1 03 Healthcare Agencies 1 PPP Public

1. 03 Healthcare Agencies #1 PPP

Public (Government) Healthcare Systems Also known as National Healthcare Plan Helps to provide healthcare to all citizens Often seen in other countries – Canada – Europe No cost to the patient Residents pay high taxes 1. 03 Understand healthcare agencies, finances, and trends 2

Private Healthcare Systems Individuals purchase a health insurance plan and/or pay out-of-pocket. Predominate system in the United States Private health insurance is often offered through employers or other organizations Systems in the United States are a combination of public and private funding. 1. 03 Understand healthcare agencies, finances, and trends 3

Government Healthcare Agencies 1. 03 Understand healthcare agencies, finances, and trends 4

Government Healthcare Agencies - International - World Health Organization (WHO) Functions: – – assess health trends compile statistics related to disease investigate health problems worldwide publish health information http: //www. who. int/en/ 1. 03 Understand healthcare agencies, finances, and trends 5

Government Healthcare Agencies - National U. S. Department of Health and Human Services (USDHHS) Functions: – – – compile statistics related to disease investigate health problems in the United States prevent disease by immunizations provide comprehensive health services publish health information It is the mission of the U. S. Department of Health & Human Services (HHS) to enhance and protect the health and well-being of all Americans. We fulfill that mission by providing for effective health and human services and fostering advances in medicine, public health, and social services. HHS has 11 operating divisions, including eight agencies in the U. S. Public Health Service and three human services agencies. These divisions administer a wide variety of health and human services and conduct life-saving research for the nation, protecting and serving all Americans. 1. 03 Understand healthcare agencies, finances, and http: //www. hhs. gov/ 6 trends

National Institutes of Health (NIH) Functions: – World’s leading research organization – Research includes AIDS Alzheimer’s arthritis cancer diabetes heart disease The National Institutes of Health (NIH), a part of the U. S. Department of Health and Human Services, is the nation’s medical research agency — making important discoveries that improve health and save lives. http: //www. nih. gov/ 1. 03 Understand healthcare agencies, finances, and trends 7

Government Healthcare Agencies - National Centers for Disease Control and Prevention (CDC) Functions: disease control disease prevention http: //www. cdc. gov/ 1. 03 Understand healthcare agencies, finances, and trends 8

Government Healthcare Agencies - National (USDHHS) Food and Drug Administration (FDA) Functions: - regulates safety of food and cosmetics - regulates safety and efficacy of drugs, biological products and medical devices http: //www. fda. gov/ 1. 03 Understand healthcare agencies, finances, and trends 9

ABC Government Healthcare Agencies - National Occupational Safety and Health Administration (OSHA) Division of the US Department of Labor Functions: - create job safety standards - implement job safety standards http: //www. osha. gov/ 1. 03 Understand healthcare agencies, finances, and trends 11

ABC Government Healthcare Agencies - National Occupational Safety and Health Administration (OSHA) OSHA standards specific to healthcare include: - personal protective equipment - blood borne pathogens - hazard communication - ergonomics http: //www. osha. gov/ 1. 03 Understand healthcare agencies, finances, and trends 12

Government Healthcare Agencies - State (USDHHS) N. C. Department of Health and Human Services (NCDHHS) Functions to provide many services: Adoption Deaf/blind services Emergency services Food and nutrition services In-Homes Aides Medicaid Mental health services Pregnancy services Senior centers Vital records http: //www. dhhs. state. nc. us/index. htm 1. 03 Understand healthcare agencies, finances, and trends 13

Government Healthcare Agencies - State (USDHHS) N. C. Department of Health and Human Services (NCDHHS) Functions to provide information: Disease and health information End of life issues Environmental health Minority health Safety Teen issues Wellness www. dhhs. state. nc. us/index. htm 1. 03 Understand healthcare agencies, finances, and trends 14

Government Healthcare Agencies - Local (USDHHS, NCDHHS) County Health Department Functions: Provides services Communicable disease control Health inspections Immunizations Laboratory services Oral health Woman and child health Provides information Health education Statistics related to health, birth and death 1. 03 Understand healthcare agencies, finances, and trends 15

Private Healthcare Agencies 1. 03 Understand healthcare agencies, finances, and trends 16

Private Healthcare Agencies Non-Profit Supported by – – donations fees fundraisers grants Usual focus: – one disease or condition – related group of disorders Examples 1. 03 Understand healthcare agencies, finances, and trends 17

Private Healthcare Agencies Non-Profit Participate in: services research 1. 03 Understand healthcare agencies, finances, and trends education 18

Private Healthcare Agencies For-Profit 1. 03 Understand healthcare agencies, finances, and trends 19

Private Healthcare Agencies For-Profit Provide patient services Expect monetary profit Use profit for agency growth and to increase services 1. 03 Understand healthcare agencies, finances, and trends 20

Private Healthcare Agencies For-Profit -Inpatient. An inpatient facility is where patients stay overnight to receive medical care and treatment. 1. 03 Understand healthcare agencies, finances, and trends 21

Private Healthcare Agencies For-Profit Hospital -Inpatient- Mostly inpatient services with some outpatient services Type is determined by size, ownership, and services offered. – – General Specialty Government University or college medical centers 1. 03 Understand healthcare agencies, finances, and trends 22

Private Healthcare Agencies For-Profit -Inpatient- Long Term Care Facilities Care provided to patients who: - have chronic conditions or disabilities that require assistance with daily activities - are adults over the age of 18 - need long term or short term care 1. 03 Understand healthcare agencies, finances, and trends 23

Private Healthcare Agencies For-Profit -Inpatient. Types of long term care facilities – Adult care homes – Assisted living facilities – Continuing care retirement communities – Nursing homes 1. 03 Understand healthcare agencies, finances, and trends 24

Private Healthcare Agencies For-Profit Outpatient Patient receives ambulatory care. Patient does not stay overnight in the facility. 1. 03 Understand healthcare agencies, finances, and trends 25

Private Healthcare Agencies For-Profit Outpatient Adult Day Care 1. 03 Understand healthcare agencies, finances, and trends 26

Private Healthcare Agencies For-Profit Outpatient Doctors’ Offices 1. 03 Understand healthcare agencies, finances, and trends 27

Private Healthcare Agencies For-Profit Outpatient Emergency Care 1. 03 Understand healthcare agencies, finances, and trends 28

Private Healthcare Agencies For-Profit Outpatient Home Health 1. 03 Understand healthcare agencies, finances, and trends 29

Private Healthcare Agencies For-Profit Outpatient Hospice Care Life expectancy is less than 6 months Family care Patient care 1. 03 Understand healthcare agencies, finances, and trends 30

Private Healthcare Agencies For-Profit Outpatient Industrial Healthcare 1. 03 Understand healthcare agencies, finances, and trends 31

Private Healthcare Agencies For-Profit Outpatient Laboratory Services 1. 03 Understand healthcare agencies, finances, and trends 32

Private Healthcare Agencies For-Profit Outpatient Mental Health Services 1. 03 Understand healthcare agencies, finances, and trends 33

Private Healthcare Agencies For-Profit Outpatient Clinics 1. 03 Understand healthcare agencies, finances, and trends 34

Private Healthcare Agencies For-Profit Outpatient School Health Services 1. 03 Understand healthcare agencies, finances, and trends 35

1. 03 #2 PPP Healthcare Finances

Healthcare Finances Government Finances Private Finances 1. 03 Understand healthcare agencies, finances, and trends 37

Healthcare Finances Government Funded by taxes 1. 03 Understand healthcare agencies, finances, and trends 38

Healthcare Finances Government Medicare – Pays 80% of the charges for care – Serves patients • Over age 65 • Who have received social security disability benefits for at least 2 years • With end stage renal disease 1. 03 Understand healthcare agencies, finances, and trends 39

Healthcare Finances Government Medicare Plans A – hospital care B – outpatient medical care C- advantage plan D – medication 1. 03 Understand healthcare agencies, finances, and trends 40

Healthcare Finances Government Medicare Plan A (The original Medicare plan) – Automatically enrolled unless the patient specifically enrolls in a Medicare Advantage Plan (Part C) – Fee-for service – Pay a deductible and co-pay 1. 03 Understand healthcare agencies, finances, and trends 41

Healthcare Finances Government Medicare Plan A – Hospital insurance at no cost to most people – Coverage includes inpatient care skilled nursing facilities critical access hospitals Hospital stays hospice Some health 1. 03 Understand healthcare agencies, finances, and trends 42

Healthcare Finances Government Medicare Plan B (Medical Insurance) – – – Pays for necessary medical services and supplies Most people pay a premium for Plan B Covers outpatient care doctor’s services physical or occupational therapies additional home healthcare Medical supplies Preventive services 1. 03 Understand healthcare agencies, finances, and trends 43

Healthcare Finances Government Medicare Plan C – Combination of Part A and Part B – Provided through private insurance companies approved by Medicare – Option of adding Part D – Includes HMOs PPOs Private fee-for-service plans Medicare special needs 1. 03 Understand healthcare agencies, finances, and trends 44

Healthcare Finances Government Medicare Plan D – stand-alone prescription drug coverage – most people pay a premium – plans vary and cover different drugs – can choose the best plan for patient’s needs 1. 03 Understand healthcare agencies, finances, and trends 45

Healthcare Finances Government Medigap – A private individual insurance policy that pays the difference between the charges for care and the amount Medicare pays. 1. 03 Understand healthcare agencies, finances, and trends 46

Healthcare Finances Government Medicaid • Provides healthcare for: Provides • people with low incomes • children who qualify for assistance • people who are disabled or blind 1. 03 Understand healthcare agencies, finances, and trends 47

Healthcare Finances Government Medicaid – Funded by federal government but regulated by individual state government – Not all people with low income qualify 1. 03 Understand healthcare agencies, finances, and trends 48

Healthcare Finances Government TRICARE Military health plan Serves: Active duty personnel and family Survivors of military personnel Retired military personnel 1. 03 Understand healthcare agencies, finances, and trends 49

Healthcare Finances Government Veterans Health Administration Provides healthcare services to former military personnel 1. 03 Understand healthcare agencies, finances, and trends 50

Healthcare Finances Private Insurance – Individual insurance plan, the insured pays the total amount of the monthly premium Group insurance plan – the insured individual and their employer share the amount of the monthly premium 1. 03 Understand healthcare agencies, finances, and trends 51

Healthcare Finances Private Health Maintenance Organization (HMO) – care is directed toward prevention of disease – patient must see only HMO approved providers – pay a monthly fee, no additional charge for care – care from non-HMO provider generally not covered 1. 03 Understand healthcare agencies, finances, and trends 52

Healthcare Finances Private Preferred Provider Organization (PPO) – Group of doctors and/or hospitals that provide care to a specific group – PPO provides services to the insured at a reduced rate – Usually require a deductible and a co-pay – Less coverage for treatment provided by non. PPO provider 1. 03 Understand healthcare agencies, finances, and trends 53

Healthcare Finances Private Indemnity Plan ־ Traditional plan with freedom to visit physician of choice ־ No referral required by insurance company ־ Pay “up front” ־ Get reimbursed amount allowed by insurance policy; amounts may vary Indemnity plans allow you to direct your own health care and visit almost any doctor or hospital you like. The insurance company then pays a set portion of your total charges. Indemnity plans are also referred to as "fee-for-service" plans. 1. 03 Understand healthcare agencies, finances, and trends 54

CASH Healthcare Finances Private Out of pocket CASH CASH CASH 1. 03 Understand healthcare agencies, finances, and trends 55

Healthcare Finances Private Workers’ Compensation Pays for the healthcare of workers injured on the job http: //www. comp. state. nc. us 1. 03 Understand healthcare agencies, finances, and trends 56

1. 03 #3 PPP Healthcare Trends

Healthcare Trends Technology Telemedicine – Imaging procedures (digital x-rays) – Telehealth – Home telehealth 1. 03 Understand healthcare agencies, finances, and trends 58

Healthcare Trends Technology Robotic Surgery Shorter hospital stay Less pain and scarring Less wound infections Less blood loss Faster recovery Quicker return to normal activities 1. 03 Understand healthcare agencies, finances, and trends 59

Healthcare Trends Technology Health Information Management Systems – – Patient records Billing Scheduling Supply inventory 1. 03 Understand healthcare agencies, finances, and trends 60

Healthcare Trends Epidemiology Study of disease patterns within a population – Identifies risks of disease – Indicates methods of disease prevention or containment Changes in treatment – Advances in diagnostics – Early intervention – Development of treatment options Increased patient awareness and education 1. 03 Understand healthcare agencies, finances, and trends 61

Healthcare Trends Geriatric Care Need for geriatric care – People live longer – Average will continue to increase – Older people need more assistance – They need care more frequently 1. 03 Understand healthcare agencies, finances, and trends 62

Healthcare Trends Geriatric Care Geriatric care facilities – Adult Day Care – Independent living facilities – Nursing Homes – Retirement incomes 1. 03 Understand healthcare agencies, finances, and trends 63

Healthcare Trends Wellness Common wellness practices – Weight management – Health foods – Nutrition – Stress reduction – Healthy behaviors 1. 03 Understand healthcare agencies, finances, and trends 64

Healthcare Trends Cost Containment Measures Outpatient Care – Patient receives ambulatory care. – Does not stay overnight in the facility. 1. 03 Understand healthcare agencies, finances, and trends 65

Healthcare Trends Cost Containment Measures Diagnostic Related Groups (DRGs) – Classification of similar clinical conditions that have similar expected use of hospital resources – Criteria Diagnoses Procedures Age Sex Discharge status Presence of complications 1. 03 Understand healthcare agencies, finances, and trends 66

Healthcare Trends Cost Containment Measures Managed Care – Designed to reduce the cost of healthcare – Contacts with a specific group of providers – Requires prior approval to see a specialist 1. 03 Understand healthcare agencies, finances, and trends 67

Healthcare Trends Cost Containment Measures Preventative Care – Focus is to maintain wellness and to prevent illness – It is less expensive to maintain good health than to treat or cure an illness – Focus is on diet, exercise, and health maintenance activities such as yearly physicals, health screenings and immunizations 1. 03 Understand healthcare agencies, finances, and trends 68

Healthcare Trends Cost Containment Measures Energy Conservation – Reduce, Reuse, Recycle – Turn off electrical equipment when not in use – Maintain comfortable temperature – Use resources wisely 1. 03 Understand healthcare agencies, finances, and trends 69

Healthcare Trends Cost Containment Measures Outpatient Care Diagnostic Related Groups (DRGs) Managed Care Preventative Care Energy Conservation 1. 03 Understand healthcare agencies, finances, and trends 70