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Chapter 2. Health Care Systems. 2:1 Private Health Care Facilities. Growth—one of the largest and fastest growing industries in the United States Employment opportunities—employs over 13 million workers in over 200 careers Expenditures—it is a four-billion-dollar- per-day business and growing.

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chapter 2

Chapter 2

Health Care Systems

2 1 private health care facilities
2:1 Private Health Care Facilities
  • Growth—one of the largest and fastest growing industries in the United States
  • Employment opportunities—employs over 13 million workers in over 200 careers
  • Expenditures—it is a four-billion-dollar-per-day business and growing

(continues)

private health care facilities continued
Private Health Care Facilities(continued)
  • Hospitals
  • Long-term care facilities (LTC or LTCF)
  • Independent living and assisted living
  • Medical offices
  • Dental offices
  • Clinics or satellite centers
  • Optical centers
private health care facilities continued1
Private Health Care Facilities(continued)
  • Emergency care services
  • Laboratories
  • Home health care
  • Hospice agencies
  • Mental health facilities
  • Genetic counseling centers
  • Rehabilitation facilities

(continues)

private health care facilities continued2
Private Health Care Facilities(continued)
  • Health maintenance organizations (HMOs)
  • Industrial health care centers or occupational health clinics
  • School health services
2 2 government agencies
2:2 Government Agencies
  • Government services are tax supported
  • World Health Organization (WHO)
  • U.S. Department of Health and Human Services (USDHHS)
  • National Institutes of Health (NIH)
  • Centers for Disease Control and Prevention (CDC)

(continues)

government agencies continued
Government Agencies(continued)
  • Food and Drug Administration (FDA)
  • Agency for Health Care Policy and Research (AHCPR)
  • Occupational Safety and Health Administration (OSHA)
  • Health Departments
2 3 voluntary or nonprofit agencies
2:3 Voluntary or Nonprofit Agencies
  • Supported by donations, membership fees, fundraisers and grants
  • Health services are provided at national, state, and local levels
  • Examples include the American Cancer Society, March of Dimes, American Red Cross and many more

(continues)

voluntary or nonprofit agencies continued
Voluntary or Nonprofit Agencies(continued)
  • Organizations focus on specific diseases
  • Educate the public
  • Provide special services
  • Purchase medical equipment
  • Staffed by many health care workers

and volunteers

2 4 health insurance plans
2:4 Health Insurance Plans
  • Health care costs are rising faster than other costs of living
  • Most people rely on health insurance plans to pay for health care costs
  • Without insurance, the cost of an illness can become a financial disaster
insurance terminology
Insurance Terminology
  • Deductible
  • Co-insurance
  • Co-payment
types of plans
Types of Plans
  • Health insurance plans
  • Health maintenance organization (HMO)
  • Preferred provider organization (PPO)
  • Medicare
  • Medigap

(continues)

types of plans continued
Types of Plans(continued)
  • Medicaid
  • The State Children’s Health Insurance Program (SCHIP)
  • Worker’s Compensation
  • U.S. government plans for all military personnel and their families
  • Managed care plans
hipaa
HIPAA
  • Five components
    • Health care access
    • Preventing health care fraud
    • Tax-related health provisions
    • Application and enforcement of group health plan requirements
    • Revenue offsets
2 5 organizational structure
2:5 Organizational Structure
  • Line of authority or chain of command
  • Indicates areas of responsibility
  • Goal: most efficient operation of facility
  • Complex or simple structure determined by size and needs of organization
  • Sample organizational charts (See Figure 2-4 and 2-5 in text)

(continues)

organizational structure continued
Organizational Structure(continued)
  • The line of authority must be clearly indicated in any organizational structure
  • Workers must identify and understand their position in the structure
  • To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor
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