Health Care Systems Introduction Various health

Health Care Systems

Introduction • Various health care systems deliver health care • Health care is one of the largest and fastest growing industries in the United States • Employs over 10 million workers in over 200 careers • Two billion dollar per day business

Hospitals • Vary in size and type of service provided • General hospitals treat wide range of conditions Specialty Hospitals • Care for certain conditions or age groups • Examples: burn, oncology or cancer, pediatric or children, psychiatric, rehabilitation, and orthopaedic

Government Hospitals • Operated by federal, state, and local government agencies • World-wide facilities for government service personnel and their dependents • Veteran’s Administration hospitals • State psychiatric hospitals • State rehabilitation centers

University or College Medical Centers • Provide services, research and education • Can be funded by private or government sources

Hospitals one of the major types of health care facilities. Vary in size and type of services offered Classification based on funding received A. Private – operated for profit – usually by pt. fees and/or organizations that provide financial support. B. Religious – religious support & Pt. fees C. Nonprofit or voluntary – Pt. fees & donations. D. Government – Tax monies and/or Pt. fees

Long Term Care Facilities (LTC or LTCF) • Provide care for elderly, individuals with chronic of long-term illness • Individuals receiving care usually called residents instead of patients (or clients)

Long-term care facilities Nursing homes or geriatric homes • Provide basic physical and emotional care • Usually for individuals who cannot care for themselves • Help individuals with activities or daily living (ADLs), provide a safe and secure environment, and promote opportunities for social interactions

Extended care or skilled care facilities • Provide skilled nursing and rehabilitative care • Prepare resident for return to home environment or other long-term facility • Some have subacute units: provide rehabilitation services for major illness or surgery, treatment for cancer, or treatments such as dialysis or heart monitoring

Extended care or skilled care facilities • Independent or assisted living facilities: individuals purchase or rent unit and can receive services such as meals, housekeeping, laundry, transportation, social events, and basic medical care

Medical Offices Services • Diagnosis • Treatment • Examinations • Basic laboratory tests • Minor Surgery • Specialties (Examples include: Pediatrics, Cardiology, and Obstetrics)

Dental Offices • Private offices to dental clinics employing several dentists • Dental clinics now found in major retail/department stores • Can provide general or specialized dental care

Clinics Satellite Clinics or Satellite Centers • Found in many types of health care • Can refer to group of medical/dental doctors who share a facility and other personnel

Clinics • Other clinics operated by corporation or private groups and provide special care: • Surgical clinics or surgicenters • Emergency care clinics • Rehabilitation clinics • Specialty Clinics: Diabetes or oncology (cancer) clinics • Hospitals often operate clinics such as outpatient clinics

Clinics • Health Departments offer clinics such as… – Pediatric care – Sexually transmitted diseases – Respiratory diseases – Immunizations • Medical Centers also sponsor clinics

Optical Centers • Can be individually owned by an ophthalmologist (eye doctor) or optometrist (eye specialist) or be part of a large chain of stores • Provide vision examinations • Prescribe eye glasses or contact lenses • Check for the presence of eye diseases

Emergency Care Services • Provide special care for accidents or sudden illness • Ambulance services: private and governmental • Rescue squads: frequently operated by fire departments • Emergency care clinics • ERs operated by hospitals • Helicopter or airplanes

Laboratories • Can be part of other facility or operated as separate health care service • Medical laboratories: perform diagnostic tests • Dental laboratories: prepare dentures and other devices

Home Health Care • Provide care in patient’s home • Examples of care… • Nursing care • Personal care: bathing dressing, and so forth • Therapy: physical, occupational, speech, respiratory • Homemaking: food preparation, cleaning, washing, and so forth

Hospice • Provide care for terminally ill persons with life expectancy of six months or less • Care provided in person’s home or hospice facility • Allows person to die with dignity and in comfort • Provides psychological, social, spiritual, and financial counseling for both patient and family

Mental Health Facilities • Deal with mental diseases and disorders • Examples… • Guidance and counseling centers • Psychiatric clinics and hospitals • Chemical abuse treatment centers for alcohol/drug abuse • Physical abuse treatment centers (child or spouse abuse)

Genetic Counseling Centers • Perform prenatal (before birth) screening tests • Checking for genetic abnormalities and birth defects • Explaining the results of the tests • Identifying medical options when a birth defect is present • Helping individuals cope with the psychological issues caused by a genetic disorder

Rehabilitation Centers • Provide care directed at helping patient with physical or mental disabilities obtain maximum self-care and function • Can include hospitals, clinics, and/or private centers • Services can include physical, occupational, recreational, speech, and hearing therapies

Industrial Health Care Centers • Located in large industries or companies • Provide care for employees of the industry • Services: basic exams, teach accident prevention/safety, provide emergency care

School Health Service • Found in schools and colleges and provide the following services… • Emergency care for accidents and sudden illness • Tests to check for health conditions: speech, vision, hearing, and so forth • Promote health education • Maintain safe and sanitary school environment • Counseling

Government Agencies • World Health Organization • International agency sponsored by United Nations • Compiles statistics and information on disease • Publishes health information • Investigates and deals with serious health problems throughout the world

United States Department of Health and Human Services 1. National Institutes of Health (NIH): research on disease 2. Centers for Disease Control and Prevention (CDC): causes, spread and control of diseases in populations 3. Food and Drug Administration (FDA): regulates food and drug products sold to the public

United States Department of Health and Human Services 4. Agency for Health Care Policy and Research (AHCPR): established in 1990 to research the quality of health care delivery and identify the standards of treatment that should by provided by health care facilities 5. Occupational Safety and Health Administration (OSHA): establishes and enforces standards that protect workers from job-related injuries and illnesses

Health Departments • Provide specific services needed by state or local community • Immunization for disease control • Inspections for environmental health and sanitation • Health education • Collection of statistics and health records

Nonprofit / Volunteer Agencies • Supported by donations, membership fees, fundraisers, and federal or state grants • Provide health services at national, state, and local levels

Nonprofit / Volunteer Agencies • Examples… • American Cancer Society • American Heart Association • American Respiratory Disease Association • American Diabetes Association • National Association of Mental Health • National Foundation of March of Dimes • American Red Cross • HOSA

Health Insurance Plans • Premium – the payment a customer must make to an insurance company • Deductibles – amounts that must be paid by the pt for medical services before the policy begins to pay

• Co-insurance – requires that specific percentages of expenses be shared by the pt & insurance company Example: 80/20 – company pays 80% and pt pays 20% of covered expenses • Co-payment – a specific amount of money a pt pays for a particular service Example: $20 co-pay means pt must pay $20 for each physician visit

Health Insurance Plans • Health Maintenance Organizations (HMO) • Preferred Provider Organization (PPO) • Medicare – Type A – Type B • Medicaid • Workers’ Compensation • TRICARE Using textbook pgs 33 -34, provide a brief description of each type of insurance plan

Health Maintenance Organizations • Preventive health care • Examinations • Basic medical services • Health Education • Hospitalization • Rehabilitation services

Preferred Provider Organization (PPO) • Type of health insurance plan provided by large industries or companies to their employees. • Companies form contracts with health care agencies to provide certain types of health care at reduced rates. • Employees are restricted to using the specific agency under contract.

Medicare • Federal government program that provides health care for almost all individuals 65 and over and for any person with a disability who has received Social Security benefits for at least 2 years • Type A: hospital services and care provided by an extended care facility or home-health care agency • Type B: additional coverage for doctors’ services, outpatient treatment, therapy, and other health care

Medicare • Type A: Medicare pays 80%; patient has to pay the balance • Type B: patient pays premium for coverage and also has a deductible

Medicaid • Medical assistance program operated by individual states • Usually pays for health care of low income, children who qualify for public assistance and those physically disabled or blind • Provides inpatient and outpatient services, surgical, medical, lab, x-rays, well baby and well child care

Worker’s Compensation • Provides treatment for workers injured on job • Administered by state • Payments made by employers and state • Pays missed wages also

TRICARE • Health insurance for all military personnel • Active duty member and family, survivors of military personnel, and retired members of Armed Forces • Veterans Administration provides for military veterans

Managed Care • Principle behind managed care is that all health care provided has a purpose • Second opinion or verification of need required • Preventative care and early diagnosis of disease provided to prevent high cost of treating disease

Summary • Many different types of health care facilities • Employ many types of health care workers • Important to be aware of facilities and type of services • Important to be aware of different insurance plans