7 - 1 introduction to us health care text by dennis d. pointer, stephen j. williams, stephen l....

7 - 1

Introduction to US Health Care

• Text by

Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs &

James R. Knickman with Tracy Barr

• PowerPoints by Robin Pickering Eastern Washington University

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Chapter 7

Hospitals in the United States

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The Evolution of Hospitals

1. Refuge2. Physician

Workshop3. Business4. System

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Components of the Modern Hospitals

• The Board• Management• Medical Staff• Operational

Staff

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The BoardGovern the hospital

on behalf of the community,

shareholders, or constituents

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ManagementRun the

organization day-to-day…

(strategically, financially, and operationally)

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Medical StaffIndependent

practitioners who provide clinical

care

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Operational Staff

Staff who perform nonmedical, clinical, and

support duties

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Hospital Costs Increasing

• Advancement of medical technologies and treatments

• Cost of prescription drugs• Aging population• Lifestyle choices• Increased governmental

regulations and oversight

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General and Specialty Hospitals

• Offer variety of services

• Treat those that cannot pay

• Pass costs onto patients that can pay

•General Hospitals

•Specialty Hospitals

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General and Specialty Hospitals

• Treat specific group of patients

• Focused area of care

• Only treat those who can pay

•General Hospitals

•Specialty Hospitals

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Hospital Ownership Designation

• Nonprofit• Propriety • Federal• State or Local

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Effects of Increased Costs…

Provide most intense service to the sickest patients

Patients often need increased care after discharge

Ambulatory care more demanding

Primary care physicians less involved

Larger role of the hospitalist

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Competition in Health Care

Competition

Increased Costs

Decreased Costs

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Copyright Notice

© 2006 John Wiley & Sons, Inc. All rights reserved. Reproduction or translation of this work beyond that permitted in section 117 of the 1976 United States Copyright Act without express permission of the copyright owner is unlawful. Request for further information should be addressed to the Permissions Department, John Wiley & Sons, Inc. The purchaser may make back-up copies for his/her use only and not for distribution or resale. The Publisher assumes no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information herein.

All clipart and photos courtesy of Microsoft.com, unless otherwise noted.

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Chapter 8

Ambulatory Care

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Increasing Ambulatory Care

• Advances in technology

• Financial incentives

• Patient convenience

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Distribution of Visits

0 5 10 15 20 25 30

General and Family Practice

Internal Medicine

Pediatrics

Obstetrics and Gynecology

Orthopedic Surgery

Ophthalmology

All Others

*Percentage of visits across specialty

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Access to Ambulatory Care

0%5%

10%15%20%25%30%35%40%45%50%

Uninsured Hispanic Age 18-24

*Key predictors of access to care include insurance status, race, and age

Adults with No Regular Source of Care

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Payment for Ambulatory Care

0% 20% 40% 60%

Private Insurance

Medicare

Medicaid

Self-Pay

Worker's Comp.

No Charge

Other

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Ambulatory Care Settings

* Defined by service, not setting

•Physician Offices

•Emergency Rooms/ Outpatient Departments

•Urgent Care Facilities

•Same-Day Surgery Centers

•Community Health Centers / Clinics

•Student Health Centers

•Occupational Health Programs

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Ambulatory Care Providers

Psychologists

Optometrists

Physical Therapists

Podiatrists

Chiropractors Pharmacists

Dentists

Nurses

Physician Assistants

Physicians

Clinical Social Workers

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Physician Offices

Solo Practices• Individual physician

and other personnel

Group Practices• Three or more

physicians, other professionals

• Share resources…

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Home Health Care Services

• Skilled Nursing• Aide Care• Physical Therapy• Speech Therapy• Occupational Therapy

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Social Workers / Home Health Care

• Education and Referral• Financial Assistance Information• Psychosocial Assessment• Psychosocial Interventions• Crisis Intervention / Trauma Support

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Copyright Notice



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Chapter 9

Long-Term Care

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Long-Term Care Services

• Ambulatory medical services

• Inpatient medical services

• Mental-behavioral services

• Social services• Daily living

support services

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Primary Users of Long-Term Care

• People with temporary disabilities

• People with chronic health problems

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Personal Care Facilities

• Assisted living facilities

• Continuing care retirement communities

• Congregate care facilities

• Nursing homes• Alzheimer’s

/dementia facilities

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• Board-and-care facilities

• Adult foster care

Licensed by the state

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• Self-sufficient communities

• All personal and medical services

• Generally only accept healthy seniors

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• Similar to CCRCs but offer no health care services

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• Intermediate-level nursing and personal services

• Serve those who are temporarily or permanently unable to care for themselves

• All states require nursing homes

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Nursing Home Staffing

• Nursing aids• Social workers and case

managers• Dietitians, rehabilitation

therapists, and other health professionals

• Administrative personnel• Licensed nurses

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• Independent unit or component of assisted living facility

• Provide constant supervision

• Help with ADLs and personalized care

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Home Health Care Agencies

• Voluntary nonprofit• Government• Proprietary

Medicare Certified?

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Community-Based Care

• Adult day care• Respite care• Senior centers• Transportation• Meals on Wheels• Telephone reassurance

Area Agencies

on Aging

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Hospice Care

• Provide physical care and counseling to terminally ill patients and families

•Medical personnel

•Social workers and counselors

•Clergy

•Therapists

•Volunteers

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Copyright Notice



Check Your Understanding

• 1. Who owns governmental hospitals?

• A. the board of directors• B. taxpayers• C. the government• D. physicians who work there

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• 2. How does a specialty hospital differ from a general hospital?

• A it focuses on a particular health issue or a special population

• B. it generally requires greater length of stays

• C. its staff is comprised solely of specialists• D. all of the above

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• 3. The next phase of hospital evolution trends toward a shift from hospital care to outpatient care. What is one of the reasons for this shift?

• A. overburdened hospital medical staff• B. creation of independent emergency care

facilities• C. rising health care costs• D. falling numbers of community hospitals

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• 4. How is the role of the acute care hospital changing?

• A. the role of hospitals is growing as more people seek medical care in the hospital setting

• B. the role of hospitals is diminishing as more people seek medical care in outpatient settings

• C. the role of hospitals is diminishing due in part because of the expense of hospital care.

• D. B and C

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• 5.What is the greatest source of payment for ambulatory care?

• A. Medicare• B. Medicaid• C. Private insurances• D. Individual out-of-pocket

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• 6. In which healthcare setting are the majority of ambulatory care services provided?

• A. hospital outpatient departments• B. physician’s offices• C. community health clinics• D. emergency rooms and urgent care

clinics

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• 7. General practitioners and family physicians are the primary providers of ambulatory care.

• True or False?

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• 8. What kind of ambulatory services to community health centers offer?

• A. general medical care• B. emergency care• C. prenatal care• D. A and B• E. All of the above

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• 9. Home health and visiting nurses agencies are most likely to serve which patients?

• A. the elderly and those who are homebound

• B. those with chronic conditions• C. those just released form the hospital• D. A and C• E. All of the above

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• 10. What is the most common reason for accessing ambulatory care?

• A. preventive care• B. symptoms of illness• C. obstetric care• D. follow-up care

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• 11. Long-term care is healthcare provided only to those suffering from lengthy illness or disabling accidents.

• True or False?

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• 12. Assisted living facilities offer what types of services?

• A. skilled medical care• B. emergency care• C. help with certain activities of

daily living• D. care for Alzheimer’s patients

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• 13. A potential resident of a continuing care retirement community must meet which of the following criteria?

• A. be referred to the facility by a doctor• B. be healthy• C. have no assets greater than an amount

specified by the state in which the retirement community exists

• D. have private insurance7 - 53


• 14. Alzheimer’s facilities are highly regulated by state health departments because of the vulnerability of the population they serve.

• True or False?

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• 15. The most common type of rehabilitation centers focus are:

• A. fitness facilities• B. mental health facilities• C. drug rehabilitation facilities• D. none of the above

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• 16. Because of the complex nature of the conditions they treat, all rehabilitation centers are residential facilities.

• True or False?

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• 17. Hospice care is end-of-life care for patients who are terminally ill.

• True or False?

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• 18. The counseling component is a large part of hospice care.

• True or False?

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• 19. Because of the debilitating nature of many conditions requiring rehab, most rehab patients participate in rehab for years.

• True or False?

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7 - 1 introduction to us health care text by dennis d. pointer, stephen j. williams, stephen l....

Documents

ambulatory care slide

clinical care slide

specialty slide

local slide

oversight slide

hospitalist slide

system slide

increased care