Component 1: Introduction to Health Care and Public Health in the U.S.
Component Description:
This component is a survey of how health care and public health are organized and services delivered in the U.S. It covers public policy, relevant organizations and their interrelationships, professional roles, legal and regulatory issues, and payment systems. It also addresses health reform initiatives in the U.S.
Component Objectives:
At the completion of this component, the student will be able to:
- Define key terms in health care and public health.
- Describe components of health care delivery and health care systems.
- Discuss examples of improvements in public health.
- Define core values and paradigm shifts in U.S. health care.
- Describe the technology used in the delivery and administration of health care.
- Describe the organization of healthcare at the federal, state, and local levels.
- Describe the organization of the VA system and Military Health System.
- Describe the structure and function of hospital clinical and administrative units.
- Describe different types of long-term care facilities, with an emphasis on their function.
- Describe the organization of clinical health care delivery in the outpatient setting and the organization of outpatient health care.
- Describe the organization of ancillary health care delivery in the outpatient setting.
- Compare the role of different health care providers, with an emphasis on the delivery of care in an interdisciplinary setting.
- Describe the history and role of the health insurance industry in financing health care in the United States, and the federal laws that have influenced the development of the industry.
- Explain the importance of the health care industry in the U.S. economy and the role of financial management in health care.
- Describe models of health care financing in the U.S. and in selected other countries.
- Explain the differences among various types of private health insurance and describe the organization and structure of network-based managed care health insurance programs.
- Describe the various roles played by government as policy maker, payor, provider, and regulator of health care.
- Describe the organization and function of Medicare and Medicaid.
- Describe the revenue cycle and the billing process undertaken by different health care enterprises.
- Explain the billing and coding processes, and standard code sets used in the claims process.
- Identify different fee-for-service and episode-of-care reimbursement methodologies used by insurers and health care organizations in the claims process.
- Review factors responsible for escalating health care expenditures in the U.S.
- Discuss methods of controlling rising medical costs.
- Describe the role of accreditation, regulatory bodies, and professional associations in health care in the U.S.
- Describe the basic concepts of law in the U.S.: the legal system, sources of law, classification of laws, the court system, and the trial process.
- Describe legal aspects of medicine involving the Affordable Care Act, professional standards in health care, medical malpractice, tort reform, and Medicare and Medicaid fraud and abuse.
- Describe key components of the Health Insurance Portability and Accountability Act (HIPAA) and efforts to promote patient safety in the U.S.
- Discuss the need for quality clinical documentation for the use of the health record as a legal document, communication tool, and a key to prove compliance for health care organizations.
- Discuss the main similarities and differences between public and private health.
- Describe the historic timeline and achievements of public health in the U.S.
- Define and discuss key terminology of public health.
- Illustrate the general organization of public health agencies and public health data flow.
- Evaluate and explain the effect and value of public health.
- Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health.
- Discuss the activities and achievements of public health in the realm of communicable disease.
- Compare and contrast the different types of terrorism and the different public health responses.
- Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards.
- Describe the application of evidence-based medicine and clinical practice guidelines
- Discuss quality indicators in medicine.
- Describe the patient-centered medical home and other models of care coordination.
- Define meaningful use (MU) of health information technology in the context of the Health Information Technology for Economic and Clinical Health (HITECH) act.
- Describe the major goals of meaningful use.
- Discuss the criteria for Stages 1-3 of meaningful use for eligible professionals, eligible hospitals, and critical access hospitals.
- Describe the standards specified for MU.
- Discuss the likely evolution of the MU program
Component Authors
Component Originally Developed and Updated by:
Assigned Institution:
Oregon Health & Science University (OHSU)
Team Lead:
William Hersh, MD, OHSU
Primary Contributing Authors:
William Hersh, MD, OHSU
Karen Eden, PhD, OHSU
Lecture Narration:
Voiceover Talent
Kim Handysides
Digital One, Portland, OR, http://digone.com/
Team Members:
Karen B. Eden, PhD, Professor, Department of Medical Informatics and Clinical Epidemiology, OHSU
Kate Fultz Hollis, MS, MBI, OHSU
William Hersh, MD, Principal Investigator, Department Chair, Medical Informatics & Clinical Epidemiology, OHSU
Krystal A. Klein, PhD, MBI, OHSU
Kerri F. Nussbaum, MS, Project Manager/Instructional Design/Development, OHSU
Dana Womack, MS, RN, OHSU
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