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health care Systems. Unit 2. Health Care Systems. Introduction The Health Care industry employs over 10 million workers in over 200 different health careers. Health Care Systems. Introduction Health care has become a 2-billion-dollar-a-day business. $2,000,000,000.00

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health care systems1
Health Care Systems

Introduction

The Health Care industry employs over 10 million workers in over 200 different health careers.

health care systems2
Health Care Systems

Introduction

Health care has become a 2-billion-dollar-a-day business.

$2,000,000,000.00

Many different types of facilities make up this network of health care systems.

health care systems3
Health Care Systems

I. Types of Facilities

A. Hospitals: vary in size as well as services provided.

1. Small: serve communities

2. Large: serve larger areas &

provide different services

health care systems4
Health Care Systems

I. Types of Facilities

A. Hospitals: fall under different income classifications:

  • Private or Proprietary (for profit)
  • Religious(funds by religious affiliation)
  • Nonprofit (funds used for institution only)
  • Government(funded by government)
health care systems5
Health Care Systems

I. Types of Facilities

A. Hospitals: types of hospitals:

General – treat all age groups & conditions; provides diagnostic, medical, surgical, and emergency care services; usually private (Health Central Hospital) (Orlando General Hospital)

health care systems6
Health Care Systems

I. Types of Facilities

A. Hospitals: types of hospitals:

Specialty – provide care for special conditions or age groups; private; donations

(Shriner’s Burn Center – Cincinnati)

(MD Anderson Cancer Centers)

(Arnold Palmer Hospital For Children)

(Winnie Palmer Hospital For Women)

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Health Care Systems

I. Types of Facilities

A. Hospitals: types of hospitals:

Government – operated/funded by federal, state and local governments

(Veteran’s Administration “VA Hospital”)

(State Psychiatric Hospital - Chattahoochee)

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Health Care Systems

I. Types of Facilities

A. Hospitals: types of hospitals:

University/College Medical Centers – provide hospital services; research & education facility as well; can be funded privately, donations, or government sources (research)

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Health Care Systems

I. Types of Facilities

A. Hospitals: types of hospitals:

University/College Medical Centers – Examples:

University of Miami (Miami)

University of South Florida (Tampa)

Johns Hopkins University (Baltimore, Maryland)

Cleveland Clinic (Ohio – School of Medicine)

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Health Care Systems

I. Types of Facilities

B. Long-Term Care: provide assistance/care for elderly patients called “residents.” They can also provide care for persons with disabilities and/or chronic long-term illness.

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Health Care Systems

I. Types of Facilities

B. Long-Term Care: Types:

- Nursing/Geriatric Homes: provide basic care for those who can no longer care for themselves; assist with ADL’s (activities of daily living); provide safe/secure environment; social interaction

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Health Care Systems

I. Types of Facilities

B. Long-Term Care: Types:

- Extended/Skilled Care: provide skilled nursing care and rehabilitative services to prepare residents to return home or to other LTC facility

health care systems13
Health Care Systems

I. Types of Facilities

B. Long-Term Care: Types:

- Extended/Skilled Care: Subacute Units:provide Services to residents who need rehabilitation to recover from major illness (surgery, cancer, dialysis, heart disease, stroke)

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Health Care Systems

I. Types of Facilities

B. Long-Term Care: Types:

  • Independent/Assisted Living: individuals who can care for themselves (ADL’s) can rent or purchase apartment in facility(meals, housekeeping, laundry, transportation, social events, basic medical care are provided)
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Health Care Systems

I. Types of Facilities

B. Long-Term Care: Types:

  • Independent/Assisted Living: most are associated with nursing homes; this allows resident to move from one facility to the other as conditions warrant
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Health Care Systems

I. Types of Facilities

B. Long-Term Care:

  • Many career opportunities are available in long term care for health care workers.
  • Regulated by AHCA and OBRA
  • AHCA=Agency for Health Care Administration
  • OBRA = Omnibus Reconciliation Act of 1987
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Health Care Systems

I. Types of Facilities

C. Medical Offices: can vary to only have a single doctor or a group of doctors; can be a general practice or specialty practice

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Health Care Systems

I. Types of Facilities

C. Medical Offices: Types:

  • General Practice: treats all ages and all conditions
  • “Family Doctor”
  • “General Practitioner”
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Health Care Systems

I. Types of Facilities

C. Medical Offices: Types:

  • Specialty Practice: specializes in one particular age group or type of treatment given
  • Pediatrics
  • Cardiology
  • Obstetrics
  • Orthopedics
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Health Care Systems

I. Types of Facilities

C. Medical Offices: Offer several different opportunities for employment. Administration, nursing, bookkeeping, billing, medical coding. offices can be found in different locations to include; office buildings, stand-alone offices and even malls.

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Health Care Systems

I. Types of Facilities

D. Dental Offices: can vary in size; one dentist, group of dentist (DDM=Doctor of Dental Medicine)(DDS=Doctor of Dental Services)

Dentists’ offices can also be found in many different places to include professional office buildings, stand-alone offices and even malls.

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Health Care Systems

I. Types of Facilities

E. Clinics: Health care facilities which can provide different types of care. Can be dental or medical or (veterinary).

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Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Surgical: perform minor surgeries, also called outpatient or “one-day” clinics; patient is sent home same day after surgery

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Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Urgent Care: provide first aid or emergency care to ill or injured patients; not equipped to treat critically ill patients

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Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Rehabilitation: offer physical occupational, speech therapies for patients after injury or illness

health care systems26
Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Specialty: offer care for patients with specific diseases (diabetes, cancer), disorders (stroke) or injuries (head injury)

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Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Outpatient: offer procedures to patients who are then not admitted to the hospital – go home. Different than surgical clinics in that procedures are not only surgeries (endoscopy, colonoscopy)

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Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Health Department: may offer treatment for pediatric patients;sexually transmitted diseases; respiratory diseases; immunizations and other services (pharmacy)

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Health Care Systems

I. Types of Facilities

E. Clinics: Types:

- Medical Center: Usually located in colleges and universities; often offer FREE medical care and treatment to provide learning experiences for medical students.

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Health Care Systems

I. Types of Facilities

F. Optical Centers: can be individually owned by ophthalmologist (M.D. or D.O.) or optometrist (O.D.); or part of large chain of stores (Lens Crafters, Pearle Vision, etc.)

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Health Care Systems

I. Types of Facilities

G. Emergency Care Services: provide care for victims of accidents or sudden illness by highly trained medical professionals

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Health Care Systems

I. Types of Facilities

G. Emergency Care Services: Types:

  • Private ambulance services
  • Rescue squads (Fire Dept.)
  • Emergency/Urgent Care Clinics
  • Emergency Rooms
  • Aircraft (helicopters/airplanes)
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Health Care Systems

I. Types of Facilities

H. Laboratories: can be part of larger facility, such as hospital, clinic or college/university, or can be stand-alone

  • Pathologist
  • Laboratory technicians
  • Phlebotomist
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Health Care Systems

I. Types of Facilities

I. Home Health Care: provide care in patient’s home

  • Nursing care
  • Personal care
  • Therapy
  • Homemaking
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Health Care Systems

I. Types of Facilities

J. Hospice: care for patients who have less than 6 months to live as a result of a medical condition

Care can occur in the patient’s home or in Hospice care centers

The family of the patient is ALSO cared for.

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Health Care Systems

I. Types of Facilities

K. Mental Health: Types:

  • Counseling centers
  • Psychiatric clinics
  • Chemical abuse
  • Physical abuse
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Health Care Systems

I. Types of Facilities

L. Genetic Counseling:

  • Prenatal (before birth) tests
  • Checking for abnormalities & birth defects
  • Identify all medical options
  • Assist parents in coping with genetic disorders of child
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Health Care Systems

I. Types of Facilities

M. Rehabilitation: can be located in hospitals, clinics or be stand-alone entity; the goal of rehabilitation is to have the patient reach their maximum potential, given their specific medical condition.

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Health Care Systems

I. Types of Facilities

N. Health Maintenance Organizations (HMO’s): provide total health care directed toward preventative health care; some HMO’s are run by large corporations with many employees (lowers costs)

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Health Care Systems

I. Types of Facilities

O. Industrial Health Care Centers: found in large companies; provide healthcare for employees of the company; focus on accident prevention and safety

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Health Care Systems

I. Types of Facilities

P. School Health Services: found in many schools and colleges; many different levels of services provided

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Health Care Systems

II. Government Agencies

Government Agencies: are financially supported by taxes. National and international organizations exist around the world which monitor health and health care-related issues.

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Health Care Systems

II. Government Agencies

A. World Health Organization (WHO): international agency sponsored by the United Nations

  • Statistics & info about diseases
  • Publishes health info
  • Investigates/addresses serious health threats around the world
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Health Care Systems

II. Government Agencies

B. U.S. Dept. of Health and Human Services (USDHHS): national agency

- Deals with health problems within the United States

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Health Care Systems

II. Government Agencies

C. National Institutes of Health (NIH): national agency

- Division of USDHHS involved in research of diseases

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Health Care Systems

II. Government Agencies

D. Centers for Disease Control and Prevention (CDC): national agency

- Division of USDHHS concerned with causes, spread, and control of diseases in populations

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Health Care Systems

II. Government Agencies

E. Food and Drug Administration (FDA): national agency

- Responsible for regulating food and drug products sold to the public

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Health Care Systems

II. Government Agencies

F. Agency For Health Care Policy and Research (AHCPR): national agency established in 1990

- Responsible for researching the quality of health care delivered and identify standards of treatment for health care facilities

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Health Care Systems

II. Government Agencies

G. Occupational Safety and Health Administration (OSHA): national agency

- Establishes & enforces standards that protect workers from job related injuries and illnesses

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Health Care Systems

II. Government Agencies

H. Health Departments: national agency; falls under USDHHS

  • Community based
  • Gather statistics, trends
  • Prevention education
  • Immunizations
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Health Care Systems

III. Health Insurance Plans

In order to pay for costs associated with health care most people rely on health insurance plans.

There are THOUSANDS of insurance plans, but most work under same basic idea: You pay premium to insurance company and insurance covers costs.

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Health Care Systems

III. Health Insurance Plans

The amount of payment and type of services covered by the insurance company you have may vary. Not all insurances are the same and no two insurance plans are alike. Some cover more, some cover less than others.

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Health Care Systems

III. Health Insurance Plans

Terms to know:

Deductible: amount paid by patient for medical services before policy begins to pay

Example: $500 out-of-pocket before insurance pays anything

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Health Care Systems

III. Health Insurance Plans

Terms to know:

Co-insurance: expenses for medical care are shared between the patient and the insurance company

Example: 80/20 plan: insurance

pays 80%, you pay remaining 20%

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Health Care Systems

III. Health Insurance Plans

Terms to know:

Co-payment: also known as “co-pay” this is the amount of $ you pay for a particular service regardless of total cost of service

Example: $25 per visit; whether for a physical or more serious illness

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Health Care Systems

III. Health Insurance Plans

A. Medicare: government programs that provides health care for individuals over the age of 65 and for any person who has been disabled for at least two years

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Health Care Systems

III. Health Insurance Plans

A. Medicare: Types:

- Part A: covers hospital services and care provided by an extended care facility, or home health care agency after hospitalization

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Health Care Systems

III. Health Insurance Plans

A. Medicare: Types:

  • Part B: covers doctor’s visits, outpatient treatments, therapy and other health care
  • A deductible is paid for Medicare Part B
  • Part B only pays 80%
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Health Care Systems

III. Health Insurance Plans

B. Medicaid: medical assistance program operated by individual states. Persons covered by this program vary from state to state.

  • Low income
  • Children who qualify
  • Physically disabled or blind
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Health Care Systems

III. Health Insurance Plans

B. Medicaid: provides inpatient and outpatient hospital services, physician’s medical and surgical care, lab, x-ray, well-baby and well-child care, including immunizations

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Health Care Systems

III. Health Insurance Plans

C. Worker’s Compensation: provides treatment for workers injured on the job. Funded by employers and each individual state

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Health Care Systems

III. Health Insurance Plans

D. TRICARE: U.S. Government health insurance program. Provides care for all active duty personnel and their families, survivors of military personnel, and retired members of the military

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Health Care Systems

IV. Organizational Structure

All health care facilities must have an organizational structure. This is the line of authority, or chain of command within a facility. This organizational structure of a facility should indicate areas of responsibility.

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Health Care Systems

IV. Organizational Structure

The higher you are on the organizational structure of an institution or facility, the more responsibility you will have.

health care systems65
Health Care Systems

IV. Organizational Structure

Superintendent

Asst. Superintendent

School Principal

Asst. Principal

Asst. Principal

Asst. Principal

Teacher

Teacher

Teacher

Teacher

Teacher

Teacher

Student

Student

Student

Student

Student

Student

Student

Student

Student

Student

Student

Student

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Health Care Systems

IV. Organizational Structure

Hospital Administrator

Chief Nursing Officer

Nurse Manager

RN

RN

RN

LPN

LPN

LPN

LPN

LPN

LPN

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNAt

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Health Care Systems

IV. Organizational Structure

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

CNA

LPN

LPN

LPN

LPN

LPN

LPN

RN

RN

RN

Nurse Manager

Chief Nursing Officer

Hospital Administrator

slide69

Health Care Systems

End of Lecture