Assigment 1 - Management
Read Carefully the Power Point Presentations for Chapter 1 & 2 . Answer the questions attached. Evaluation available until Sunday, 09/05/2021 at 11:00 pm.
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Chapter 1
Understanding Health Systems:
The Organization of
Health Care in the United States
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2
Reference Table 1.1
The Development of Health Care
• 1850-1900:
– Epidemics of acute infections due to unsanitary
living conditions.
• 1900-1941:
– Development of scientific medicine and the
beginning of governmental and societal
intervention.
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Reference Table 1.1
The Development of Health Care
• 1941-1980:
– Shift from acute illnesses to chronic illnesses
• Classic model of illness
– Development of health insurance, and the
explosion of medical technology.
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Reference Table 1.1
The Development of Health Care
• 1980-present:
– Chronic diseases now include illnesses related
to environmental hazards and working
conditions, a rapid growth in costs due to
technology, and an increase in governmental
influence.
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Social Organization
• 1850-1900:
– No formal structure.
• 1900-1941:
– The development of local hospitals and health
insurance plans.
• Mid 1960’s:
– Implementation of Medicare and Medicaid
insurance programs.
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Three Perspectives on
the American Health Care System
1. Public policy perspective
2. Management strategy perspective
3. Clinical/patient perspective
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Public Policy Perspective
• U.S. health care system is comprised of five
individual sub-systems:
1. Employment-related system
2. Poor and uninsured system
3. Veterans Administration system
4. Worker’s compensation system
5. Active duty military system
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The Employment System
• Covers approximately two-thirds to three-
quarters of the total American population.
• Finances one-third of health care
expenditures.
• Collection of private employers providing
health insurance in the private sector.
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The Poor and Uninsured System
• Local governments supported by taxes and
individual incomes are the sources of
financing.
• Services are provided by safety-net
providers and local hospitals in the public
sector.
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The Poor and Uninsured System
• Individuals who qualify for state Medicaid
programs may obtain care in the private
sector.
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The Veterans Administration System
• National system operated by the federal
government.
• Financed by federal tax revenues.
• Coverage is only available to military
veterans based on length of service or
service-connected disability.
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The Workers’ Compensation System
• Care is provided to individuals who suffer
from injuries or illnesses related to work
environments.
• Insurance benefits include direct financial
support for living expenses and health care.
• Both the employer and the employee share
the cost of the insurance.
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The Active Duty Military System
• Care is financed and provided entirely by
the military system for active-duty
members.
• Private insurance is provided to cover
dependents.
• Dependents may receive care from
hospitals and physicians in the private
sector or within the military system.
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Management
Strategy Perspective
• In the 1980s
– Employers began to demand that insurance
companies constrain the rising costs of health
insurance premiums.
• Employers began utilizing managed care
policies to reduce their costs.
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Management
Strategy Perspective
• This resulted in a major shift from a
“provider-controlled” health care system to
a “payer-controlled” system.
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The Clinical Perspective
• How patients obtain care
• Basic service components provided to the
patients
• Perceived quality of care and patient
satisfaction
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Table 1.2
The Basic Service Components
Health Promotion
Emergency Medical Services
Ambulatory Care for Simple/Limited Conditions
Ambulatory Care for Complex/Continuing Conditions
Inpatient Care for Single/Limited Inpatient Conditions
Inpatient Care for Complex/Multiple Inpatient Conditions
Long-term care (either in-home or institutional services)
Services for Social/Psychological Conditions (both inpatient and outpatient)
Rehabilitation services (both inpatient and ambulatory)
Dental Services
Pharmaceutical Services
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Table 1.3
Factors Affecting Utilization Rates
Consumer Provider System
Signs and symptoms Access mechanisms Contractual
arrangements
Beliefs Provider incentives Payment mechanisms
Insurance coverage Operational systems Legal considerations
Income and wealth Technology and
medical information
Networks and
providers
Information access and
knowledge
Referral arrangements
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Technology in the
United States Health Care System
Chapter 2
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Health Care Technology
“Technology is credited with the benefits of
American medicine as well as what ails it.
It is the hope for a long, productive life for
millions of people, a primary reason for the
spiraling costs of care, and the source of
many social and ethical dilemmas...”
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Figure 2.1 Classification of
Healthcare Technology by Industrial Group
• Pharmaceuticals
• Medical Devices
• Medical Equipment
• Medical Processes and Procedures
• Healthcare Information Technology
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Figure 2.3 Stages in
Development of Medical Technologies
1. Scientific background and development
of the idea for a product
2. Product development, approval, and
distribution
3. Diffusion, adoption, and utilization of the
product
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Stage 1
• Involves a broad array of basic science
discoveries that provide a fertile
environment from which useful products
may eventually emerge.
• National Institutes of Health (NIH) plays a
critical role in this stage by providing funds
to many organizations.
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Stage 2
• Product development
– Process of moving from basic research to
implementation
• Three questions are answered during this
phase
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Stage 2
Is there a need and a viable market for
this product?
Can an appropriate product be developed
that accomplishes what the basic science
research suggests it can?
Can the necessary tests and clinical trials
be carried out to win the regulatory
approval required for public sale and use
of the product?
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Stage 3
• Mixture of scientific promotion to technical
experts and general marketing to the
health care system.
• Availability of health insurance coverage
for new products is a major factor in the
eventual diffusion and use of new
technology.
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Policy Issues
1. Priorities determined by government may
take precedence over mandates set forth
by the scientific community.
2. The best way to evaluate returns from a
public investment in basic science
research.
3. Private sector benefits achieved as a
result of significant public investments in
basic science research.
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Food and Drug Administration
• FDA must approve all drugs and
pharmaceuticals, all medical devices, and
some medical equipment.
• Clinical trials conducted during Stage 2 are
central to FDA regulatory approval.
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Specific Methods for
Evaluating Medical Technologies
• Review by regulatory agencies
• Technology assessments used by health
insurance carriers
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Review by Regulatory Agencies
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Preclinical Testing
• Sponsor must evaluate the product’s
safety and biological activity through in
vitro and in vivo animal testing.
• Sponsor must:
– Develop pharmacologic profile of product’s
effects.
– Determine its acute toxicity in at least two
animal species.
– Conduct short-term toxicity studies.
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Phase I
• Typically involves less than 100 healthy
volunteers.
• Purpose
– Observe how the drug works in humans, to
determine general safety, and to see if there
are any unexpected side effects.
• Clinical effectiveness is not measured
during this phase.
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Phase II
• Typically involves 250+ subjects.
• Purpose
– Obtain a first reading about the potential
effectiveness of the drug and to determine
whether it is appropriate for the trial to
progress to the next phase.
• Phase II also provides additional
information on safety and side effects.
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Phase III
• Typically involves 1000+ subjects.
• Purpose
– Determine drug’s effectiveness and to see if
side effects will need to be considered.
• If the FDA is satisfied with the results, the
sponsor must submit an application to the
FDA for approval as a new drug (NDA).
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Phase IV
• Sponsor must continue to monitor patient
experiences with the new drug and report
any adverse events.
• Purpose
– Pick up on any previously unexpected adverse
reactions that may only appear with longer
term or widespread use of the medication.
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Drug Development Process
• Preclinical trials
– 6 years
• Clinical trials
– 7 years
• Final NDA approval
– 1-2 years
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Technology
Assessment by Insurance Carriers
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Request for
Technology Assessment
• Health insurance organizations will be
approached by developers and/or
clinicians.
• Insurance organization will then request a
formal assessment of the technology.
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Request for
Technology Assessment
• Request for assessment focuses on
effectiveness of the technology and usually
does not include any reference to cost or
price.
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Strengths of the
Technology Assessment Process
• Rigorous review of published scientific
evidence.
• No discussion of economic or financial
details.
• Carried out in an open public forum with all
background information and discussions
available to all interested parties.
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Differential Impacts of
Technology on Health Care
• Economic
• Clinical
• Organizational
• Industrial
• Patients and insurance beneficiaries
• Societal and governmental policy
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Economic Impact
• Technology significantly contributes to the
rise of health care costs.
• Short-term analyses may show that the
use of new technologies significantly
increase short-term expenditures.
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Economic Impact
• Long-term cost effectiveness analyses
may show a much more positive impact on
health status thereby reducing total health
care costs over a lifetime.
• Cost-elevating technologies versus cost-
reducing technologies.
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Clinical Impact
• Development of new technologies has
vastly improved what physicians can do for
their patients and the outcomes that can be
achieved.
• Physicians are now faced with the
increased need to follow expert clinical
standards and guidelines in practice.
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Clinical Impact
• Physicians are faced with competitive
pressure to be seen by their peers and
patients as up-to-date on the latest
technologies and pharmaceuticals.
• Physicians may exert pressure on
hospitals and medical groups to acquire
the latest technologies.
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Organization Impact
• Health care organizations are continuously
pressured to maintain the latest
technologies.
• Hospitals and clinics are also faced with a
growing array of regulatory, compliance,
and legal issues.
– Many of these pressures can only be met by
an increased use of newer technologies.
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Industrial Impact
• Technology has given rise to new industrial
organizations and has expanded the range
of many existing companies.
• The increasing complexity and expansion
of the health care system has enabled
niche organizations to serve specialized
needs.
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Industrial Impact
• IT organizations have expanded to
accommodate an increased demand for
accessible health information.
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Impact on Individual
Patients and Insurance Beneficiaries
• Individuals are more directly informed
about their illnesses and the treatments
available to mitigate them.
• Insurance carriers are able to reduce
overutilization and improve the quality of
their care by educating their beneficiaries
via the Internet.
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Societal and
Governmental Policy Impact
• Both the increase in the number of
uninsured individuals and the possibility of
reduced access to the latest technology
have raised significant questions regarding
social equity and fairness.
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Societal and
Governmental Policy Impact
• Federal government prohibition against the
importation of drugs from countries with
lower prices versus the willingness of state
and local governments to encourage such
purchases.
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Societal and Governmental
Policy Impact: FDA Issues
• Time it takes the FDA to approve
pharmaceuticals, medical devices, and
other treatments
• FDA process may not always uncover
long-term hazards to health.
Florida National University
HAS 3111 Introduction to Health Service Administration
Assignment 1
Read Carefully the Power Point Presentations and answer the following questions
Chapter 1:
1. Summary the Development of Health Care from 1850-Present
2. Name the Three Perspectives on the American Health Care System
3. Name the five individual sub-systems in the U.S. health care system
4. Explain the Employment-related system
5. Explain the Poor and uninsured system
6. Explain the Veterans Administration system
7. Explain the Worker’s compensation system
8. Explain the Active duty military system
9. Explain the Management Strategy Perspective
10. Explain the Clinical Perspective
Chapter 2: Technology in the United States Health Care System
1. Classify the Healthcare Technology by Industrial Group
2. Name the three Stages in Development of Medical Technologies
3. Explain the role of the Food and Drug Administration
4. Explain the Preclinical Testing
5. Explain Phase I through IV and their purpose
6. Drug Development Process
7. Explain briefly the request for Technology Assessment
8. Name the differential Impacts of Technology on Health Care
9. Explain the Impact on Individual Patients and Insurance Beneficiaries
10. Explain the Societal and Governmental Policy Impact
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