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Outline
NCKU Course No.: CHE 7081

Diseases
疾病及治療 Classification based on causes
Diseases ICD-10
Top 10 deadliest diseases
and Therapies
Therapies Classification based on levels of care
Classification based on intent
Alternative Therapy or Medicines
Traditional Ethnic Medical Systems
Gordon Tsai
Healthcare Systems
Healthcare Access and Quality Index

Diseases (Wikipedia) Diseases

Disease:
Any condition that impairs the normal functioning of the
body.
Infectious Diseases:
Diseases that are resulted from the presence of pathogenic
agents, including viruses, bacteria, fungi, protozoa,
multicellular organisms, and aberrant proteins known as
prions.
Acquired Disease vs Congenital Disease
Acquired disease began at some point during one's lifetime, as opposed to
disease that was already present at birth, which is congenital disease. The
latter is often genetic and can be inherited. It can also be the result of a
vertically transmitted infection from the mother such as HIV/AIDS.
Acute Disease vs Chronic Disease
Acute disease is of a short-term nature and chronic disease has a fulminant
nature disease that is a long-term issue.

Genetic Disease
Non-infectious Diseases:
It is caused by genetic mutation. It is often inherited, but some mutations are
Diseases other than infectious diseases, including most
random and de novo (present for the first time).
forms of cancer, heart disease, and genetic disease due to
the aging of the body, the damage of the body from
Hereditary or Inherited Disease
environment, food, chemicals, the mutation of cells as well as
inherited gene defects. It is a type of genetic disease caused by mutation that is hereditary (and can
run in families)

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Diseases Diseases – Type of Causes

Iatrogenic Disease Infectious, Transmissible, or Communicable
A disease condition caused by medical intervention. The diseases result from the infection, presence, and growth of
pathogenic biological agents in an individual host organism.
Idiopathic Disease Non-communicable
The disease whose cause is unknown. Non-communicable diseases cannot be spread directly from one person
to another, such as heart disease and cancer.
Incurable Disease
Disease that cannot be cured. Airborne
A disease that is caused by pathogens and transmitted through the air.
Primary Disease vs. Secondary Disease
Disease that came about as a root cause of illness, as opposed to Foodborne
secondary disease, which is a sequela of another disease. For example, Foodborne illness or food poisoning is any illness resulting from the
bacterial infections can be either primary (healthy but then bacteria consumption of food contaminated with pathogenic bacteria, toxins,
arrived) or secondary to a viral infection or burn, which predisposed by viruses, prions or parasites.
creating an open wound or weakened immunity (bacteria would not have
gotten established otherwise). Lifestyle
A lifestyle disease is any disease resulting from behavioral choices in
Terminal Disease life, such as a sedentary lifestyle and a diet high in unhealthful foods
such as refined carbohydrates, trans fats, or alcoholic beverages.
Disease with death as an inevitable result

Diseases – ICD-10 Top 10 Deadliest Diseases (2012)

o ICD-10 is the 10th revision of the International Statistical Death
Rank Disease Trend
Classification of Diseases and Related Health Problems Wordwide
(ICD). Coronary Artery
7.4 M Rates are going down in U.S. and Europe, but
1 Disease (Ischemic
(13.2%) are on the rise in developing countries
o It is a medical classification listed by the World Health Heart Disease)
Organization (WHO). 6.7M
About one in four strokes occur in people
2 Stroke who have had a prior stroke. Stroke is also
(11.9%)
o It contains codes for diseases, signs and symptoms, a leading cause of disability.
abnormal findings, complaints, social circumstances, and Chronic
The main causes of COPD are tobacco,
external causes of injury or diseases. Obstructive
3.1M including secondhand smoke, air pollution
3 (5.6%) (PM2.5). There’s no cure for COPD, but its
Pulmonary Disease
progression can be slowed down with
o The code set allows more than 14,400 different codes and (COPD)
medication.
permits the tracking of many new diagnoses. The codes
can be expanded to over 16,000 codes by using optional About 20 percent of travelers returning to
Lower Respiratory 3.1M
4 the United States seek medical attention
sub-classifications. Infections (5.5%)
for respiratory infection following a trip.

http://apps.who.int/classifications/icd10/browse/2016/en

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Top 10 Deadliest Diseases (2012) Top 10 Causes of Death

Death Trend of Top 10 Disease Deaths
Rank Disease Trend
Wordwide 10
Trachea, bronchus, and lung cancer are all 9 2015
Trachea, Bronchus, 1.6M respiratory cancers. The main causes of 8

Deaths in Millions
5 2012
and Lung Cancers (2.9%) this type of cancer are smoking, second- 7
2000
hand smoke, and environmental toxins. 6
1.5M About 5,700 more become infected every 5
6 HIV/AIDS 4
(2.7%) day.
3
1.5M Diarrheal disease is the second top killer
7 Diarrheal Diseases 2
(2.7%) of children under age five.
1
People in low to middle income countries 0
1.5M
8 Diabetes Mellitus are more likely to die from complications
(2.7%)
of diabetes.
Preterm Birth 1.1M Deaths were due to prematurity and
9
Complications (2%) complications of low birth weight.
The majority of TB-related deaths happen
0.9M
10 Tuberculosis (TB) in poorer countries. It is one of the top
(1.6%)
causes of death for people who have HIV.

Top 10 Causes of Death in the U.S Top 10 Causes of Death in Taiwan

. .
1.Heart disease (23.4% of all deaths)
2.Cancer (22.5%)
3.Chronic lung diseases (5.6%)
37%

4.Accidents (unintentional injuries; 5.2%)

5.Stroke (5.1%)
15%

6.Alzheimer's disease (3.6%) 9%

8% 8%

7.Diabetes (2.9%)
6% 5% 4% 4% 4%

8.Influenza and pneumonia (2.1%)

9.Kidney disease (1.8%)
10.Suicide (1.6%) (www.mohw.gov.tw/MOHW_Upload/doc/Caues of death in.2012 )

Malignant neoplasms: 惡性腫瘤 Nephritis: 腎臟炎

Nephrotic syndrome: 腎病綜合症
Cerebrovascular diseases: 腦血管疾病
Nephrosis: 腎(變)病
http://www.webmd.com/heart-disease/news/20160701/top-10-death-causes

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Therapy Types of Therapy

(Care or Treatment) By Levels of Care

Levels of care classify health care into categories of chronology, priority, or

intensity, as follows:

The attempted treatment of Home care is care at home, including care from providers (such as
physicians, nurses, and home health aides) making house calls,
diseases or disorders, as by care from caregivers such as family members, and patient self-care.

some remedial, rehabilitating, Ambulatory care is care provided on an outpatient basis. Typically
patients can walk into and out of the clinic under their own power
or curative process after a (hence "ambulatory"), usually on the same day.

medical diagnosis. Emergency care handles medical emergencies and is a first point of
contact or intake for less serious problems, which can be referred to
other levels of care as appropriate.

Types of Therapy Types of Therapy

By Levels of Care By Levels of Care

Intensive care, also called critical care, is care for extremely ill or
injured patients. It thus requires high resource intensity,
knowledge, and skill, as well as quick decision making.
End-of-life care is care near the end of one's life. It often includes
the following: Palliative care is supportive care, most especially
(but not necessarily) near the end of life. Hospice care is
palliative care very near the end of life when cure is very unlikely.
Its main goal is comfort, both physical and mental.
Primary care is meant to be the main kind of care in general, and ideally a
medical home that unifies care across referred providers.
Secondary care is care provided by medical specialists and other health
professionals who generally do not have first contact with patients, for
example, cardiologists, urologists and dermatologists. A patient reaches
secondary care as a next step from primary care, typically by provider
referral although sometimes by patient self-initiative.
Tertiary care is specialized consultative care, usually for inpatients and on
referral from a primary or secondary health professional, in a facility that has
personnel and facilities for advanced medical investigation and treatment,
such as a tertiary referral hospital.

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Types of Therapy Alternative Therapy or Medicine

By Intent
Type of Therapy Description
CAM: Complementary and Alternative Medicine
Preventive therapy To prevent a medical condition from occurring (also called prophylaxis). For
(prophylactic therapy) example, many vaccines prevent infectious diseases.
Alternative therapy or medicine is a practice
Gold standard therapy A therapy that is definitive.
claimed to have the healing effects of medicine,
The first therapy that will be used in the treatment. Its priority over other options is
First-line therapy usually either: (1) formally recommended on the basis of clinical trial evidence for but it is not proven scientifically or via the
(Induction therapy) its best-available combination of efficacy, safety, and tolerability, or (2) chosen
based on the clinical experience of the physician. normal clinical test process.
To consolidate the gains from induction therapy. In cancer, this means chasing
Consolidation therapy
after any malignant cells that may be left.

Salvage therapy
A therapy to be used after others have failed; it may be a "last-line" therapy.
In general, the scientific consensus is that the therapy
(Rescue therapy)
does not, or can not, work because the known laws of
Maintenance therapy A therapy taken during disease remission to prevent relapse.
nature are violated by its basic claims.
A therapy that does not treat or improve the underlying condition, but instead
Supportive therapy
increases the patient's comfort.
A therapy given on an empiric basis using the clinically proven drug(s) as off-level
Empiric therapy care; that is, one given according to a clinician's educated guess despite
uncertainty about the illness's causative factors.

Alternative Therapy or Medicine Alternative Therapy or Medicine

Facts Why it exists
o Alternative medicine has grown in popularity
and is used by a significant percentage of the ❑ Patients failed on modern medical
population in many countries.
therapy or treatment and looked for
o While it has extensively rebranded itself: from other alternatives.
quackery to complementary or integrative
medicine, it promotes essentially the same ❑ Incurable disease
practices.
❑ Cost concern - cheaper
o Despite being illegal to market alternative
therapies for cancer treatment in most of the
developed world, many cancer patients use ❑ Illiterate and easy to be cheated
them.

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Alternative Therapy or Medicine Traditional Ethnic Medical Systems

System Claims Issues
The practices are based on belief in a
Common practices include herbal
Traditional medicine, acupuncture (insertion of
supernatural energy called qi (氣) combined
with Chinese Astrology and Chinese
Chinese needles in the body at specified numerology.
medicine points), massage (Tui na; 推拿),
The model is based on 5 elemental substances
exercise (qigong 氣功), and dietary
(中藥) therapy. (金木水火土) that are different from the
anatomy and physiology of internal organs.

Ayurveda believes in the existence of
three elemental substances,
the doshas (called Vata, Pitta and
Kapha), and states that a balance of
Ayurveda the doshas results in health, while
(Traditional imbalance results in disease. Such
disease-inducing imbalances can be
India adjusted and balanced using traditional
medicine) herbs, minerals and heavy metals.
(印度草醫學) Ayurveda stresses the use of plant-
based medicines and treatments, with
some animal products, and added
minerals, including sulfur, arsenic,
lead, copper sulfate.
Safety concerns have been raised about
Ayurveda, with two U.S. studies finding about
20 percent of Ayurvedic Indian-
manufactured patent medicines contained toxic
levels of heavy metals such as lead, mercury,
and arsenic.
Other concerns include the use of herbs
containing toxic compounds and the lack of
quality control in Ayurvedic facilities. Incidents
of heavy metal poisoning have been attributed
to the use of these compounds in the United
States.

Chinese Medicine Healthcare Systems

Insurance
Does Chinese medicine fall into the category of
alternative medicine?

Yes or No
❖ Efficacy is based on observation by eye,
patient’s feeling, and disappearance of the
symptom.

Comment: Cannot distinguish placebo

effect from real efficacy.

❖ Multiple compounds, synergy effect or the

other way around.

Ellis, R.P., et al., Encyclopedia of Health Economics, Culyer, Anthony ed., Elsevier Press ( 2014)

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Healthcare Systems
System I is a private good market, in which consumers buy health
care services directly from providers. This system is still used in all
countries for non-prescription drugs and many developed countries for
certain specialized goods (e.g., routine dental and eye care, and elective
cosmetic surgery,) but is rare for the majority of health care services. Most
consumers in Singapore and uninsured consumers in the US rely on a
private good market, and pay for their health care when needed, without
insurance.
System II is a reimbursement insurance market, in which
consumers pay premiums directly to an insurer in exchange for the right to
submit receipts (or ‘claims’) for reimbursement by the insurer for spending
on health care. Under a reimbursement insurance system the insurer
need not have any contractual relationship with health care providers,
although the insurer will need rules for what services are covered and how
generously. As will be seen, System II, is most common for secondary
insurance in developed countries, and it is also widely used for automobile
and home insurance.
Ellis, R.P., et al., Encyclopedia of Health Economics, Culyer, Anthony ed., Elsevier Press ( 2014)
Healthcare in Taiwan
Universal Health Care System
The health care system in Taiwan, known as National
Health Insurance (NHI), was instituted in 1995.
NHI delivers universal coverage offered by a government-
run insurer. The working population pays premiums split
with their employers, others pay a flat rate with
government help and the poor or veterans are fully
subsidized. The system promises equal access to health
care for all citizens.
Under this system, citizens have free range to choose hospitals and
physicians without using a gatekeeper and do not have to worry about
waiting lists. NHI offers a comprehensive benefit package that covers
preventive medical services, prescription drugs, dental services, Chinese
medicine, home nurse visits and many more.
Most preventive services are free such as annual checkups and maternal
and child care. Regular office visits have co-payments as low as US $5 per
visit. Co-payments are fixed and unvaried by the person's income.
Wikipedia
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Healthcare Systems
System III is a conventional insurance market in which the consumer
pays a premium to a health plan, who in turn contracts with and pays providers.
Although popular in theoretical models of insurance, System III is not used for
the primary insurance system in any developed country, but is sometimes used
for secondary insurance programs. Note the key difference in incentives
between these two systems: System II incents the consumer, but not the health
plan, to search for low price, high quality providers, while System III does the
reverse, reducing consumer incentive but enabling the health plan to negotiate
over price and quality.
System IV is a sponsored insurance market in which the revenue is
collected from consumers (directly or indirectly) by a sponsor who then
contracts with health plans, who in turn contract with and pay providers. All
developed countries that we have studied involve a sponsor, although in
some developing countries the sponsor may be a health plan.
Ellis, R.P., et al., Encyclopedia of Health Economics, Culyer, Anthony ed., Elsevier Press ( 2014)
Healthcare Access and Quality Index
Mortality rates from 32 GBD (Global Burden of Diseases) that should not
be fatal in the presence of effective medical care (ie, amenable mortality).
GBD 2015 Healthcare
Access and Quality
Collaborators
www.thelancet.com
Vol 390 July 15, 2017
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Healthcare Access and Quality Index Summary

Diseases
Classification based on causes
ICD-10
Top 10 deadliest diseases
Therapies
Classification based on levels of care
Classification based on intent
Alternative Therapy or Medicines
Traditional Ethnic Medical Systems
Healthcare Systems
HAQ Index
www.thelancet.com Vol 390 July 15, 2017

Q & A