anipulation- etc.

Limited %or Restricted& Care Providers

• dvanced trainin! in a health care specialty

• 'rovide care or a specic part o the body

• &entists- opto#etrists- podiatrists- audiolo!ists- psycholo!ists- etc.

#'rses

• ver 4 #illion "orkin! in nursin! proession

• *icensed 'ractical Nurses *'Ns2o >(@ years o education in vocational pro!ra# ssociates2o 'ass licensure e:a#

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• /e!istered Nurses /Ns2o Co#pleted accredited acade#ic pro!ra# ,achelors2o State licensure e:a#

• dvanced 'ractice Nurses 'Ns2o )aster or &octoral de!rees )asters- 'h&2

#on!hysician Practitioners

• 'ractice in #any areas si#ilar to physicians- but do not have )& or &de!rees

• %rainin! beyond /N- less than physician

• Nurse practitioners- certied #id"ives- physician assistants '2

Allied Health Care Professionals

• ssist- acilitate- and co#ple#ent "ork o physicians and other health

care specialists• Cate!ories<

o *aboratory technolo!ist6technicianso %herapeutic science practitioners

'hysical %herapist- ccupational %herapisto ,ehavioral scientists

&ietitians- Nutrition Specialistso Support services

• Education and trainin! varies

'ublic Health 'roessionals• Fork in public health or!ani9ations

• Usually nanced by ta: dollars

• vailable to everyone pri#arily serve econo#ically disadvanta!ed

• 'ublic health physicians- environ#ental health "orkers-epide#iolo!ists- health educators- public health nurses- researchscientists- clinic "orkers- biostatisticians- etc.

o 'roessor- researcher- "ork or state public health depart#ent-C&C- nonprot or!ani9ations- health educator- teach atuniversities- social "orker

Health Care +acilities B %heir ccreditation• 'hysical settin!s "here health care is provided

n!atient care facilitieso 'atient stays overni!ht

"'t!atient care facilitieso 'atient receives care and does not stay overni!ht

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Inpatient Care +acilities• Hospitals- nursin! ho#es- assisted(livin!

• Hospitals oten cate!ori9ed by o"nershipo 'rivate G prot #akin! specialty hospitals

)ale clinico 'ublic G supported and #ana!ed by !overn#ent urisdictionso $oluntary G not(or(prots >6@ o U.S. hospitals

/ed Cross- St. Hospital-

• %eachin! and nonteachin! hospitalso Usually cheaper

• +ull(service or li#ited(service hospitals

Clinics• A0? o physicians "ork in clinics in the US

o %"o or #ore physicians practicin! as a !roup• &o not have inpatient beds

• +or(prot and not(or(prot

• %a: undedo 'ublic health clinics- co##unity health centerso ver >->00 co##unity health centers in U.S.o Support pri#ary health care needs o underserved populations in

the U.S.

utpatient Care +acilities• Care in a variety o settin!s- but no overni!ht stay re!ardless o "hy

patient is in the acilityo Health care practitionersJ o;ces- clinics- pri#ary care centers-

a#bulatory sur!ery centers- ur!ent care centers- serviceso1ered in retail stores Fal!reens- Fal#art2- dialysis centers-i#a!in! centers

/ehabilitation Centers• Fork to restore unction

• )ay be part o a clinic or hospital- or reestandin! acilities

• )ay be inpatient or outpatient

*on!(%er# Care ptions• Nursin! ho#es- !roup ho#es- transitional care- day care- ho#e health

care• Ho#e health care

o 7ro"in! due to restructurin! o health care syste#- technolo!icaladvances- and cost contain#ent

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ccreditation o Health Care +acilities• ssists in deter#inin! uality o health care acilities

• 'rocess by "hich an a!ency or or!ani9ation evaluates and reco!ni9esan institution as #eetin! certain predeter#ined standards

(oint Commissiono 'redo#inant accreditin! or!ani9ationo /evie"s the uality o the hospital to evaluate its accreditation

Health Care Syste# +unction• U.S. Dsyste# is uniue co#pared to other countries

o /ecent decadesJ challen!es led to ne" le!islation

A)orda*le Care Act %"*ama Care&

o 7oal< to put #erican consu#ers back in char!e o their healthcovera!e and care

%o i#prove the uality o healthcare in the U.S. %o reduce the cost o healthcare in the U.S.

o Si!ned into la" )arch @0>0 chan!es to be i#ple#ented @0>0(@0@0 so#e e1ective #id(@0>0 bulk !o into e1ect @0>4

Structure o the Health Care Syste#• U.S. Structure G co#ple:- e:pensive- #any stakeholders- intert"ined

policies- politics• )aor issues<

o Cost containment %he process o havin! a bud!et and developin! a pro!ra#

based on the bud!eto Access

'atient access to health careo +'ality

%he Kuality o health care

• ll eually i#portant e:pansion o one co#pro#ises other t"o

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• %he Cost Contain#ent bud!et li#its ho" #uch is spent on ccess vs.Kuality.

ccess to Health Care

ccess to Health Care• $ariety o #eans to !ain access

o Insurance covera!e and !enerosity o covera!e are #aordeter#inants o access to health care

o @00L,.3 million 'nins'red %1/.,0&

• &ecreased in @0>5 due to ba#aCare L.@?2 M30#illion2

5.5 #illion uninsured or part o the year >L.4?2o *ikelihood o bein! uninsured is !reater or those< youn!- less

educated- lo" inco#e- non"hiteo 7reatest reason or lack o insurance< cost

• out o >0 uninsured are ro# "orkin! a#ilies

$edically indigento nyone "ho cannot a1ord to pay or #edical care

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&elay or "ithdra" treat#ent because you cannot a1ord topay or it

2oring !ooro E#ployed- but inco#e is not !ood enou!h to cover health

insurance

• )aor co#ponent o 1ordable Care ct is increasin! the nu#ber o#ericans "ith health insurance

Kuality o Health Care• &oin! the ri!ht thin!- at the ri!ht ti#e- in the ri!ht "ay- or the ri!ht

people- and havin! the best resultso Kuality health care should be<

E)ective it "orks Safe no har# Timely treat#ent at the ri!ht ti#e S'2- in the ri!ht

"ay Patient centered

E4'ita*le eual health care despite specialcharacteristics rican #ericans- lesbians- etc.2

E5cient to spend the least a#ount o #oney- "ith the#a:i#u# outco#e

%he Cost o and 'ayin! or Health Care

• >st< +ederal 7overn#ent

• @nd< 'rivate health insurance

•

/ei#burse#ento 'ay#ents #ade by the third part payer to providers

>st party< the patient @nd party< physicians providers2

• 'rovide care or the >st party 3rd party< ederal !overn#ent insurance co#pany2

• 'ays the @nd party ater the treat#ent is co#pleted

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o %he insurance co#pany "ill pay a percenta!e o the total costPO4-000Q

R5?2

• Insurance "ill pay or R5? o the cost o thetreat#ent PO3-000Q

• 8ou pay @5? o the cost o the treat#ent out(o(pocket PO>-000Q

• Co(pay#ent<o %he a#ount you need to pay out(o(pocket2 or each visit

'ay O30 or each visit to the doctor

• +i:ed inde#nity<o Insurance co#pany "ill only pay or health care until a lar!e

a#ount o #oney is reached +i:ed inde#nity 0.R #illion. %reat#ent O> #illion2

• O0.3 #illion is not paid or by insurance

•'re(e:istin! condition

o Insurance co#panies do not like to pay or those "ho alreadyhave conditions that "ill cost the# #ore #oney

o HI' Health Insurance 'ortability and ccountability ct2 o>LLA

*a" that #akes sure insurance co#panies "ill pay orthose "ith 're(e:istin! conditions

%ypes o Health Insurance Covera!e

%he Cost o Health Insurance• Cost o insurance #irrors cost o care

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• In U.S.- burden alls pri#arily on the e#ployer- then the e#ployeeo Increased "orker share o pre#iu#o /aisin! deductibleso Increasin! prescription co(pay#ent

E#ployer pays less to the insurance co#panyo Increasin! nu#ber o e:clusions

/educe the ran!e o covera!e

• Cost o policy deter#ined by risk o !roup and a#ount o covera!eprovided

Sel(+unded Insurance 'ro!ra#s• 'ro!ra#s created or6by e#ployees rather than usin! co##ercial

insurance carrierso )any benets to the e#ployero 7enerally or lar!er co#panies- unless lo"(risk e#ployees

Health Insurance 'rovided by the 7overn#ent• 7overn#ent health insurance plans only available to select !roup

o )edicare< elderly A5=2o )edicaid< pooro ChildrenJs Health Insurance 'ro!ra#< children "hose parents do

not have health covera!eo $eterans d#inistration benet< #ilitary- ar#y- veteranso Indian Health Services< Native #ericano +ederal e#ployeeso Health care or the unior#ed serviceso 'risoners

)edicare• Covers #ore than 4A.5 #illion people

• +ederal health insurance pro!ra# or those<o elderly2 A5=- per#anent kidney ailure- certain disabilities

• SS Social Security2 handles enroll#ento %he #ore #oney that is earned #ore #oney or retire#ent

• Contributory pro!ra# throu!h +IC +ederal Insurance Health Cared#inistration2 ta:

• +our partso Hos!ital ins'rance %Part A& Ppri#ary #edical careQ

'art G #andatory has deductible B co(insuranceo $edical ins'rance %Part 6& Ppri#ary #edical careQ

'art , G those in 'art auto#atically enrolled unlessdecline has deductible B co(insurance

o $anaged Care Plans %Part C&

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'art C G o1ered by private insurance co#panies notavailable in all parts o U.S.

o Prescri!tion 7r'g Plans %Part 7& 'art & G optional run by private insurance co#panies

#onthly pre#iu#s lar!e nu#ber o plan available

co#ple: to navi!ate 7on't hole a !ap o covera!e that so#e part o

insurance does not cover or prescription dru!s• Spent a certain a#ount deter#ined by )edicare

• Need to pay out(o(pocket until CatastrophicCovera!e is #et

Catastrophic Covera!e< covera!e or an e:tre#e a#ount o #oney

• Uses &ia!nosis /elated 7roups &/7s2 "hich is doctors !et rei#bursedthe sa#e a#ount o the #oney or the sa#e dia!nosis by prospectiverei#burse#ents

)edicaid• Health insurance pro!ra# or lo"(inco#e no(a!e reuire#ent

• 4A= #illion covered by )edicaid

• Eli!ibility deter#ined by each state very costly bud!et ite# or states

• Noncontributory pro!ra#

CHI' ChildrenJs Health Insurance 'ro!ra#2• Created in >LLR or >0 years

o /eauthori9ed in @00L throu!h @0>3 +undin! assisted by increase in ederal e:cise ta: rate on

tobacco• @00L ( R. #illion children enrolled

• %ar!et< lo"(inco#e children ineli!ible or )edicaid

• State6+ederal pro!ra#o $accines unded by CHI'

E:. H'$ vaccine

'roble#s "ith )edicare and )edicaid

• 'ro!ra#s created to help provide health care to those "ho #i!ht havei#possibilities o obtainin! health insurance

• /ecurrent 'roble#<o So#e providers do not accept )edicare or )edicaid as or#s o

pay#ento )edicare6)edicaid raud

%ransparent pro!ra#

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Costs e:tra #oney on the bud!et in the nation

• M>? o 7'& on healthcare

• MO-000 per person per year

Supple#ental Health Insurance

• Help cover out(o(pocket costs not covered throu!h pri#ary insuranceo )edi!apo Specic(disease insuranceo +i:ed(inde#nityo *on!(ter# care insurance

'reserve nancial assets- prevent need or a#ily or riendsto provide care- enable people to stay independent lon!er-easier to !o into acility o choice

Fho 'ays or *on!(%er# CareT

)ana!ed Care• 7oal to control costs by controllin! health care utili9ation

o $ariety o skills that "e use to reduce the cost and i#prove theuality o care

• @0>0 G >35 #illion enrolled in #ana!ed care plan

• )ana!ed by )Cs )ana!ed Care r!ani9ations2o Have a!ree#ents "ith providers to o1er services at reduced cost

• Co##on eatures G provider panels !roup o doctors "ithin anet"ork2- li#ited choice o healthcare that people have access to2-!atekeepin!- risk sharin! packa!ed deals2- uality #ana!e#ent andutili9ation revie"

%ypes o )ana!ed Care

Preferred Provider "rgani8ation %PP"&o Hi!hest 're#iu#

E9cl'sive Provider "rgani8ation %EP"&o &o not need reerence to see a specialist

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o ut o Net"ork doctors

Health $aintenance "rgani8ation %H$"&

o )ore strictly #ana!edo &o not need reerence to see a specialist

Sta1 #odel H)

Independent 'ractice ssociation I'2 ther H) #odels

• &i1erences<o 'ri#ary physician- doctor outside o net"ork- reerences to

specialists

ther rran!e#ents or &eliverin! Health Care• National health insurance

o syste# in "hich the ederal !overn#ent assu#es responsibility

or health care costs o entire population 'ri#arily paid or "ith ta: dollars

o U.S. only developed country "ithout national health care plano Seven ailed atte#pts at national health care in U.S. over past R0

years• State health plans

Health Care /eor# in the United States• Consu#er(directed health plans C&H's2

o Consu#er responsibility or health care decisions "ith ta:(sheltered accounts

o Health savin!s accountso Hi!h rei#burse#ent arran!e#ents

• 1ordable Care ct

CHAPTER 1,"vervie: of the A)orda*le Care Act %ACA&

Fhat is the C ba#a Care- /eor#ed Health Care ct2T• 'resident ba#a si!ned the 1ordable Care ct C2 in )arch @0>0.

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• %he C is intended to !rovide a)orda*le coverage options throu!h$edicaid and Health ns'rance $aret!laces

%itle o the 1ordable Care ct

• %itle >< health insurance

• %itle @< i#provin! )edicaid

• %itle 3< i#prove )edicare

• %itle 4< prevention

• %itle 5< e:pand the "orkorce or health care

• %itle A< reduce raud- abuse- and transparency

• %itle R< reduce cost or prescription dru!s

• %itle < care or disabled and those in need o lon!(ter# care

• %itle L< arran!in! e:penses or ba#a Care• %itle >0< education

Fhy CT

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7oals o the C reduce cost- increase access2• E9!and health care coverage to 3@ #illion #ericans "ho are

uninsured• Slo: do:n the rising cost of health care "hich accounted or

M>? o USJ 7ross &o#estic 'roduct in @0>0

Fhat &oes It &o +or Colle!e StudentsT•

Since @0>0- child dependents are allo"ed to re#ain on their parentsJpolicies until a!e @Ao MR #illion adolescents are uninsured

• Children can oin or re#ain on a parentJs plan even i they are<o )arriedo Not livin! "ith their parentso ttendin! schoolo Not nancially dependent on their parentso Eli!ible to enroll in their e#ployerJs plan

• Fhen a child loses covera!e at a!e @A- they ualiy or a Special

Enrollment Period

E:a#ple< @00L vs. @0>4• &avid @32 ust !raduated ro# colle!e. He recently ractured one o his

ribs. His current ob does not provide insurance• @00L<

o #o ins'rance. Had to pay ;<=>>> or e#er!ency roo# costs

• @0>4<

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o Eli!ible to stay on his !arent?s ins'rance. *et hospital "ithonly ;1=>>> bill or deductible

o Savin!s< O-000

Chan!es in Colle!e Health 'lans

• >.A #illion youn! adults >>? o students2 are enrolled in colle!ehealth plans

o )any had lo" benetso &iscri#inated on pre(e:istin! conditions- a!e- se:

• CJs e1ect<o 1er covera!e to all re!ardless o health statuso 'rovide ree preventative careo No discri#ination based on se:o ,an on rescissionso ,an on annual and lieti#e li#its

•

Catastrophic health planso )aor car accidento verall e:pense is cheaper

Ho: 2ill "ther Peo!le @et Health Care Coverage

• %he C e:pands health care covera!e in the ollo"in! "ays<o Individual )andate

)andatory health insurance or everyoneo 7uarantee issue

7uarantee covera!e insurance policyo )edicaid E:pansion

I#prove )edicaid and e:tend covera!eo 're#iu# ta: credits

/educe the #onthly a#ount "e payo Cost Sharin! Subsidies

ut o pocket pay#ento S#all ,usiness %a: Incentives

Health insurance or s#all business e#ployeeso Health Insurance )arketplace

Febsite to re!ister or health insuranceo Essential Health ,enets

&ene essential health benets

%er#inolo!y• )edicare<

o ederal pro!ra# that provides health care covera!e to peoplea!ed A5 and older

• )edicaid<

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o ederal and state unded pro!ra# that provides #edicalassistance or certain individuals and a#ilies "ith lo" inco#eand resources

• &eductible<o %he a#ount you o"e or covered health care services beore

your health plan be!ins to pay• 're#iu#<

o %he a#ount you pay- oten on a #onthly basis- or healthinsurance

• ut(('ocket Costs<o Health care costs that are not covered by your health plan- such

as &eductibles- co(pay#ents

Individual )andate• /euire all citi9ens and le!al residents "ith e:ceptions2 to have health

covera!e be!an on anuary >- @0>4• %he )andate does not pply<o /eli!ious obectionso Undocu#ented i##i!rantso Incarceratedo #erican Indians and laskan Nativeso Inco#e belo" to ta: lin! thresholdo %he lo"est cost plan option e:ceeds L.5? o an individualJs

outco#e• Fhat is the penaltyT

o @0>5< O3@5 per adult and O>[email protected] per child up to OLR5 or a

a#ily2 or @? o a#ily inco#e- "hichever is !reater

7uarantee Issue G Insurance /e!ulation• ,e!ins in @0>4- Insurers #ust provide covera!e to any person

re!ardless o #edical history or current health• Insurers cannot<

o &eny covera!e based on pre(e:istin! conditionso E:clude pre(e:istin! conditionso Char!e a hi!her pre#iu# or individuals "ith pre(e:istin!

conditions•

S#all insurance co#panies reuired to spend 0? o pre#iu#s ondirect #edical costs *ar!e co#panies< 5?2

)edicaid E:pansion• E1ective anuary >- @0>4- states have the option to e:pand )edicaid

• #ericans a!ed >L or older and under a!e A5 "ith a household inco#eo less that >3? o the ederal poverty level #ay enroll

• States "ill receive al#ost >00? ederal undin! or the rst 3 years

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're#iu# %a: Credits• &esi!ned to #ake pre#iu#s a1ordable or individuals and a#ilies

"ith lo"er inco#es• %he C provides pre#iu# subsidies to individuals "ith inco#es

bet"een >33? and 400? o the +'* level that purchase health plano Can be used to reduce #onthly pre#iu#so Can be clai#ed as a credit on annual ta: return

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Cost Sharin! Subsidies• Helps protect lo"er(inco#e individuals ro# hi!h out(o(pocket costs

• Cost Sharin!<

o portion o the costs o your care you pay out o pocket E:a#ples o these costs include Co(pay#ents- and annual

&eductibleso re available to those "ith a household inco#e o up to @50? o

the +'*o Health and Hu#an Services throu!h the )arketplace noties the

insurer i an enrollee is eli!ible or the subsidy

S#all ,usiness %a: Incentives• ,e!innin! in @0>4- s#all e#ployers "ith up to 50 e#ployees #ay o1er

insurance throu!h the S#all ,usiness Health ption 'ro!ra# SH'2)arketplace

• S#all(e#ployer ta: credit reuire#ents<o Covera!e #ust be purchased throu!h the SH' )arketplaceo %he e#ployer #ust cover at least 50? o the cost or sin!le not

a#ily2 covera!e or each e#ployeeo %he e#ployer #ust have no #ore than @5 ull(ti#e euivalent

e#ployeeso E#ployeesJ avera!e annual "a!es can be no #ore than O50-000

Health Insurance )arketplace

• %he Health Insurance )arketplace is intended to help individuals ndand purchase health insurance to t their bud!et

• %he individuals #ost likely to enroll throu!h the Health Insurance)arketplace include @L #illion #ericans "ho are<

o Uninsuredo Une#ployedo Sel(e#ployedo Insured today in the individual #arket

• these individuals- >L #illion #ay be eli!ible or a pre#iu# ta:credit

Essential Health ,enets• Every health insurance plan available in the #arketplace should o1er

essential health benets

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Fhat is the 1ordable Care ctT• Health Care Insurance /eor#

Fho can use the ne" health insurance )arketplacesT• ny U.S. citi9en

&ependent children can stay on their parentsJ insurance plan until a!e• @A

%oo #any people have insurance plans that li#it the a#ount o care that iscovered- but donJt reali9e it until they ace a costly disease like cancer.Fhich o the belo" "ill be eli#inated as a result o the la"T

• *ieti#e covera!e li#its on insurance benets

• nnual covera!e li#its on insurance benetso Since Septe#ber @0>0- health plans have been banned ro#

settin! lieti#e dollar li#its on covera!e- ensurin! that people"ith cancer have access to needed care. nnual dollar li#its onbenets are no" ti!htly restricted or #ost plans and "ill nolon!er be allo"ed be!innin! in @0>4.

Fhat are the t"o key !oals o the 1ordable Care ctT• Slo" do"n the risin! cost o health care

• E:pand health care covera!e to uninsured #ericans

ne "ay the 1ordable Care ct "ill e:pand health care covera!e isV• %hrou!h pre#iu# ta: credits

Cost sharin! reductionsV• re a "ay to reduce consu#er out(o(pocket health care e:penses

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CHAPTER 1/nB'ries as a Comm'nity Health Pro*lem

Introduction•

Inuryo 'hysical har# due to #echanical reasons- physical stress-

ther#al- che#ical- radiation• Unintentional Inuries

o ccidental- "ithout intention

• Intentionalo 'urposeully inWicted caused by the perpetrator or the victi#

the#selves. Suicide- ho#icide

Cost o Inuries to Society• +atal Inuries

o 5th leadin! cause o death in the U.S. 5. #illion people die ro# inuries each year

• &isablin! Inurieso 7reat hu#an burden attributed to inurieso Si!nicant econo#ic costs< O500= billion annuallyo 7reatly contribute to pre#ature death

Inury &eaths- United States- @0>>

• Intentional< M30?o Suicide< @>?o Ho#icide< L?

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,urden o Inury- United States- @0>>

Unintentional nB'ries

• %he cause o nearly @63 o all inury(related deaths in the U.S.

•

#aor co##unity health proble#• *eadin! cause o unintentional inuries<

o )otor vehicle crashes X>2o 'oisonin! X@2o +alls X32o ther unintentional inuries X42

)otor $ehicle Crashes• *eadin! type o unintentional inury death

• *eadin! type o nonatal unintentional inury

• lcohol plays a si!nicant role

• )aority o those killed are<o &rivers A4?2o 'assen!ers @R?2o )otorcycle riders 4?2o 'edestrians 3?2o 'edal cyclists @?2

Poisonings

• @nd leadin! cause o unintentional inury deatho Sources<

Unintentional in!estion o atal doses o #edicines anddru!s

• Children accidently consu#e dru!s Consu#ption o to:ic oods E:posure to to:ic substances in the "orkplace or else"here

• )ost occur in the ho#e

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'laces or Unintentional Inuries• Ho#e

o )ore occur in the ho#e than anyplace else X>2

• Hi!h"ayo @nd leadin! place or inuries and inury death

Car accidents• /ecreation6Sports rea

• Forkplace

Inuries by 'lace o ccurrence- @0>0

• 4L.3 ? at ho#e

• @A.? ro# #otor vehicle accidents

%i#e• Seasonal variations in various causes o unintentional inuries

o )ost inuries in Su##er )ore physical activities- s"i##in! (Y dro"nin!

• &ays o the Feeko )ore likely on "eekends

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• %i#e o dayo )ore likely at ni!ht

lcohol I#pair#ent or &rivers Zilled

lcohol and ther &ru!s as /isk +actors• lcohol #ay be #ost i#portant actor contributin! to inuries

• Involved in hi!h a#ount o #otor vehicle crasheso /elated to speedin!- seat belt use- #ultitaskin!- and other

behaviors

'revention throu!h Epide#iolo!y• Early contributors or inury prevention and control

o

ohn 7ordon +irst researcher to study inuries usin! epide#iolo!y

#odelso Fillia# Haddon- r.

Create saety policies or hi!h"ay

• Hi!h "ay prevention speed li#it2o 'ioneer or the idea o airba!so Hel#ets or #otorcyclists

• )odel or Unintentional Inuries %rian!leo Environ#ent< ootball eld !rass !uard rails on hi!h"ayo Host< hel#et- pads seatbelto Ener!y 'roducin! !ent< speed o run- "ei!ht o person speed

li#it

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'revention and Control %actics• 'revent accu#ulation o ener!y producin! a!ent

o /educin! speed li#its- lo"erin! settin!s on hot "ater heaters

• 'revent inappropriate release o e:cess ener!yo +la#e(retardant abric- nonslip suraces

• 'lacin! barrier bet"een host and a!ent

o Sunscreen- non(heat handles on cook"are• ther tactics

Co##unity pproaches to 'revention• Education

o 'rocess o chan!in! peopleJs health(directed behavior

• /e!ulationo Enactin! and enorcin! la"s to control conduct

• uto#atic 'rotectiono )odiyin! products or environ#ents to reduce risk

Child Safety Ca!s on prescription dru!s• *iti!ation

o Seekin! ustice or inury throu!h courts

ntentional nB'ries

• utco#e o sel(directed or interpersonal violence

• ssaults- rapes- suicides- ho#icides

• Can be perpetrated a!ainst a#ily #e#bers- co##unity #e#bers- orco#plete stran!ers

Epide#iolo!y o Intentional Inuries• Interpersonal violence disproportionately a1ects those rustrated-

hopeless- obless- livin! in poverty- "ith lo" sel(estee#• )ore acts co##itted by #ales

• +irear#s increasin!ly involved

• lcohol and dru!s use contributes

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• 'erpetrators #ore likely to have been abused or ne!lected as childrenor e:posed to violence

Ho#icide- ssault- /ape and 'roperty Cri#es• Ho#icide victi#i9ation rate or blacks si!nicantly hi!her than "hites

o )ost ho#icides co##itted "ith rear#s• *o"er inco#e associated "ith hi!her rate o bein! a victi# o violence

• E:cept or rape and se:ual assault- all violent cri#e victi#i9ation ratehi!her or #ales

o @005(@0>0< only 3A? o rapes and se:ual assaults reported tothe police

Suicide and tte#pted Suicide• Suicide rate or #en 4: than or "o#en

o @0 #en a year6 >00-000 populationo

5 "o#en a year 6 >00-000 population• Suicide rate or youn! people increased ro# @00L(@0>0 to hi!hest

rate in >0= yearso Elderly A5=2

30 elders 6 >00-000o 8oun! dults >5(@42

5 youn! adults 6 >00-000

• lder6Elderly #en : #ore likely to co##it suicide than senior "o#en

+irear# Inuries and Inury &eaths• Intentional and unintentional acts- rear#s 3rd leadin! cause o inury

death• Hi!hest risk or ho#icide and suicide involvin! rear#s are teena!e

boys and youn! #en• 7uns on colle!e ca#puses

• bsence o detailed ederally supported reportin! syste#

+irear#(/elated Inury vs. ll Causes

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$iolence in ur Society• Individuals and $iolence

• +a#ily $iolence and buseo Child )altreat#ent

Child abuse Child ne!lect

• 'revention o Child )altreat#ento Elder )altreat#ent

Usually sel(ne!lect- due to depression and #ental healthissues

o Inti#ate 'artner $iolence I'$2 'revention o Inti#ate 'artner $iolence

• 7roup ctivity<o Fhat strate!ies are considered #ost e1ective in preventin!

do#estic violence ro# a public health perspectiveTo ny could be applied to datin! violence preventionT

$iolence in Schools• $icti#i9ation rates have re#ained steady in recent years

• +i!htin! and "eapon carryin!

• [ero tolerance policies

• ,ullyin! and bein! bulliedo 'hysical and verbal

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• Sae Schools6Healthy Students Initiative

• 8outh violence ater school

$iolence in ur Co##unities• 8outh !an! violence

• Costs to the co##unity• Co##unity response

• State response

• +ederal response

CHAPTER 1,Comm'nity Health and the Environment

History and vervie"• Health is a1ected by the uality o the environ#ent

o ir "e breatheo Fater "e drinko +ood "e eato Co##unities in "hich "e live

• 'hysical Environ#ent<o ir- "ater- ood availableo *andscapin!o

• Social Environ#ent<o

CHAPTER 1Safety and Health in the 2or!lace

Introduction• 7lobally- each year<

o M3>R #illion nonatal occupational inurieso 3@>-000 atal inuries

• ter ho#e- #ericans spend #ost ti#e at "ork• "cc'!ational disease lon!(ter# or short(ter# e:posure related to

the "orkin! environ#ento ccupational illness

• "cc'!ational inB'ry >(ti#e incidence

Scope o the 'roble#

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• +e"er than >> "orkers die each day in the U.S. ro# inury sustained at"ork

• +atalities have declined si!nicantly over the past 5 years

• /eportin! o illness vs. inuryo Inury is easier to !ather datao Illness is di;cult to reco!ni9e- di;cult to provide proo that it is

related to "ork• Econo#ic i#pact

• Ne" cases o sel(reported "ork(related illness a#on!st people "ho

"orked in the last >@ #onthso $ost common illnesses

)usculoskeletal disorders- #ental health

I#portance o ccupational Saety and Health to the Co##unity• Industry is a subset o the lar!er co##unity

• 1ects "orkplace and those outside the "orksite

• Forkers the#selves are a co##unity

History o ccupational Saety and Health 'roble#s• ,eore >LR0<

o Industrial revolution )ass #anuacturin!- #inin!-

o State *e!islation Child la*or la:s >AR- )assachusetts2

• 'reviously< children "ork >3 hours a day in te:tileand cotton #ills

o No"< *o"ered the #a: "orkin! hours ochildren to >0 hours a day

o )ini#u# "orkin! a!e in klaho#a< >4(>5- but#ust have school6a#ily certication

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E:ceptions< "orkin! in a ar#- or a#ilyindustry6restaurant

2orer?s com!ensation la:s >L0@- )aryland2

• 'reviously< did not allo" co#pensation or the"orkers and a#ilies "ho have illness6inuries due to

"ork related conditionso No"< the co#pany co#pensates the "orkers

or their inurieso +ederal le!islation

,ureau o *abor >42 )any la"s ro# >L0(>LR0 "cc'!ational Safety and Health Act of 1<D>

• >st co#prehensive ederal le!islation ai#ed atprovidin! sae and healthy environ#ent or "orkers

ccupational Saety and Health ct o >LR0 SHct2• %o ensure e#ployers in private sector urnish each e#ployee a

"orkplace ree ro# reco!ni9ed ha9ards causin! or likely to causedeath or serious physical har#

• ccupational Saety and Health d#inistration SH2 established toenorce SHct

• National Institute or ccupational Saety and Health NISH2o pply or undin! or '%6%o /esearch institute "ithin the C&C

'revalence o ccupational Inuries- &iseases- and &eaths

• /ecent trendso &ecline in nu#ber o "orkplace inuries and illnesses reported in

private industry since >LL@• 7oods(producin! industries hi!her rate o nonatal inury than service(

producin!o Highest a!riculture- orestry- shin!- huntin!

Hi!hest non(atal inuries in 7oods(producin! industrieso Highest service-!rod'cing education and health care- leisure

and hospitality Sick children- #ental illness

Inectious diseases- blood spills- cuts-

Nonatal Forkplace Inury and Illness Incidence /ates by Industry- @0>>

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Unintentional Inuries in the Forkplace• )inor inuries<

o Cuts- bruises- abrasions- #inor burns

• )aor inuries<o #putations- ractures- severe lacerations- eye losses- acute

poisonin!s- severe burns• /eported by #any sources

o Co##on E#er!ency /oo# visits

+atal Fork(/elated Inuries

• *eadin! cause< Hi!h"ay incidentso +alls- bein! struck by obect- ho#icide

• Industries "ith hi!hest rates o atal occupational inurieso !ricultureo +orestryo +ishin! and huntin!o )inin!o %ransportation and "arehousin!o Construction

+atal ccupational Inuries by )aor Event- @0>>

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Nonatal Fork(/elated Inuries• In @0>>- nearly 3 #illion inuries and illnesses in private industry

o @>-000 inuries reported in state and local !overn#ent "orkers

• )ales account or #aority o treat#ent A>? o non(atal inury cases2o +e#ales account or 4R? o total "ork e#ploy#ent

• &isablin! inuries and illnesseso

/epeat trau#a disorders Cu#ulated %rau#a &isorders C%&s2

• 'ain- s"ellin!- tin!lin!- nu#bness

• Carpal tunnel- back pain- "rist pain

Characteristics o Forkers Involved in Fork(/elated Inuries• !e

o 8oun!er "orkers have hi!her non(atal inury incidents- lo"eratal inury incidents @5(35 years old2

Healthy- ast reactions-o lder< take #ore ti#e o1 ater they have been inured

• 7endero )ales account or @63 o nonatal inuries

• 'overty and raceo sians have lo"est "ork related inuryo *o"er salary obs have hi!her inuries

• 7eo!raphic di1erences in "orkplace inuries

• %e#poral variations in "orkplace inuries

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o )ore inuries in the su##er- by adolescents

• Forkplace inuries by industry and occupationo +atal and nonatal occupational inuries and illnesseso !ricultural saety and health

Hours Forked and +atal Fork Inuries by 7ender- @0>>

7eo!raphic &i1erences in Forkplace Inuries

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'revention and Control o Unintentional Inuries in the Forkplace o'r f'ndamental tass

o nticipation +oresi!ht to envision uture adverse events and take action

to prevent

o /eco!nition Surveillance and #onitorin! o the "orkplace

o Evaluation ssess the data that "ere collected durin! the reco!nition

and #onitorin! activitieso Control

Chan!es to #ake it saer

Forkplace $iolence< Intentional Forkplace Inuries• >.R #illion victi#s each year

•

Ho#icides< 4

th

leadin! cause o "orkplace atalities• Cate!ories o "orkplace violence<

o Cri#inal intent %ype I2 %he perpetrator and the victi# have no le!iti#ate

relationship• /obber vs. bank teller

o Custo#er6Client %ype II2 Have a business relationship beore- currently- or

potentially2• 'roessor vs. student

o Forker(on(Forker %ype III2 ,et"een co("orkers

o 'ersonal /elationship %ype I$2 /elated

/isk +actors or Forkplace $iolence• Forkin! "ith the public

• Forkin! around #oney or valuableso e"elry store- bank

• Forkin! alone

• Forkin! late at ni!ht

• obs "ith hi!her risko %a:icab driverso obs in liuor storeso &etective and protective services

'revention Strate!ies• Environ#ental desi!ns

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o Chan!e the environ#ent to #ake it saer Security ca#eras

• d#inistrative controlso %he policies or protocols the e#ployer has to ollo" to #ake sure

their practice is sae

Ho" to turn o1 a dish"asher• ,ehavior strate!ies

o Should behave accordin!ly instructed ho" to handle hot plates +ace #ask is al"ays "orn "hile "orkin!

ccupational Illnesses and &isorders• Illness #ore di;cult to acuire data on than inury

o Inco#plete data

• &i;cult to link occupational e:posure

• So#e conditions slo" to develop and di;cult to associate "ith the

"orkplace

%ypes o ccupational Illnesses

$'sc'loseletal disorders

o ccu#ulated %rau#a &isorders repeated use2

Sin diseases and disorderso 'oison- che#icals- soaps- deter!ents- !as

#oise-ind'ced hearing loss

Res!iratory disorderso 'neu#oconiosis G #ineral dust

7roup o brotic pneu#onias inhaled #ineral dustparticles ro# #inin! black lun!- @## particleso sbestosis G asbestos

'eople "ho construct roo and house or insulationo Silicosis G crystalline silicao ,yssinosis G cotton- Wa:- or he#p dust bro"n lun! disease2

ther Fork(/elated &iseases and &isorders• 'oisonin!s

o !ricultural "orkers

• Inectionso Health care industryo Ha9ardous dru!s

• n:iety- stress- neurotic disorders #ental health2

• /adiation

'revention and Control o ccupational &iseases and &isorders• /euires vi!ilance o e#ployer and e#ployee

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• !ent(host(environ#ent #odel

• E:a#ples o activities<o Identication and evaluation o a!entso Standard settin! or the handlin! o and e:posure to causative

a!entso En!ineerin! controlso Environ#ental #onitorin!o )edical settin!s

/esources or the 'revention o Forkplace Inuries and &iseases• ccupational saety and health proessionals

o Saety en!ineerso Certied saety proessionalso Health physicistso Industrial hy!ienistso

ccupational physicianso ccupational therapisto ccupational health nurses

ccupational Saety and Health 'ro!ra#s• 'replace#ent e:a#inations

o physical e:a#ination o a ne"ly hired or transerred "orkers todeter#ine #edical sustainability or place#ent in a specicposition

• &isease prevention pro!ra#s

• Saety pro!ra#so 'arts o the "ork place saety and health pro!ra# ai#ed at

reducin! unintentional inuries on the ob• Forksite health pro#otion pro!ra#s

o &esi!ned to chan!e e#ployee health behavior and reduce risksassociated "ith diseases or inuries

• E#ployee assistance pro!ra#so ssist e#ployee "ho have substance abuse- do#estic-

psycholo!ical or social proble#s that interere "ith their "orkperor#ance

hes 4503 unit 3 notes

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