Chapter 2

1. Chapter 2 Health Care Systems

2. 2:1 Private Health Care Facilities • Growth—one of the largest and fastest growing industries in the United States • Employment opportunities—employs over 13 million workers in over 200 careers • Expenditures—it is a four-billion-dollar-per-day business and growing (continues)

3. Private Health Care Facilities(continued) • Hospitals • Long-term care facilities (LTC or LTCF) • Independent living and assisted living • Medical offices • Dental offices • Clinics or satellite centers • Optical centers

4. Private Health Care Facilities(continued) • Emergency care services • Laboratories • Home health care • Hospice agencies • Mental health facilities • Genetic counseling centers • Rehabilitation facilities (continues)

5. Private Health Care Facilities(continued) • Health maintenance organizations (HMOs) • Industrial health care centers or occupational health clinics • School health services

6. 2:2 Government Agencies • Government services are tax supported • World Health Organization (WHO) • U.S. Department of Health and Human Services (USDHHS) • National Institutes of Health (NIH) • Centers for Disease Control and Prevention (CDC) (continues)

7. Government Agencies(continued) • Food and Drug Administration (FDA) • Agency for Health Care Policy and Research (AHCPR) • Occupational Safety and Health Administration (OSHA) • Health Departments

8. 2:3 Voluntary or Nonprofit Agencies • Supported by donations, membership fees, fundraisers and grants • Health services are provided at national, state, and local levels • Examples include the American Cancer Society, March of Dimes, American Red Cross and many more (continues)

9. Voluntary or Nonprofit Agencies(continued) • Organizations focus on specific diseases • Educate the public • Provide special services • Purchase medical equipment • Staffed by many health care workers and volunteers

10. 2:4 Health Insurance Plans • Health care costs are rising faster than other costs of living • Most people rely on health insurance plans to pay for health care costs • Without insurance, the cost of an illness can become a financial disaster

11. Insurance Terminology • Deductible • Co-insurance • Co-payment All are amounts that must be paid by the insured individual. Expenses are shared by the individual and the company. 80-20%: company pays 80%, insured pays 20%.

12. Types of Plans • Health insurance plans • Health maintenance organization (HMO)-pay monthly fee or premium • Preferred provider organization (PPO)-usually provided to employees of industries/companies; can use only providers affiliated with the health care provider • Medicare- (65 > or persons w/a permanent disability) (continues)

13. Types of Plans(continued) • Medicaid • The State Children’s Health Insurance Program (SCHIP) • Worker’s Compensation • U.S. government plans for all military personnel and their families (TRICARE or CHAMPUS) • Managed care plans

14. HIPAA Health Information Portability Accountability Act Set of federal regulations adopted to protect the confidentiality of patient information and the ability to retain health insurance coverage. • Five components • Health care access • Preventing health care fraud • Tax-related health provisions • Application and enforcement of group health plan requirements • Revenue offsets • Health Information Portability Accountability Act

15. 2:5 Organizational Structure • Line of authority or chain of command • Indicates areas of responsibility • Goal: most efficient operation of facility • Complex or simple structure determined by size and needs of organization • Sample organizational charts (See Figure 2-4 and 2-5 in text) (continues)

16. Organizational Structure(continued) • The line of authority must be clearly indicated in any organizational structure • Workers must identify and understand their position in the structure • To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor