UNIT A

Health Care Systems

AH-II

Objectives:

Analyze health care facilities including government, profit and non-profit agencies.

Explore health insurance, organizational structure, and trends in health care.

Assignment

Read Unit-1 on page 8-23 Complete review questions 1-8.

Health Care Facilities

General Hospitals

General Hospitals Treat a wide range of conditions & age groups: usually provide diagnostic, medical, surgical & emergency care services. Patients usually stays a few days to a week.

Specialty Hospitals

Specialty Hospitals provide care for special illnesses or age groups: example would be burn, oncology or psychiatric hospitals. Patients are generally hospitalized over a long time.

Government Hospitals

Government Hospitals operate by federal, state & local government agencies. Facilities. Facilities are located all over the world to provide care for government services personnel & their dependants. Examples of Government hospitals are Veterans Administration hospitals & state psychiatric hospitals.

University/College Medical Centers

University/College Medical Centers provide hospital services along with research & education; can be funded by private and/or governmental services.

Long-Term Care Facilities

Long-term care facilities are nursing homes or geriatric homes (convalescent care) mainly provide assistance & care for elderly patients, usually called residents. Also provides care for disabled or handicapped and individuals with chronic long-term illness.

Extended Care Facilities

Extended care facilities or skilled care facilities provides skilled nursing or/and rehabilitative care to prepare patients to return home, recover from major illness or surgery. Examples: Treatments for cancer, dialysis or heart monitoring.

Independent Living Facilities

Independent living facilities allows individuals who can take care of themselves to rent or purchase an apartment in the facility; provides services such as meals, housekeeping, laundry, medical care & social events.

Medical Offices

Services vary from offices that are privately owned by one physician to large complexes that operate as corporations and employ many physicians and other health care professionals. Services offered range from physical exams, treatments, basic lab testing and minor surgery.

Medical Specialties Include

Obstetrics Cardiology Pediatrics

Dental Offices

Dental offices vary in size. Some offices are privately owned by one or more dentist. Dentist can work for major or retail department stores. Some dentist provide general care for all age groups or specialized care offered to a certain age group.

Clinics or Satellite Centers

Clinics or satellite centers performs minor surgical procedures. Called frequently “one-day” surgical centers that send patients home immediately after they

recover from their operation.

Urgent or Emergency Care Clinics

Urgent or emergency care clinics provide first aid or emergency care to the ill or injured patients.

Rehabilitation Clinics

Rehabilitation clinics offer physical, occupational, speech and other similar therapies.

Laboratories

Laboratories are often a part of other facilities but can operate as a separate health care service. Medical laboratories can perform special diagnostic tests such as blood or urine test. Dental labs can prepare dentures and many other devices used to repair or replace teeth.

Home Health Care Agencies

Home health care agencies are designed to provide care in a patients home. The services are frequently used by elderly & disabled. Examples such as occupational, speech, homemaking, personal and/or respiratory care.

Hospice Agencies

Hospice agencies provide care for terminally ill persons with life expectancies of six months or less. Care is provided in a person;s home or in a hospice facility. Hospice allows the person to die with dignity & in comfort. Psychological, social, spiritual & financial counseling are provided for both the patient & the family.

Government Agencies

World Health Organization (WHO)-

Complies statistics and information on disease, publishes health information.

U.S. Department of Health & Health Services (DHHS)

National agency that deals with the health problems in the U.S.

National Institutes of Health (NIH)

Involved in disease research.

Centers for Disease Control & Prevention

Concerned with causes, spread, & control of diseases in populations.

Food & Drug Administration

Federal agency responsible for regulating food & drug products sold to the public.

Health Maintenance Organization (HMO’s)

Another type of insurance plan that is focused on preventative care. A monthly fee or premium is paid for membership, and the fee stays the same regardless of the amount of healthcare used. The premium can be paid by an employer and/or an individual. The disadvantages of an HMO is that the insured is required to use only HMO-affiliated healthcare providers, labs & hospitals. If patient chooses a non-affiliated provider, the patient pays for the care.

Mental Health Facilities

Mental health facilities treat patients with mental disorders & diseases.

        

      

Health Maintenance Organizations

(HMOs) provide total healthcare directed toward preventive health care. Services include examinations, basic medical services, health education & hospitalization or rehabilitation services.

Industrial Health Care

Industrial health care centers or occupational health clinics are found in large companies or industries. Such centers provide health care for employees of the industry or business by performing basic examinations, teaching, accident, safety prevention & emergency care.

School Health Services

School health services are found in schools & colleges. Examples of services provided include:

Emergency care or sudden illnesses

Screening for speech, hearing & vision problems.

Health Education Counseling Maintaining a safe school

Occupational Safety & Health Administration

(OSHA) OSHA establishes

& enforces standards that protect workers from job-related injuries & illnesses.

Health Departments

Health Departments provide health services as directed by the U.S. Department of Health & Human Services (USDHHS) Example of services such as immunizations, inspections of restaurants, communicable diseases, collection of statistics, health education, record related to health & clinics for health care prevention.

                                                      

      

Voluntary or Nonprofit Agencies Voluntary or Nonprofit Agencies are

supported by donations, memberships fees, fundraisers & federal or state grants. They provide health services at national, state & local levels.

Examples of nonprofit agencies include:

American Heart Association American Diabetes Association National Association of Mental Health National Foundation of the March of

Dimes American Red Cross

Health Insurance Plans

Health insurance plans help pay for the costs of health care. Health insurance plans are offered by several thousand insurance agencies. A common example is Blue Cross/Blue Shield. When an insured individual has health care expenses covered by the insurance plan, the insurance company pays for the services. The amount of payment & the type of services covered vary from plan to plan.

Common Insurance Terms Deductibles:amounts that must be paid by the patient

for medical services before the policy begins to pay.

Co-insurance: requires that specific percentages of expenses be shared by the patient & insurance companies; for example, in as 80/20 % co-insurance, the company pays 80% of covered expenses & patient pays remaining 20%.

Co-payment: a specific amount of money a patient pays for a particular service; for example, $10 for each physician visit regardless of the total cost of the visit.

Premium – monthly cost for insurance

Health Maintenance Organization

(HMO) (HMO) is another type of health insurance plan,

a monthly fee or premium is paid for membership, and the fee stays the same regardless of the amount of healthcare used. The premium can be paid by an employer and/or an individual. Total care provided is directed toward preventive type healthcare. The disadvantage of an HMO is that the insured is required to use only HMO-affiliated healthcare providers, labs or hospitals for healthcare. If the patient chooses a nonaffiliated provider, the patient pays for the care.

Preferred Provider Organization

(PPO) (PPO) is another type of health insurance

plan. It is usually provided by large industries or companies to their employees. The industry or company forms a contract with certain health care agencies, such as a large hospital, specific dentists or doctors to provide care at a reduced rate. Employees are restricted to using only the specific hospital and or physicians.

Medicare

Medicare is a federal government program that provides health care for almost all individuals over the age of 65 and for any person with a disability who has received Social Security benefits for at least two years.

Medicare Two Types:

Type A: Covers hospital services and care provided by an extended care facility or home care agency with hospitalization.

Type B : Offers additional coverage for doctors services, outpatient treatment, therapy, & other health care. Individual pays a premium for types B coverage & also must pay an initial deductible for services. Medicare pays for only 80% of services; the patient must either pay the balance or have another insurance policy to cover expenses.

Medicaid

Medicaid is a medical assistance program operated by individual states. This program usually pays for the health care for the low income, children who qualify for public assistance & individuals who are physically disabled or blind.

Worker’s Compensation

Worker’s Compensation is a health insurance plan providing treatment for workers injured on the job. It is administered by the state. Payments are made by employers & the state. This plan also pays the worker for wages lost because of on the job injuries.

Tricare, formerly called CHAMPUS, the civilian health and medical programs for the uniform services, is a U.S. government health insurance plan for all military personnel. It provides care for all active duty members & their families survivors of military personnel & retired members of the Armed Forces.

Managed Care Managed Care is an approach that has developed in

response to rising health care costs. All health care provided to a patient must have a purpose & a verification of need is frequently required before care can be provided. Every effort is made to provide preventative care & early diagnosis of disease in order to avoid the high cost o treating disease. The health care consumer who is enrolled in a managed care plan receives quality care at the most reasonable cost but is restricted in choice of healthcare providers.

Trends in the Health Care

Cost Containment -To save money by buying hospital supplies in bulk.

Cap on malpractice settlements. Outpatient services DRG’s Wellness

Alternative Methods of Health Care

Chi Acupuncture Herbs

DRG’s Diagnostic Related Groups

A group of diagnosis codes used with Medicare patients to keep cost down.

The codes allow only certain procedures to be preformed on the patient. I.e. Chest X-ray code 969

Dx-pneumonia

National Health Care Plan

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THE END