Chapter 1
Introduction: The Big Picture
Chapter Outline
Learning Objectives ........................................................................................................................ 1
Key Terms....................................................................................................................................... 1
What Is Health and Health Care?.................................................................................................... 1
The “Iron Triangle” of Health Care ................................................................................................ 3
Types of Health Care Services........................................................................................................ 4
Types of Care.................................................................................................................................. 4
Types of Medicine .......................................................................................................................... 7
Traditional or Conventional Medicine......................................................................................... 7
Complementary and Alternative Medicine (CAM) ..................................................................... 8
Major Stakeholders in the U.S. Health Care System ...................................................................... 9
Illness and Disease, the Sick Role .................................................................................................. 9
Medicalization of Social Problems ............................................................................................... 10
Vignette: Anna lives with her boyfriend of 9 months................................................................... 10
Your Opinion Matters: Should the Health Care System Be Responsible for Treating Social
Problems?...................................................................................................................................... 12
Yes ............................................................................................................................................. 12
No............................................................................................................................................... 13
Principal Problems in the U.S. Health Care System..................................................................... 14
The Culture War—Polarization of the Nation .............................................................................. 16
Your Opinion Matters: Should We Have a Right to Health Care in the United States? .............. 19
Yes ............................................................................................................................................. 20
No............................................................................................................................................... 20
Environmental Change and Restructuring .................................................................................... 21
Public Image of Health Care Entities......................................................................................... 22
The Authors’ Intentions ............................................................................................................. 23
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 1
,Summary ....................................................................................................................................... 24
Review Questions ......................................................................................................................... 25
Additional Resources .................................................................................................................... 25
References..................................................................................................................................... 26
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 2
,Learning Objectives
• Describe an overview of the U.S. health care system, including the relationships among
quality, cost, and access; stakeholders; and types of health care services.
• Discuss key medical care and health care designations and definitions.
• Identify and discuss the principle problems in the U.S. health care system.
• Describe the major forces that have shaped the delivery of health care services, and cite
examples of each.
Overview of Your Opinion Matters
Your Opinion Matters: Should the Health Care System Be Responsible
for Treating Social Problems?
Yes
• Health includes social and psychological health as well as physical health.
• If child abuse is suspected, health care providers are required to notify authorities.
• It is in the patients’ and public’s interest to prevent abuse and crimes when possible.
• All patients must provide informed consent for treatment.
• By law, health care providers have to provide translators for those who do not speak
English and informed consent forms written in other languages.
• To treat the whole person, providers have to be prepared to address patients’ entire needs:
medical, social, psychological, and spiritual.
No
• The U.S. health care system is truly a medical care, or illness-driven, system.
• Doctors are not trained to deal with a host of social issues.
• Social services exist and should be used in conjunction with the health care system.
• For translation and literacy issues, patients should bring someone to translate.
• Placing translation burden on providers drives up costs, resulting in higher premiums and
taxes.
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 3
, Instructor Talking Points
1. What role should the health care system play in addressing social issues?
• YOM addresses the “medicalization” of social issues and the role the health care
system should or should not play in addressing them. Students should appreciate that
there is always a cost for placing a medical label on a social issue. Costs may include
shifting resources that are dedicated to treatment and rehabilitation to “heal” the
person who is “sick.”
• However, there are real societal issues that place patients in danger, such as child
abuse, child endangerment, eating disorders, drug and alcohol abuse, and prescription
drug misuse. Many of these conditions have a social component, but place the health
of patients in substantial danger.
2. Can the health care system effectively engage in the holistic assessment and
treatment of patients to address such issues as lack of employment, domestic abuse,
and spiritual needs?
• Emphasize tension between the high cost and the appropriateness of dedicating
resources to holistic assessment and treatment of patients to address a litany of
contributing factors such as lack of employment, domestic abuse, and spiritual needs.
• Students should appreciate that many societal issues, such as unemployment and
underemployment, may be root causes of lack of health insurance. Lack of insurance
and usual source of care may lead to poorer health status for patients and society as a
whole.
• However, it is not the responsibility of the health care system to treat employment
status and unmet spiritual needs.
3. Where does the health care system draw the line between treating a condition or
episode of care and dedicating resources to address other societal issues?
• Societal issues may include poverty, child abuse, alcoholism, illiteracy, and domestic
abuse.
• The U.S. health care system focuses on curative treatments and interventions because
the reimbursement structure focuses on payment for the delivery of tests and
procedures.
• These other societal issues, such as poverty, child abuse, and illiteracy, require much
broader societal initiatives and strategies to combat.
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 4
Introduction: The Big Picture
Chapter Outline
Learning Objectives ........................................................................................................................ 1
Key Terms....................................................................................................................................... 1
What Is Health and Health Care?.................................................................................................... 1
The “Iron Triangle” of Health Care ................................................................................................ 3
Types of Health Care Services........................................................................................................ 4
Types of Care.................................................................................................................................. 4
Types of Medicine .......................................................................................................................... 7
Traditional or Conventional Medicine......................................................................................... 7
Complementary and Alternative Medicine (CAM) ..................................................................... 8
Major Stakeholders in the U.S. Health Care System ...................................................................... 9
Illness and Disease, the Sick Role .................................................................................................. 9
Medicalization of Social Problems ............................................................................................... 10
Vignette: Anna lives with her boyfriend of 9 months................................................................... 10
Your Opinion Matters: Should the Health Care System Be Responsible for Treating Social
Problems?...................................................................................................................................... 12
Yes ............................................................................................................................................. 12
No............................................................................................................................................... 13
Principal Problems in the U.S. Health Care System..................................................................... 14
The Culture War—Polarization of the Nation .............................................................................. 16
Your Opinion Matters: Should We Have a Right to Health Care in the United States? .............. 19
Yes ............................................................................................................................................. 20
No............................................................................................................................................... 20
Environmental Change and Restructuring .................................................................................... 21
Public Image of Health Care Entities......................................................................................... 22
The Authors’ Intentions ............................................................................................................. 23
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 1
,Summary ....................................................................................................................................... 24
Review Questions ......................................................................................................................... 25
Additional Resources .................................................................................................................... 25
References..................................................................................................................................... 26
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 2
,Learning Objectives
• Describe an overview of the U.S. health care system, including the relationships among
quality, cost, and access; stakeholders; and types of health care services.
• Discuss key medical care and health care designations and definitions.
• Identify and discuss the principle problems in the U.S. health care system.
• Describe the major forces that have shaped the delivery of health care services, and cite
examples of each.
Overview of Your Opinion Matters
Your Opinion Matters: Should the Health Care System Be Responsible
for Treating Social Problems?
Yes
• Health includes social and psychological health as well as physical health.
• If child abuse is suspected, health care providers are required to notify authorities.
• It is in the patients’ and public’s interest to prevent abuse and crimes when possible.
• All patients must provide informed consent for treatment.
• By law, health care providers have to provide translators for those who do not speak
English and informed consent forms written in other languages.
• To treat the whole person, providers have to be prepared to address patients’ entire needs:
medical, social, psychological, and spiritual.
No
• The U.S. health care system is truly a medical care, or illness-driven, system.
• Doctors are not trained to deal with a host of social issues.
• Social services exist and should be used in conjunction with the health care system.
• For translation and literacy issues, patients should bring someone to translate.
• Placing translation burden on providers drives up costs, resulting in higher premiums and
taxes.
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 3
, Instructor Talking Points
1. What role should the health care system play in addressing social issues?
• YOM addresses the “medicalization” of social issues and the role the health care
system should or should not play in addressing them. Students should appreciate that
there is always a cost for placing a medical label on a social issue. Costs may include
shifting resources that are dedicated to treatment and rehabilitation to “heal” the
person who is “sick.”
• However, there are real societal issues that place patients in danger, such as child
abuse, child endangerment, eating disorders, drug and alcohol abuse, and prescription
drug misuse. Many of these conditions have a social component, but place the health
of patients in substantial danger.
2. Can the health care system effectively engage in the holistic assessment and
treatment of patients to address such issues as lack of employment, domestic abuse,
and spiritual needs?
• Emphasize tension between the high cost and the appropriateness of dedicating
resources to holistic assessment and treatment of patients to address a litany of
contributing factors such as lack of employment, domestic abuse, and spiritual needs.
• Students should appreciate that many societal issues, such as unemployment and
underemployment, may be root causes of lack of health insurance. Lack of insurance
and usual source of care may lead to poorer health status for patients and society as a
whole.
• However, it is not the responsibility of the health care system to treat employment
status and unmet spiritual needs.
3. Where does the health care system draw the line between treating a condition or
episode of care and dedicating resources to address other societal issues?
• Societal issues may include poverty, child abuse, alcoholism, illiteracy, and domestic
abuse.
• The U.S. health care system focuses on curative treatments and interventions because
the reimbursement structure focuses on payment for the delivery of tests and
procedures.
• These other societal issues, such as poverty, child abuse, and illiteracy, require much
broader societal initiatives and strategies to combat.
© 2013 Cengage Learning. All rights reserved. No distribution allowed without express authorization.
Fundamentals of U.S. Health Care Chapter 1 Page 4
