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Chapter 1- Health Care Systems

Chapter 1- Health Care Systems. History of Health Care. Pertinent questions. When did most of the most significant changes in health care occur? Why were the greatest advances made in this time period? What are some possibilities for the future of health care?. Health Care Systems.

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Chapter 1- Health Care Systems

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  1. Chapter 1- Health Care Systems History of Health Care

  2. Pertinent questions • When did most of the most significant changes in health care occur? • Why were the greatest advances made in this time period? • What are some possibilities for the future of health care?

  3. Health Care Systems Many different types deliver health care Largest & fastest growing industry Employs over 10 million workers in over 200 careers $2,000,000,000 per day industry

  4. Hospitals – vary in size & type of services • General hospitals – varied services • Specialty hospitals – certain conditions or ages (burns, pediatrics, cancer, heart, etc) • Government hospitals – fed, state, local (VA, military, state rehab or psychiatric) • University or college medical centers – provide services, RESEARCH, education

  5. Classification – based on funding sources • Private or proprietary – for profit (pt. fees & organizational support) • Religious – religious support, pt. fees • Non-profit or voluntary – pt. fees, donations • Government – taxes, pt. fees

  6. Long Term Care Facilities (LTC) • Provide care for elderly, physical or mental disabilities, chronic or long term illnesses • Pts are usually called residents • Nursing homes or geriatric homes – provide ADLs for those unable to care for themselves, provide a safe environment, & promote social interactions

  7. Extended Care or Skilled Care Facilities • Provide skilled nursing & rehab care • Prepare resident for return to home environment • Subacute units – rehab for surgery, cancer tx, dialysis • Independent or assisted living facilities – individuals receive the help they need (meals, transportation, housekeeping, etc) • Many are associated with LTC facilities, enabling the individual to move from facility to facility as need arises

  8. Medical Offices • Privately owned offices to large corporations • Services: diagnosis, treatment, examinations, basic lab tests, minor surgery • Some treat wide variety of illness/ages & others specialize

  9. Dental Offices • Private offices to dental clinics • Can be found in major retail stores • Can provide general or specialized dental care

  10. Clinics • Can refer to a group of medical/dental professionals who share a facility & staff • Others specialized – surgery, emergency care clinics, rehab clinics, diabetes or oncology clinics • Can be affiliated with a hospital • Health department – pediatrics, sexually transmitted diseases, immunizations, other special services • Medical centers at universities – frequently free or reduced cost care to provide learning experiences

  11. Optical Centers • May be individually owned or part of a large chain • Provide vision examinations, prescribe eyeglasses or contacts, check for eye diseases

  12. Emergency Care Services • Provide special care for accidents or sudden illness • Examples – ambulance, rescue squads, emergency care clinics, emergency rooms in hospitals, helicopter or airplane

  13. Laboratories • Can be part of another facility or separate health care service • Medical labs – perform diagnostic tests • Dental labs – prepare dentures and other devices

  14. Home Health Care • Provides care in patient’s home • Examples – nursing, personal cares, therapy, homemaking • Offered by health departments, hospitals, private agencies, government agencies, nonprofit agencies, volunteer groups

  15. Hospice • Provides care for terminally ill persons with a life expectancy of 6 months or less • Care provided in home or hospice facility • Allows death with dignity & comfort • Provides psychological, social, spiritual, & financial counseling for pt. & family

  16. Mental Health Facilities • Deal with mental diseases and disorders • Examples – guidance/counseling centers, psychiatric clinics/hospitals, chemical abuse treatment centers for alcohol or drug abuse, physical abuse treatment centers

  17. Genetic Counseling Centers • Can be independent or affiliated • Works with couples or individuals who are pregnant or considering pregnancy • Performs prenatal screening, check for genetic abnormalities & birth defects, explains test results, identify medical options when defect is present, help individuals cope with psychological issues caused by genetic disorder • Used especially for older women, family history of genetic disease, specific race/nationality where genetic disease is prevalent

  18. Rehabilitation Facilities • Care directed at helping pt. with mental or physical disability obtain maximum function • Includes hospitals, clinics, private centers • Services – physical, occupational, recreational, speech, & hearing tx

  19. Health Maintenance Organizations • Provide total health care directed toward preventive care • Services: examinations, basic medical services, health education, hospitalization, rehabilitation • Mode of operation – large industry/corp, private agencies, uses services of other health care facilities

  20. Industrial Health Care Centers or Occupational Health Clinics • Located in large industries or companies • Provides health care for employees • Services – basic exams, teach accident prevention/safety, provide emergency care

  21. School Health Services • Found in schools & colleges • Services – emergency care for accidents & sudden illnesses, speech/vision/hearing screenings, promote health education, maintain safe & sanitary school environment, counseling

  22. Government Agencies • Offered at international, federal, state, local levels – most tax supported • World Health Organization (WHO) – international agency supported by United Nations that provides statistics & information about disease, publishes health information, & investigates & deals with serious health problems throughout the world

  23. United States Department of Health & Human Services (USDHHS) • National Institute of Health (NIH) – researching disease • Centers for Disease Control & Prevention (CDC) – researches causes, spread, & control of diseases in populations • Food & Drug Administration (FDA) – regulates food & drug products sold to the public

  24. USDHHS (cont) • Agency for Health Care Policy & Research (AHCPR) – established in 1990 to research quality of health care delivery & identify standards of treatment • Occupational Safety & Health Administration (OSHA) – establishes & enforces standards protecting workers from job-related injuries & illnesses

  25. State & Local Health Departments • Provides health services as directed by USDHHS • Provides specific needed services – immunizations, inspections for environmental health & sanitation, communicable disease control, collection of statistics & health records, health education, clinics for health care & prevention

  26. Volunteer or Nonprofit Agencies • Supported by donations, membership fees, fundraisers, & grants • Provides health services at national, state, or local levels • Examples – American Cancer Society, American Heart Association, American Diabetes Association, American Red Cross, March of Dimes, etc. • Many deal with one disease or group of diseases to study, provide funding for research, promote education, purchase medical equipment, provide treatment centers, & supply information

  27. Health Insurance Plans • Cost of health care a major concern • Cost of health care is >12% of gross national product • Health care costs are increasing faster than other costs of living • Most people rely on health insurance plans to pay for health care costs • Without insurance, cost of illness disastrous

  28. Health Insurance Plans • Different plans offered by thousands of agencies • Pay a premium to purchase insurance • If insured person has expenses covered by the plan, the insurance company pays for them • Amount of payment and services vary from plan to plan

  29. Insurance terminology • Deductibles – amounts that must be paid by the insured individual before policy begins to pay • Co-insurance – requires specific percentage of expenses to be shared by individual & company (80-20 80% paid by company, 20% paid by individual) • Co-payment – specific amount of money patient pays for a particular service (example - $20 per doctor’s appointment regardless of total cost)

  30. Insurance Plans • Many people have insurance from place of employment • Private policies can be purchased by individuals

  31. Health Maintenance Organizations • Special type of insurance plan • Monthly fee is paid for membership & price remains same, regardless of number of visits • Premium paid either by employer or individual • Most pay for total health care – routine visits & exams & preventive health care (not usually covered by private insurance)

  32. Health Maintenance Organizations • Advantages – provides ready access to health care, early detection & treatment of disease, individual usually maintains better health • Disadvantages – individual can only use HMO affiliated providers for health care. If choose a provider outside of HMO, individual pays for all costs

  33. Preferred Provider Organizations (PPO) • Usually provided by large company • Company contracts with health care agency • Employee must use specific health care agency • Industry/company can provide health care at lower rates

  34. Medicare • Federal government health care plan • Provides health care to those over 65 years of age or persons with a disability who have had social security benefits for at least 2 years • Type A coverage – hospital services & LTC facility after hospitalization • Type B coverage – Dr. services, outpatient therapy, other health care. Individual pays premium for this coverage. 80-20 co-insurance – Medicare pays 80%, individual or insurance pays 20%

  35. Medicaid (MediCal) • Medical assistance program offered by states (vary from state to state) • Covers individuals with low incomes, children who qualify for public assistance, the physically disabled or blind • State Children’s Health Insurance Program (SCHIP) – established 1997 to provide health care to uninsured children of working families who earn too much to qualify for Medicaid

  36. Worker’s Compensation • Provides treatment for workers injured on the job • Administered by the state • Payments made by employers & state • Provides payment for health care & lost wages

  37. United States Government Plans • Provides health care for all military personnel • TRICARE • Cares for all active duty members & families • Cares for survivors of military personnel & retirees & their families • Veteran’s Administration provides for military veterans with service connected disability

  38. Managed Care • Developed because of rising health care costs & need to spend money efficiently • All health care must have a purpose • Second opinion or verification of need often required • Includes preventive care, physical exams, well-baby care, immunizations, wellness education (good nutrition, exercise, weight control, healthy living) • Usually provided by HMOs & PPOs by setting up network of providers – restricted usage

  39. Organizational Structure • Often called line of authority or chain of command • Indicates area of responsibility • Leads to efficient operation of facility

  40. Hospital Organizational Chart • Shows organization by departments • Notes various divisions of departments • Each department can have an individual organization

  41. Medical Office Organizational Chart • Simpler organizational chart • Even with fewer people, lines of authority are clearly shown & easy to follow

  42. Summary • In both cases, chain of command is clearly indicated • Health care workers must identify & understand their position in the organizational structure • Allows workers to know the line of authority & understand who is their immediate supervisor • Questions/concerns/problems – go to immediate supervisor • If supervisor is unable to solve the problem, go to the next level in the chain.

  43. Trends in Health Care • Many events lead to changes in health care (example AIDS) • Changes occur almost daily • 1st trend is cost containment

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