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layout: post title: "061-100 《Contemporary Health Informatics》第一章" date: "2015-08-30 08:30:30" categories: 阅读 auth: conge

tags: 读书笔记 Health_Informatics

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图书信息：豆瓣

这本书是我正在上的一门课 Intro to Health Informatics的教材。教材的内容与课程的内容相对应。读这本书目的是对这门课进行预习，然后做一些读书笔记以备以后复习之用。读书笔记和课程笔记之间会有重复的地方，但是，学习过程就是一个不断重复的过程呀。

本章是对美国医疗系统的一个简单介绍，提出了这个系统所面临的问题：花费高昂却没有相应的效益。这里面原因很多，一个最重要的原因就是美国人越来越多人患慢性疾病，而医疗体系的建立从根本上还是应对急性病的那一套。

急性医疗问题，我的理解就是你的了短时间内不治疗就会死亡的那种。比如非典那样的传染病，车祸这样的意外。而慢性病也会死人，但不是马上死。如果调养得当，也能活很长时间。一般的慢性病的例子，高血压高血脂肥胖，糖尿病。一些先天的遗传病也可以归入这里面去。这些病，目前没治，只能维持。之前在《The World Until Yesterday》的读书笔记里也提到了现代人的各种慢性病的行为成因，如有兴趣，不妨与这篇同读。

慢性病有许多是生活习惯不当造成的。慢性病互为诱因。

还有一些对美国医疗保险制度和健康信息科学的看法，我写在了Intro to Health Informatics 第一周课程笔记里面。这里不多写了。

下面是书的内容总结：

Summary of the book

Part I: Problems and Policies

Chapter 1 The US Healthcare Systems

The Problems

The US healthcare system is very good at acute care, AKA "rescue care". E.G. the mortality rates for Heart Attack, Major Trauma are low in the US when compared to other developed countries.

But the US healthcare system has its own problems

High cost: probably the highest in the world, both in absolute $ number and percentage of GDP.
Cost are rising faster than other countries.
Return on investment are poor: People die younger in the US than citizens in other advanced countries
Health disparities within the country: E.g. infant mortality rate is higher in African Americans.
Many people do not have health insurance.
The US face huge future spending increase in healthcare.
The US healthcare system is more attuned to the management of acute than chronic conditions.
The system is not effective or efficient: Each of the agent (e.g. pharmaceutical company, physician) of the system has its own interest
No one is in charge of the system, so no one is taking responsibility
Perverse financial incentives: physicians makes more money if they prescribe more test, labs. Alternative pay-for-performance.

The Challenge of Chronic Disease

Acute medical problems: Often kill people in short amount of time if untreated. E.g. infections (H1N1, flu), fractions (e.g. car accident). -- The US healthcare system is good at this.

Chronic medical problems: Incurable, but can be managed so patients can avoid complications and live a better life. E.g. Obesity, Hypertension, diabetes, etc. They will:

last for the rest of the patient's life
they can cause each other
They usually have a behavioural cause

about Obesity: 1) The largest behavior causing chronic disease is Obesity（吃货们注意了）. 2) Obesity can cause other problems: type II diabetes, heart failure, hypertension, some cancer. 3) The greatest single cause of rising healthcare cost is the rising prevalence Chronic disease

We need a system of "continuity of care" which to address wellness and prevention of chronic diseases.

A Brief Review of the Current US Healthcare System

The root of the problem: the current healthcare system is designed to treat acute medical problems but 84% of the spendings it for chronic disease.

The US healthcare system typically adapts a fee-for-service model. The healthcare providers are paid for providing services no matter what the outcome is. and there is no incentive for care coordination, wellness or prevention.

other Models

Health maintenance Organizations (HMOs): One goal is to lower medical cost, use less expensive forms of care. it is a form of "managed care", a Primary Care Physician (PCP) is required as a "gate keeper" for access of specialists.

HMO is early adopters of Health information technology (HIT) to audity physicians' performance.

HMO do incent physicians based on the quality of the care but also focus on if they keep the cost low. it's not a "pay-for-performance" model.

Accountable care organizations (ACOs). ACOs are very much like HMOs but they accept more physician by making them accountable.<it seems to me that ACOs are something between traditional PPOs and HMOs.>

How Did Healthcare Evolve

The invention and availability of antibiotic meds changes the morbidity of human being. Infectious disease are not leading cause of death any more. People live longer and adapt to a more sedative life style, together these causes the increasing prevalence of chronic diseases. all these drives up the cause of the healthcare.

Technology (e.g. CAT, MRI) also drives up the spending. Also, people used to pay for the care by themselves, but nowadays, the insurance companies and government programs are paying a big chunk of the whole cost.

Cost is high but the return is not so good.