This is a sample of the instructor resources for Understanding the U.S. Health Services
System, Fourth Edition by Phoebe Lindsey Barton. This sample contains the instructor
notes and PowerPoint slides for Chapter 4.
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SECTION II
CHAPTER 4: ORGANIZATION OF THE U.S. HEALTH SERVICES
SYSTEM
CHAPTER 4: ORGANIZATION OF THE U.S. HEALTH SERVICES
SYSTEM
Purposes of This Chapter
The organization of a health system is one of the components of the Roemer
model. This chapter underscores the pluralism of the U.S. health services
system, namely its private, quasi-public, and public sections. Because the private
sector is the focus of Section VI, this chapter concentrates on the quasi-public
and public health sections. Public means that a governmental role is an essential
support to the services being provided; this chapter describes the local, state,
and federal roles involved in providing health services. Public health means the
health of a population rather than individual health.
Points for Inclusion in a Lecture/Discussion
1. The government’s role, whether at the local, state, or national level, is
central to a discussion of public health. Roemer’s model places a ministry
of health at the center of a public health system. In the United States, the
equivalent unit is the U.S. Department of Health and Human Services
(DHHS). Because the U.S. system is pluralistic, DHHS has a much less
central role than do ministries of health in European and other countries.
•
A review of all of the entities in DHHS (Exhibit 4.2) should help
students understand DHHS’s responsibilities. Students may be
familiar with some of these entities—for example, the Centers for
Disease Control and Prevention and the Food and Drug
Administration—but many may be unfamiliar with the major roles
and responsibilities of such units as the Centers for Medicare &
Medicaid Services.
•
The National Institutes of Health (NIH) (Exhibit 4.3) is the leader in
much of the biomedical and applied research done in the United
States. It does not engage in pharmaceutical research, except as a
byproduct of other clinical research, but it is instrumental in the
advancement of technology in healthcare. Students may be
particularly interested in one of the newest centers, the Center for
Complementary and Alternative Medicine, because it has begun to
legitimize some therapies once scorned by traditional providers.
•
The various roles of public health, defined in at least three iterations
(Exhibit 4.1), may be an interesting topic for discussion. For
example, in times of economic turmoil and reduced resources, does
agreement exist about the ten services listed as essential public
health services?
Complementary Points and Readings
Two Institute of Medicine reports are important to developing a fuller
understanding of the role of public health in the United States: The Future of
Public Health and Who Will Keep the Public Healthy? Educating Public Health
Professionals for the 21st Century. Full citations of these reports are included in
the textbook’s bibliography.
Class Discussion Questions and Key Answer Components
10. To what extent, if any, do you believe public health departments should
provide personal healthcare services? Why?
•
You may want to reword this question so that is doesn’t ask about beliefs.
A reasonable answer would be that population protection services, such
as immunizations or the tracking of sexually transmitted diseases, are
appropriate services to provide, but the private sector is unlikely to
approve the delivery of services that they would see as an incursion on
their territory, and public funding is not available for this kind of activity.
11. What are some of the major public health issues facing the U.S. health
services system? In your view, is the public sector capable of resolving these
issues? Why or why not?
•
•
An appropriate level of funding is among the most significant issues.
Now that public health departments have become first responders for
bioterrorist activities, they may not be able to stretch their resources
further to provide other services.
12. What is your opinion about the disaggregation of public health services and
programs among a number of cabinet-level departments and other high-level
agencies at the national level? Is the population well-served by this
disaggregation? For example, would it have been preferable to include the
Department of Homeland Security as part of a larger ministry of health rather
than establish it as a stand-alone entity?
•
The answers to these questions are probably a matter of opinion and
could be argued from several perspectives. This question gets students to
start thinking about organizational issues in public health.
13. When is the use of regulation appropriate in a mixed public-private health
services delivery system? How would you evaluate the effectiveness of
regulatory efforts aimed at hospitals? Physicians? Nursing homes? Other
components of the health services system?
•
Certain issues cry out for a standardized, national regulatory effort, such
as the certification of hospitals and nursing homes to ensure that they
meet a minimum standard of quality of care. Regulation of bioterrorism
responsibilities would also be appropriate. Millions of dollars have been
provided to improve the compatibility of communication systems,
evacuation procedures, and other controls that may be needed to protect,
as well as possible, the health and safety of threatened populations.
Small Group Activities/Homework
Individual students or small groups could be asked to check out a particular
DHHS unit online and identify the issues the unit is dealing with currently.
Students could also report on recent publications, the issuance of recent rules
and regulations, or notices of public hearings scheduled on key issues. Students
interested in NIH could investigate one institute or center of interest rather than
explore all units. The starting point is simple; some examples follow.
www.dhhs.gov
www.fda.gov
www.cdc.gov
www.cms.gov
www.ahrq.gov
www.ihs.gov
www.hrsa.gov
Exam Questions and Suggested Answers
1. Explain the meaning of public in the term public health, and provide an
example of a public health service.
• Public indicates a governmental role in the definition and support of
health services.
• Exhibit 4.1 is a good starting place for examples of public health
services.
2. What organization serves as the ministry of health for the United States?
How does it differ from ministries of health in other countries?
• DHHS
• DHHS differs from other ministries in that the United States has a quasipublic, public, and strong private health sector. DHHS can control
certain aspects of the private health sector, but it does not have central
authority over the entire U.S. system.
3. Why did the U.S. health services system begin with a focus on public
health? In the pluralistic U.S. system, what is the role of the public health
system in supporting and/or delivering health services?
• The public health role began as a way to protect populations from the
dangers of communicable diseases, to protect the quality of water (and
later air) that had to be used by all of the population, and to provide
food, housing, and work to impoverished populations.
• The role of public health in delivering services has always been a
sensitive one. The private sector zealously guards its right to be the
provider of services. The public sector, however, does deliver
preventive services (i.e., immunizations, treatment of sexually
transmitted and some other communicable diseases), and basic
services for impoverished populations (e.g., well-child care, women’s
and infants’ food services). Through the Medicare and Medicaid
programs, the public sector also supports significant and costly services
for such populations as the elderly, the disabled, children from lowincome families and their caregivers, and people with end-stage renal
disease.
Exhibit 4.1 page 78
p g
The Roles of Public Health
Exhibit 4.2 page 80
U.S. Department of Health and Human Services Organization Chart Exhibit 4.3 page 83
National Institutes of Health
National Institutes of Health