Chapter 3

Health Policy and the Delivery System

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

The Patient Protection and
Affordable Care Act (PPACA)
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New health care federal reform law signed in 2010 requiring the largest change in the financing of the
American health care system since the enactment of Medicare and Medicaid
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Designed to address the issues of affordability, accessibility, and financing of health care
Focus efforts on meeting the needs of vulnerable populations US Supreme Court upheld the ACA in June 2012
Will be fully enacted by 2018
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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The Health of the Nation
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Measuring the nation’s health
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Health, United States report
• Informs policymakers of trends in nation’s health
Healthy People 2020
• Goal is to increase quality and years of healthy life, and eliminate health disparities

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World Health Organization (WHO) statistics
• Morbidity data
• Compares United States with other countries

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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US Health Trends
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Successes in infection, other diseases
Concerns: Sedentary lifestyle, obesity, chronic illness Health disparities persistent
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Contribute to unfavorable US health indicators
Compromise progress in world health

Vulnerable populations due to age, education, language, location
Work environment changes identified for a safer
US health care system
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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A Safer System
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The health care delivery system in the United
States is experiencing changes sparked by health care reform, recommendations from large organizations involved in forming health policy. The Institute of Medicine (IOM) conducts research from a systems approach to advise the nation in improving health.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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Global Health
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The World Health Organization’s (WHO) overriding objective is to influence health opportunities and outcomes for all people so that they can attain the highest possible level of health.

Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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History of Health Care
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Early influences (through Middle Ages)
 Holistic; Illness understood in mystical terms or as part of religious worldview  Infectious disease epidemics (e.g., bubonic plague, smallpox):
Health meant the survival/absence of disease
Industrial influences (1600s and on)
 Increased longevity
• Adequate food supply
• Sanitary engineering—decreased infectious disease
Socioeconomic (SES) influences
 1834 philosophy: Pauperism among the able-bodied indicated a moral failing
 Attitude towards poor: Punitive
 People held individually responsible for SES standing and health maintenance Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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History of Health Care (Cont.)
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Public health influences
 Edwin Chadwick (1800-1890), father of British and American public health • Environmental sanitation
• Improved health of masses for economic reasons
• Linked health/welfare policies
 Lemuel Shattuck—US public health
• Modeled British system
• Puritan ethic influence re: Work, attitude toward poor
Scientific influences
 1800s: Public health change from sanitation to biological control of communicable disease
 Mid-20th century: Antibiotics decreased infectious disease; more chronic disease with aging
 Now: New emphasis on infectious disease due to antibiotic-resistant organisms; bioterrorism
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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History of Health Care (Cont.)
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Influences of special populations
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Vulnerable populations: Greatest risk
• Minorities—lower quality care (even when insured)
Health: Related to SES, education, lifestyle

Political/economic influences
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Policy: Determine desired outcomes
Economics: How/to whom resources distributed
Governmental programs: Social Security Act,
Medicare, Medicaid

Copyright © 2014 by Mosby, an imprint of Elsevier