Health Care Facilities

1. Health Care Facilities

2. Objectives • Students will be able to: • Differentiate between private, public, and non-profit facilities. • Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models. • Research the organizational structures and services of various types of health care facilities. • Differentiate between various types of health care insurance plans • Analyze the cause and effect on health care system change based on the influence of technology epidemiology, bio-ethics, socioeconomic and various forms of complimentary medicine

3. Hospitals • Vary according to: • Size • Small • Large • Ownership • Proprietary / private / for profit • Nonprofit • Government • Religious • Services • General • Specialty

4. Long-Term Care Facilities • Provide long-term care for elderly patients and for patients in rehabilitation. • Levels of long-term care: • A nursing home provides care for patients who can no longer care for themselves. • An independent living facility allows patients to use only the services they need, such as transportation or housekeeping.

5. Medical Offices • May be operated by one or two doctors or a large groups of health care professionals. • Some medical offices treat a wide range of conditions. • Others are specialized for specific ages or medical conditions.

6. Dental offices Clinics Optical centers Emergency Care Centers Laboratories Home Health Care Hospice Mental Health Genetic Counseling Centers Rehabilitation Health Maintenance Organizations (HMO’s) Industrial Care Centers School Health Services Other Types of Facilities

7. Government Agencies • World Health Organization (WHO) • U.S. Department of Health and Human Services (USDHHS) • National Institute of Health (NIH) • Centers for Disease Control and Prevention (CDC) • Food and Drug Administration (FDA) • Agency for Health Care Policy And Research (AHCPR) • Occupational Health and Safety Administration • State and local health departments

8. Volunteer and Nonprofit Agencies • American Cancer Society • American Heart Association • American Red Cross • National Association of Mental Health • National Foundation of the March of Dimes

9. Health Insurance Plans

10. Health Care Systems • Nearly every industrialized country has a national health care system. • Some countries have public or national health care systems, and other countries have private health care systems.

11. Public / NationalHealth Care Systems • Mainly funded by taxes and social security insurance. • Advantage – Every citizen is guaranteed health care regardless of economic status. • Disadvantages – Health care is not always comprehensive, and taxes may be higher. • Norway, France, the United Kingdom, and Canada

12. Private Health Care Systems • Mainly funded by private insurance agencies and out-of-pocket payments. • Advantages – Coverage is often comprehensive, taxes may be lower, and economic growth is stimulated. • Disadvantage – Not every citizen is guaranteed health care. • United States and Switzerland

13. Mixed Systems • Very few countries have a purely public or private system • Most countries create a mixed system by using various funding sources to cover health care expenses. • Example: Canada and the United States

14. Health Insurance • The rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families. • In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses.

15. Health Insurance Terms • Premium – the amount paid to an insurance agency for a health insurance policy • Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments • Co-payment - an amount paid by the patient for a certain service • Out-of-pocket - a medical bill that must be paid by the patient

16. Individual and Group Insurance • Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage. • Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.

17. Managed Care • Two primary concepts of managed care: • To promote good health • To practice preventive medicine • Managed care plans offer medical services through a system of health care providers. The system of providers offers services at reduced rates.

18. Managed Care • Health Maintenance Organizations • Preferred Provider Organizations • Point of Service

19. Health Maintenance Organizations • Clients must pay a premium, deductible, and co-payments. • Clients must visit in-network doctors and select a primary care physician. • HMOs urge clients to practice healthy living and to receive preventive treatments.

20. Preferred Provider Organization • Clients must pay a premium, deductible, and co-payments. • Clients do not have to choose a primary care physician. • Clients may visit non-network physicians, but coverage is greater with in-network physicians. • PPOs often have other fees and co-payments.

21. Point of Service • Clients must pay a premium. • Clients must chose a primary care physician. • For in-network physicians, there is usually no deductible and co-payments are low. • Specialists may be non-network physicians, but coverage may be limited

22. Government Programs • In the 20th century, the United States government began to realize the need for public medical assistance. • In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance. • Medicaid • Medicare

23. Medicaid • Income or needs based program • Designed by the federal government, but administered by state governments • Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled.

24. Medicare • Program for any citizen age 65 or older • Administered by the federal government • After an individual pays a deductible, Medicare will cover 80% of all medical expenses.

25. Medicare Services • Part A: Hospital Care • Hospitalization • Skilled nursing facilities • Home health care • Hospice care • Long-term care facilities • Part B: Outpatient Services • Medical expenses, including therapy, medical equipment, and testing • Preventive Care

26. Worker’s Compensation • Provides treatment for workers injured on the job • Administered by the state • Reimburses the worker for wages lost because of on-the-job injury

27. TRICARE • Formerly called CHAMPUS (the Civilian Health and Medical Programs for the Uniform Services) • Administered by the federal government • Provides care for all active duty members and their families, survivors of military personnel, and retired members of the Armed Forces

28. Health Insurance Portability and Accountability Act (HIPPA) • Health Care Access, Portability, and Renewability • Preventing Health Care Fraud and Abuse; Administrative Simplification, and Medical Liability Reform • Tax-Related Health Provisions • Application and Enforcement of Group Health Plan Requirements • Revenue Offsets

29. Trends in Today’s Health Care Systems • Advances in technology • Epidemiology • Bio-ethics • Socioeconomics • Complementary (nontraditional) medicine

30. Organizational Structure • An tool designed to help a facility operate smoothly by outlining responsibilities • It describes the line of authority that establishes levels of responsibility and supervision

31. The End!