Aims for 21st Century HCS
What are the 3 things the report looked at?
- Low average age before death (60 years old)
- Infant mortality
- Mortality due to medical care
What drove healthcare during the Agricultural Era
Who provided healthcare during colonial times?
Family, firends, clergy
During colonial times was there a clear distinction between medicine and pharmacy?
During what era did more products become available for treamtment?
During what era was there an explosion in delvery of healthcare and what is available
What happened in 1956?
Clerical and managerial jobs overcame blue collar jobs.
What are the 3 major economic eras in the US?
- Agricultural (Late 18th - Early 19th)
- Industrial (Late 19th - Early 20th)
- Information (1956 - Present)
How was reimbursement handled during the Agricultural Era?
Fee for service: cash or "in kind"
What year was the first medical school?
What year was the first US Pharmacopeia?
What year was the first college of pharmacy?
Philadelphia College of Apothecaries
When did the Germ Theory of Disease start to become accepted?
Agricultural Era (Late 1800's)
Shift toward scientific based medicine (not leeches)
When did hospitals start transforming from charitable institutions to showcases of modern technology?
Agricultural Era (Late 1800's)
When was there a large scale manufacture of patent medicines?
What is Pharmacopeia?
Pharmacopeia is a deliniation for the preparation of medicines.
What were patent medicines?
marketed as cures. Primary ingredient was alcohol. Also had narcotics: cocaine, morphine, etc)
Why was regulation of patent medicines needed?
The ingredients caused addiction and death. So by 1920's regulation was needed.
When did we start seeing the government become involved as a regulator?
In the 1920's we started seeing the government become involved as a regulator.
What was the Pure Food and Drug Act of 1906?
Government involvement started with the Pure Food and Drug Act of 1906. It addressed misbranding. What was on the label, it had to label the active ingredients accurately. It did not address whether the product was safe or effective.
Why was the Food, Drug and Cosmetic Act (1938) significant?
It created the FDA. Put under govt control the safety of drugs in the market. Required drugs to be pre-approved by the govt before going to market in the US. It still had no distinction between prescription and non prescription drugs so anyone could prescribe.
Name the other goverment involvement agencies of the 1900's - 1940's
- Public Health Service (1912)
- Children's Bureau (1912)
- Sheppard-Towner Maternity & Infancy Act (1921)
- National Institute of Health was for medical research (1930)
When did the first insurance plans come out?
1929, Baylor University - plan for public school teachers, then Blue Cross
What is the significance of health care plans?
if you have health insurance you have greater access to healthcare.
What are the 2 major health reports of the early 1900's?
Flexner Report (1910)
Charters Report (1927)
They defined professionalism of the medical and pharmacy professions
What was the Flexner Report?
Revealed deficiencies in medical training and called for reform in the way of medical education being placed with Universities, accreditation under the AMA, closing of weaker schools, eliminated apprentice programs.
It was the start of the Golden Age of medicine
What was the Charters Report?
It studied the needs of profession/curriculum, defined pharmacy as a profession, adopted a 4 year BS degree(1928)
When was the Era of Expansion?
When was the Era of Cost Containment
When was the Era of Assessment & Accountability?
1990's - Present
What was the Era of Expansion known for?
Significant growth in # of facilities, insurance, utilization of services (due to available funding)
What were the 2 major legislations of the Era of Expansion?
- Hospital Service and Construction Act (Hill-Burton, 1946) - construction of hospitals in underserved area (Jackson Hospital in Miami)
- 1935 Social Security Act - Established Medicare/Medicaid (1965) that provided service to underserved.
Most legislation during the Era of Expansion (1940's - 1960's) were amendments to what?
FDC Act of 1938
What was the Durham-Humphrey Amendment (1951)?
Creation of legend drugs (required physiscian authorization to dispense)
What was the Drug Amendment (Kefauver-Harris) of 1962?
- Proof of efficacy and safety
- Acurate advertising
- Adverse Drug Reactions (ADR) reported to FDA
- Can no longer market generics as a new costly drug under a different brand name
- Human studies required informed consent
What did the 1965 Drug Abuse Control Amendments
controlled substances and eventually creation of Drug Enforcement Agency
In what era did we In this era we see streamlining in manufacturing and marketing?
Era of Expansion (1940-1970)
What happened to HC expenditures in the 1970's (Cost Containment Era)?
Exponential increase in expenditures due to new expensive medications and technology and specialization of professions.
What did health insurace coverage encourage during the 1970's (Cost Containment Era)?
Overuse of HC services (due to cost per fee structure)
What were some measures to control costs?
- Voluntary hospital planning
- Wage and price freezing
- Development of cost effective HC delivery systems (HMO Act 1973)
- Changes in reimbursement for services and implementation of Medicare DRGs (1983) (payment amounts for different treatments)
- Utilization review
When cost control methods of the 1970's did not work, what did they look at?
They started looking at outcome data to determine the value of medical care interventions for people.
What were the major outcomes of the Era of Assessment & Accountability (1990-Present)
Health care outcome data essential to determine value of medical care
- Standardization of care
- Comparative effectiveness research
- Evaluation of medical errors
- Evaluation of population outcomes & disparities
- Reimbursement based on outcomes
In the Colonial Era up to the early 20th Century what were Americans mainly affected by?
Infectious diseases (malaria, dysentery, respiratory infections)