Health Care Systems

1. Health Care Systems Health Science

2. Objectives: • Compare healthcare delivery systems (public, private, government, and nonprofit) • Explain factors influencing healthcare delivery systems • Describe responsibilities of consumers within the healthcare system. • Explain the impact of emerging issues such as technology, epidemiology, bioethics, and socioeconomics, on healthcare delivery systems • Discuss common methods of payments for healthcare

3. Health Care Delivery Systems • It is a system that provides (delivers) health care for people who need it in various ways • Providing different methods of health care based on what a patient needs • It includes many agencies, facilities, and personnel involved in the delivery of health care

4. Private Health Care Facilities • Health care – one of the fastest growing industries in the US • It attracts people with a wide range of educational backgrounds because it offers multiple career options.

5. Types of Facilities • hospitals • long-term care facilities (nursing homes) • independent living and assisted living • medical, dental offices, clinics, optical centers • emergency care services • home health care and hospice • laboratories

6. mental health • genetic counseling centers • rehabilitation centers • health maintenance organizations (HMOs) • industrial health care centers • school health services

7. Hospitals: Complex centers that provide medical or surgical care and treatment for the sick and injured. They serve the basic needs of the community. • Long Term Care Facilities: Mainly provides assistance and care for elderly patients, usually called residents who no longer can care for themselves.

8. Medical Offices: Owned by one doctor or a corporation which employs many doctors, who provide medical services such as: diagnosis, treatment, exams, lab testing for a wide variety of illnesses and age groups.

9. Home Health Care: Provides care in a patient’s home and frequently used by the elderly and disabled. They include services such as nursing care physical and occupational therapy.

10. Hospice: Provides care for the terminally ill persons with life expectancies of 6 months or less. Care is directed toward allowing the person to die with dignity and in comfort. This is called palliative care

11. Government Agencies • CDC • OSHA • FDA • Heath Department

12. CDC—Centers for Disease Control and Prevention is concerned with causes, spread, and control of diseases in the population • FDA—Food and Drug Administration is a federal agency responsible for regulation food and drug products and cosmetics sold to the public

13. OSHA—Occupational Safety and Health Administration establishes and enforces standards that protect workers from job-related injuries illnesses • Health Department provides health services as directed by the Department of Health and Human Services and also provide specific services needed by the state or local community

14. Examples of health dept services • Immunization for disease control • Inspections for environmental health and sanitation DHEC-Department of Health and Environmental Control (rate restaurants) • Communicable disease control • Collection of statistics and records related to health • Health education • Clinics for healthcare and prevention and other services needed in the community.

15. Voluntary or Non-Profit Organizations • Are supported by donations, membership fees, fundraisers and federal or state grants • They provide health services at national, state, and local levels

16. Examples • American Cancer Society • American Heart Association • National Foundation of March of Dimes • American Red Cross • American Diabetes Association • United Way • Cure Search

17. These organizations focus on one specific disease or group of diseases • Each typically studies the disease • Provides funding to encourage research directed at curing or treating the disease • Promotes public education regarding information obtained through research

18. Provides special services to victims of disease or disaster such as purchasing medical equipment and supplies and providing treatment centers etc. • Nonprofit agencies employ many health care workers in addition to using volunteer workers to provide services

19. Factors Influencing Healthcare Delivery System and The Impact of Emerging Issues

20. Aging Population • Geriatric Care (care for the elderly) is on the rise because of an increase in the elderly population. • People are living longer. • The “baby boom” generation (a large number of people born after World War II) will reach geriatric age in the near future. • This increases the need for more health care workers; also older individuals use more medications, have more chronic diseases, and often need frequent health care services.

21. Computers and Rapid Communication • Able to monitor health problems throughout the world. • Tracking new viruses such as the bird flu, preventing epidemics from spreading which could occur quickly in our global society because people can travel easily from one country to another. • These factors have made health care a global concern and countries are working together to promote good health in all individuals.

22. Rising Costs and Technological Advances • Highly technical procedures such as heart, lung, or kidney transplants and valuable diagnostic tools can cost hundreds of thousands of dollars but allow people to survive illnesses that used to be fatal. • However these individuals may require expensive and lifelong care which adds to the high cost of the growing health care industry

23. Telemedicine • Involves the use of video, audio and computer systems to provide medical and/or health care services • Examples: • Transmitting medical data from an ambulance to the emergency room physician • Surgeons guide a robotic arm to perform surgery on a patient miles away By watching a procedure on video beamed by satellite system one surgeon can direct the work of another surgeon

24. In the comfort of their homes, patients can test blood sugar levels, oxygen levels, blood pressure measurements, monitor pacemakers and other vital signs and send the results to a physician/nurse through telemedicine machines, some allow a patient to talk face to face with a health care provider through video monitors.

25. Health related lawsuits: Leads health care providers to have to pay for expensive malpractice insurance

26. Early Intervention & Preventive Services Providing care before acute or chronic disease occurs. (Prevention) Individuals with limited access to health services and restricted finances use expensive emergency rooms much more frequently.

27. Consumers Objective: Describe responsibilities of consumers within the healthcare systems

28. Cost Containment • Controlling the high costs of health care • Methods • Mass or bulk purchasing—buying equipment and supplies in larger quantities at reduced prices. • Energy conservation—monitoring the use of energy to control costs and conserve resources

29. Diagnostic related groups (DRGs)—Under this plan, a limit is placed on the cost of care and the agency (hospital) providing care receives a set amount for certain illnesses • Combination of services—When health care agencies join together or share specific services, care can be provided to a larger number of people at a decreased cost per person

30. Outpatient services—Patients receive care without being admitted to the hospital. • Reduces the need for hospital admission • Reduces the length of hospital stay • Care is replaced by less expensive home care • Surgery is now performed on an outpatient basis as well as X-rays and diagnostic tests.

31. Consumers are becoming more aware of the need to maintain health and prevent disease • Taking on the responsibility to live a healthy life style. • This includes: exercise, good nutrition, weight control and healthy living habits

32. Other methods used to prevent illness include: • Immunizations (shots to prevent diseases) • Regular physical exams to detect problems early • Easy access to preventive health care

33. Methods of Payment Objective: Discuss common methods of payments for healthcare (Chapter 2 page 32)

34. Cost of Health Care Costs are increasing much faster than other costs of living Health insurance plans do not solve all the problems of health care costs, but they do help many people by paying for all or part of the cost of health services.

35. There are thousands of health insurance agencies available, one common example is: • Blue Cross/Blue Shield: with this type of insurance plan, a premium, or a fee is paid by the individual and usually the employer pays the rest and the health care service is paid by the insurance. The amount covered varies from plan to plan.

36. Insurance Terms • Deductible: amount that must be paid by the patient for medical services before the policy begins to pay • Co-insurance: where percentage of expenses is shared by the patient and the insurance company. • Example is an 80-20% where the insurance company pays 80% and the patient pays the remaining 20%

37. Co-payment: a specific amount of money a patient pays for a particular service. • Example: Patient pays a $10 co-pay for doctor visit regardless of the total cost of the visit.

38. Health Maintenance Organization (HMO)-total care provided is directed toward preventive type health care which gives the insured ready access to health examinations and early treatment and detection of disease. • Must use only approved providers (doctors, labs, hospitals) or not covered

39. Medicare - federal government program • Provides health care for almost all individuals over the age of 65 and for any person with disability who has received Social Security benefits for at least 2 years

40. Medicaid- A medical assistance program • Operated by individual states • Usually pays for the health care of: • Individuals with low incomes • Children who qualify for public assistance • Individuals who are physically disabled or blind

41. Affordable Care Act March 2010, Congress passed and the President signed into law the Affordable Care Act, which puts in place comprehensive health insurance reforms that will hold insurance companies more accountable, lower health care costs, guarantee more health care choices, and enhance the quality of health care for all Americans.  

42. Summary Health care has changed and will continue to change Workers must be constantly aware of changes that occur Workers must make every attempt to learn about trends