CMN 260 UIUC Test 1 2023

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Health

Health

"State of complete physical, mental, and social well-being; not merely the absence of disease" (World Health Organization, 1948) Not simply the opposite of being sick, broader than that

Communication

"The process of understanding and sharing meaning" (Pearson and Nelson, 1991) Previous experiences shape later experiences, involves personal goals, is interdependent (mutual influence), shared meaning

Health Communication

The way we seek, process, and share health information." (Kreps and Thorton, 1992)

Importance of health communication

*Communication is crucial to the success of healthcare encounters

*Communication helps healthcare organizations operate effectively

*Communication is an important confidence and coping ability

*Wise use of mass media can help people learn about health and minimize the influence of unhealthy an unrealistic media portrayal

*Effective communication saves time and money

*The health industry is rich with career opportunities

Biomedical Model

Health is a physical phenomenon that can be explained, identified, and treated through physical means Communication: talk is centered around physical symptoms, providers dominate conversations, patients have little input Efficient, definitive CON: makes patient feel process is "mechanic" instead of sensitive to their emotions

Biopsychosicial Model

Health seen not solely a physical phenomenon, but as a combination of feelings, ideas, and experiences Accounts for: physical conditions(biology), thoughts and beliefs(psychological), and social expectations and experiences Communication: more thorough, can address patients' personal concerns CONS: time consuming and difficult

Sociocultural Model

Health seen as complex array of factors involving personal choice, social dynamics, and culture Accounts for: social variables/barriers (prejudice, access to health services), culture Communication: also more thorough than biomedical, addresses patient's environment CONS: time consuming and difficult

Pooled risk

the transfer of risks between high and low risk groups

premiums

monthly payments

deductibles

you pay 100% of care until certain point, protects against moral hazard

upper limit (out of pocket maximum)

maximum amount to pay for care; beyond this, insurance pays 100%, prevents patients from going broke if they have extreme medical bills

copay

participate in paying for care (20%), protects against moral hazard(excess use of care)

exclusions

some conditions not included (infertility car, cosmetic surgery), helps insurance company control costs

free for service system

• doctors/hospitals paid for each service provided

• Traditional insurance; PPO; POS; HDHP

• Compensation for how much is spent on patient, not the quality of procedures and meds

capitated system

• doctors/hospitals paid a set amount per patient

• HMO; POS

• Seemed to make teams be more collaborative and proactive

primary reason for managed care efforts

To control rising health care costs

ways health care is "managed" under managed care

• Limit access to providers

• Require patients to assist in paying for care

• Limit coverage of certain procedures

• ADVANTAGES: cheaper premiums, access to large patient networks, saves insurance companies money since patients have to pay for some themselves, they will use less resources

HMO (health maintenance organization)

• Hires medical providers; you must go to these providers

• Will only pay for providers that they hire

POS (point of service)

• Combination of HMO and PPO

• Only difference from PPO is you need referrals to see specialist

PPO (preferred provider organization)

• Contracts with "preferred" providers

• Coverage is less "outside" network

• As long as you are "in" network, they will cover it

• If you go to "outside" provider, you would have to pay more

• Don't have to go to primary doctor first (don't need referrals)

HDHP (high deductible health plan)

• Catastrophic health plan for when you get REALLY sick

• No premiums

• Really high deductible (out-of-pocket)

• If you have dangerous job and can't afford premiums

medicare

government run insurance program for people 65 or older

medicaid

Social welfare program (not insurance), assisted to those with limited income/resources (65 and older)

medicaid qualifications

• No billing, no deductibles, no copayments, generally small out of pocket costs

• 65 and older

• Children under 19

• Women who are pregnant

• A parent or adult caring for a child

• Individuals with disabilities

• Low income adults with children (ACA) o Eligible immigrants

benefits of medicaid

• Doctor visits

• Hospital stays

• Long-term services and supports (institutional care)

• Preventative care (immunization, mammograms, colonscopies

• Prenatal and maternity care

• Mental health care

• Necessary medication

• Vison and dental care (for children)

part A

• Hospital insurance (inpatient care)

• Short-term care in skilled nursing facilities

• Hospice care

• Home health care

Part B

• Medical insurance (outpatient care)

• Services from doctors and other health care providers

• Home health services not covered under part A

• Diagnostic tests, medical equipment, ambulance services, limited preventative services, and (some) outpatient prescription drugs

Part C

Medicare Advantage (MA), coverage through a traditional private health insurance plan

Part D

Prescription drug plan o Problem: creates donut hole Big gap that elders don't get coverage once cap is met

single-payer

one insurer in place for country

multi-payer

competing insurers in country that people choose from

universal coverage

System that provides health care and financial protection to all citizens of particular country

problems with claiming Americans don't want reform because it's "socialized medicine"

• Associated with communism

• Problem 1: most systems are not "socialized." Many countries provide private doctors, insurance companies, etc. Some countries have smaller government roles than the US

• Problem 2: in practice, Americans like government-run medicine Department of Veteran Affairs* Medicare (covers 44 million people

5 guidelines of national health insurance model

• Public administration

• Comprehensive (cover medically necessary treatments)

• Everyone has equal access to treatment

• Patients can get help anywhere in Canada for treatment

• Everyone gets charged same fee regardless of age or illness

US Health Model of Health Care

• All of them

• Working people under 65 use Bismarck

• Native Americans, military personnel, and veterans use Beveridge

• Over 65 with low income use National Health Insurance Model

• The uninsured use Out of Pocket

individual mandate

o Require most US citizens and legal residents to have health insurance: to expand care

basic approach of ACA

Expand Care

changes ACA made to US system

• Uninsured may sign up through healthcare marketplaces

• Medicaid expansion o Young people can stay on their plans

• Regulates current industry

current status of ACA

o Proposals to repeal and replace ACA American Health Care Act (2017, AKA: Trumpcare)

Ancient Egypt

• Knowledge about circulatory system begins

• Imhotep: first known physician, attained godlike status after his death, knowledge of the circulatory system and the body's organs before Western world Religio-empirical approach:

  • Combines spiritualism and physical study

  • Healers were holy men like Imhotep

Imhotep

first known physician, attained godlike status after his death, knowledge of the circulatory system and the body's organs before Western world

Religio-empirical approach

• Combines spiritualism and physical study

• Healers were holy men like Imhotep

Ancient Greece

• Rational/empirical approach: Disease is best understood by careful observation and logical analysis

• Hippocrates: founder of scientific medicine and medical ethics, influenced by writings of ancient Egyptians

• Contributions:

  • Humoral Theory of Illness

  • Hippocratic Oath

  • 4 Forces: Blood, yellow bile, black bile, phlegm

Hippocrates

• founder of scientific medicine and medical ethics, influenced by writings of ancient Egyptians

• Contributions: Humoral Theory of Illness, Hippocratic Oath, 4 Forces: Blood, yellow bile, black bile, phlegm

Rational/empirical approach

Disease is best understood by careful observation and logical analysis

Middle Ages

• Emphasis put back on faith Catholic church banned secular medicine

• The roles of magic, good, and evil were thrust back into medicine

• Plagues kill millions in Europe

• Monks and Barber Surgeons Monks' increasing "scientific" practices led to banishment as healers

Renaissance

• Cartesian Dualism: Separation between mind/soul and body

• The difference between illness and disease emerges. This separated medicine into two branches

  • Today: physicians (body) and psychologists (mind)

• Explanations of disease built and improved upon the Greek ideas

• Principle of verification: Do not believe it if you cannot prove it.

  • will not tell you you are sick unless they can prove it

  • Look to verifiable signs of illness (biomedical approach)

cartesian dualism

• The separation between mind/soul and body

• Difference between illness and disease emerges

• This separated medicine into two branches

  • Today: physicians (body) and psychologists (mind)

The New Western World (17th and 18th centuries)

• Health care mainly home efforts and remedies (folk therapies)

• Some physical treatments, but mostly folk medicine Seen and kinder, gentler, less cruel than alternatives (i.e. Hippocratic bloodletting and purging)

Orthodox Medicine (late 1800s- early 1900s

• "Ordinary" medical practices, more modern/realistic view

• Urban centers created new health demands

• More scientific practices

• Shift from folk medicine to orthodox practitioners (trained in medical schools)

• Flexner Report

• Germ Theory Joseph Lister: "Father of modern surgery"

Germ theory

Louis Pasteur: proved germs were a thing and causes illness

Flexner Report

led to 2/3 of schools closing in the US

20th/21st century

1950s- techniques invented due to was injuries

1960s- medicare and medicaid, private insurance became widespread

1970s- US begins to lag in health care status, led to questions regarding access, cost, effectiveness

1980s- third-party players take larger role, employers take more active role in managing plans

1990s- growing awareness of connection between health and lifestyle

2000- Today: growing health disparities and number of uninsured, free market, new technologies, increased specialization for providers

Longevity Perspective

• Health is equal to living as long as possible

• Progress in medicine has led to longer life expectancy

  • 1900: males (46.3) females (48.3)

  • 2011: males (75.9) females (80.9)

• Being able to see inside the body, run tests, have scans, etc. gives us vast amount of information that can extend life

• Shift from acute illness to chronic illness, and understanding that chronic illness even really exists

• One dose of medicine isn’t going to fix it, you need constant medical intervention

Economic Perspective

• Health as the optimal expected length of time to live

• Not necessarily equal to life span

• Balance between extra year and resources required for that year

• Quantity of years vs quality of life

• Focus on your function in society and less on your happiness or quality of life

Human Rights Perspective

• Health is inherently a human right

• Everyone should have access to the resources that keep us healthy without bankrupting them or destroying them

• Individuals must have access to care to fight disease

  •   Universal coverage/healthcare, obviously big issue in the US right now

• If everyone has access to those resources and can stay safe less people will be sick anyways, we herd immunize the population

Barriers to adequate healthcare include:

• Health insurance

• Culturally sensitive care

• General access to health information

• Where you live + how much money you make -> predicts how long you’ll live

  • Direct correlation