Chapter 1- Health Care Systems

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

7. 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?

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

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

17. 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

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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)

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

36. 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)

37. 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

38. 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

39. 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%

40. 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

41. 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

42. 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

43. 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

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

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

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

49. 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.

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