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Course Learning Outcomes for Unit VIII Upon completion of this unit, students should be able to:

1. Assess current public health developments in the community.

2. Analyze key public health concepts and principles.

3. Discuss the different public health disciplines’ impact on population health.

4. Explain the role of government regarding public health practice and policy.

5. Evaluate the impact of social determinants of health on population health. 5.1 Identify ways to reduce medical costs in your community.

Course/Unit Learning Outcomes

Learning Activity

1 Unit VIII Reflection Paper

2 Unit VIII Reflection Paper

3 Unit VIII Reflection Paper


Unit Lesson Chapter 26: Is the Medical Care System a Public Health Issue? Unit VIII Reflection Paper


Unit Lesson Chapter 27: Why the U.S. Medical System Needs Reform Unit VIII Reflection Paper

Reading Assignment Chapter 26: Is the Medical Care System a Public Health Issue? Chapter 27: Why the U.S. Medical System Needs Reform

Unit Lesson Balancing Public Health and the Medical System Medicine is a crucial part of public health in that individuals are taken care of as opposed to the community in general. For example, public health officials could educate the community about immunizations and wellness exams to avoid chronic diseases, but it is up to the individual to use that education and visit his or her physician. Medical care is expensive, and the costs have risen over time in the United States. More money is spent every year on medical bills than public health preventive measures. There is always the debate of who is superior in the health sector—medical care or public health measures (Schneider, 2017). The government, in this situation, makes it a point of duty to set boundaries, discipline unethical behavior, and establish standards. While public health is important, the government needs to safeguard individuals’ privacy as well as religious and personal beliefs while healthcare providers are providing good care for their patients without being biased or providing improper diagnoses.


The Healthcare System

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Certain types of medical care are necessary for the community’s overall health, including the prevention and treatment of infectious diseases. Public health officials try to contain certain infectious diseases by providing immunization programs and free medical treatments or testing for those without insurance. Another way public health officials try to be responsible for medical care is through emergency services. In the late 1960s, the federal government encouraged communities to provide emergency care through the assistance of public health officials, particularly in the wake of the Highway Safety Act of 1966 where it was necessary to get immediate care (Schneider, 2017). Part of the emergency care was the creation of 911 services, dispatch ambulances, and trained emergency personnel. In addition, state and federal laws require that everyone should be treated and stabilized in the emergency room before payment is requested. After the patient is stabilized, any uninsured or poor patient is then transferred to a charity or public hospital. Paying for Medical Costs Employers usually provide health insurance in the United States, which covers the employee and his or her family. This has assisted many families for decades, as they do need to worry about major medical bills. Another way people have been covered is through their car insurance. In the case of an accident, patients pay their deductibles, and the car insurance takes care of the rest. If the person not at fault in the accident goes to the hospital, the insurance of the person at fault takes care of his or her medical bills. Health insurance is extremely important because patients usually pay deductibles at the beginning of the year and also have copayments when they go to the hospital as opposed to paying large sums of money if they are without insurance. Community health centers are also good places to pay for care, especially for the poor and uninsured because the copayment is decided by annual income and the family size. The United States hosts over 1000 community health centers, and many of them are located in rural areas to serve local communities (Schneider, 2017). These community health centers are also used by public health officials to educate communities on certain problems in their communities and how to tackle them. School children have been major carriers of communicable diseases, so communities began to employ nurses and doctors to examine potentially sick children and send them home before their diseases spread. In December 2017, about 150 students were exposed to tuberculosis at Hanks High School in the Ysleta Independent School District in El Paso, Texas (Martinez, 2017). This came as a result of one of the students who tested positive for the disease. The problem with immunization is that many people do not vaccinate their children for personal and religious reasons. As you may remember from an earlier unit, in Orange County, California, there was a measles outbreak in Disneyland, which was not strange considering that only 60% of children had been vaccinated in that county. As a result, the personal belief exemption was abolished in Orange County in 2015 (Schneider, 2017). In these situations, it becomes expensive to eradicate the spread of the disease due to those children without medical insurance and those who choose not to vaccinate. The United States has attempted several times to provide universal health insurance like in Canada, Hungary, Netherlands, and other industrial countries. The attempt that was closest to success was the Affordable Care Act or Obamacare of 2010. Medicare was initiated in 1965 for people over 65 years, and Medicaid is for the poor; both are expenses shared by the federal government and states (Schneider, 2017). In 1992, President

Health Care and Costs Balance (Sermulis, 2015)

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Bill Clinton also attempted to initiate a universal care system. While that was unsuccessful, he created a health program to serve all poor children called the Children's Health Insurance Program (CHIP). This was to serve people who may not qualify for Medicaid but do not make enough to afford private insurance. Ethical and Legal Issues in Providing Medical Care One of the major legal issues in the United States is abortion. The country is divided between when, why, and who might have an abortion and the right to life opinion that life begins at conception (Schneider, 2017). The present situation in the United States is characterized by high division and intense conflicts that is not as common in other industrialized countries (Beckman, 2017). A bitter battle between two opposing ideologies remains at the root of abortion politics in the United States. Those who are in support of abortion view it as a right that is necessary for social equality and justice for women, while those who oppose it see abortion as a threat to social cohesion, motherhood, spirituality, and morality (Beckman, 2017). Another legal issue that has caused controversy is the right to life when someone is faced with a terminal disease. The Right to Die or Death with Dignity laws are another social or religious controversy in the United States. The first one was passed in Oregon in 1994, followed by Washington in 2008, and others like Vermont in 2013, California in 2015, Colorado in 2016, and Hawaii in 2018 followed suit (CNN, 2014). While it still remains a controversy, several other states are thinking of enacting the right for patients to choose how and when they die when faced with a terminal disease. The right to end life has also been a problem with people who have suffered brain death or are on life support. While some families supported the fact that a life on life support is not a quality life, others argued that it was life as long as the person is breathing (Schneider, 2017). Some popular cases were those of Nancy Cruzan, Terri Schiavo, and Karen Ann Quinlan. Rising Costs of Health Care It is obvious the United States’ medical system needs reform, specifically with the issues in the Affordable Care Act, difficult access to Medicare, and quality of care for all (Schneider. 2017). Although health expenditure is high in the United States, more Americans are unhealthy. In 2011, the United States ranked 27th out of 30 industrialized countries in infant mortality rates, and life expectancy at 65 years was ranked at 25th out of 34 for woman and 20th out of 34 for men (Schneider, 2017). To top it off, access to medical care is difficult. For example, in 2013, over 13% of Americans did not have insurance for the entire year, while many more did not have health insurance for part of the year (Schneider, 2017). The access problem is related to the cost—high monthly premiums, deductibles, and copays. The United States has the highest number of uninsured people of any other industrialized country. Medicare and Medicaid are also hard to access with about 14% of the income of elderly people being used to pay out-of- pocket medical costs (Schneider, 2017). Some reasons for the high or rising healthcare costs are as follows.

 Aging population: More elderly people are on Medicare that is funded by states and the government.

 Lack of access to the latest technology: Despite continuous development of medical technology, it is sometimes not covered by insurance or has copays that are too expensive.

 Administrative costs: In 2013, 31% of the medical budget in the United States was used for administrative purposes (Schneider, 2017).

 Chronic disease: More people are being diagnosed with chronic diseases like type 2 diabetes,

cancer, and heart disease. While public health encourages preventive health measures, most Americans do not participate and have to deal with high bills that may never be paid after they are diagnosed with a chronic disease.

Controlling Medical Costs About 44% of medical care is paid by local, federal, and state departments and about 21% by private insurance (Schneider, 2017). Therefore, the local, state, and federal departments try to work with public health officials on how to reduce these costs by working on preventive education for their local communities.

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Another way of trying to reduce medical costs is limiting spending on new technology and facilities. Medical care spending rises steadily in the United States, causing a stir for health policy makers. Public health officials generally point to new medical technologies as the main driver for escalating expenditures (Sorenson, Drummond, & Bhuiyan Khan, 2013). Therefore, the government is constantly looking for ways to reduce that expense. This is particularly noticeable with new treatments for certain diseases like cancer. People are constantly going for less invasive surgeries; however, those surgeries are the most costly because of the technology involved. Employers try to keep costs down by bargaining with providers for discounted services. One of such discount services is a preferred provider organization (PPO); this is a health plan that allows for medical providers (doctors and hospitals) to create a network of participating providers. It allows for the patients under the plan to pay less to providers that are within that network (Schneider, 2017). One company that uses this plan is the University of Texas where members are able to get many health problems resolved with discounted prices. Conclusion The United States has the most expensive healthcare system in the world, which also has many flaws including uninsured people, difficult access, and expensive copays and deductibles. Even though the Affordable Care Act reduced the number of uninsured, it also created several problems for families including high deductibles and copays. While public health officials feel like rationing or controlling the cost of medical care, the quality of care for all is still a challenge.

References Beckman, L. J. (2017). Abortion in the United States: The continuing controversy. Feminism & Psychology,

27(1), 101-113. https://doi.org/10.1177/0959353516685345 CNN. (2014, November 26). Physician-assisted suicide fast facts. Retrieved from

https://www.cnn.com/2014/11/26/us/physician-assisted-suicide-fast-facts/index.html Martinez, J. (2017, December 7). About 150 Hanks High School students may have been exposed to

tuberculosis. Retrieved from http://kfoxtv.com/news/local/about-150-yisd-students-may-have-been- exposed-to-tuberculosis-health-officials-say-12-07-2017

Schneider, M.-J. (2017). Introduction to public health (5th ed.). Burlington, MA: Jones & Bartlett Learning. Sermulis, E. (2015). Health care and costs balance [Photograph]. Retrieved from

https://www.dreamstime.com Sorenson, C., Drummond, M., & Bhuiyan Khan, B. (2013). Medical technology as a key driver of rising health

expenditure: Disentangling the relationship. ClinicoEconomics and Outcomes Research, 2016(5), 223–234. https://doi.org/10.2147/CEOR.S39634