Health Care Facilities

1. Health Care Facilities

2. Hospitals • Vary according to: • Size • Small • Large • Ownership • Proprietary / private / for profit • Nonprofit • Government • Religious • Services • General (Diagnostic, medical, surgical, and emergency care) • Specialty (Patients needing long-term stays; chronic diseases, psychiatric problems, pulmonary rehab)

3. Long-Term Care Facilities • Provide long-term care for elderly patients and for patients in rehabilitation. • Levels of long-term care: • A nursing home provides care for patients who can no longer care for themselves. • An independent living facility (assisted living) allows patients to use only the services they need, such as transportation or housekeeping.

4. Medical Offices • May be operated by one or two doctors or a large groups of health care professionals. • Some medical offices treat a wide range of conditions. • Others are specialized for specific ages or medical conditions.

5. Other Types of Facilities • Physician and dental facilities – illness dx, simple surgery, counseling, diagnostic services, x-rays, admin of drugs • Rehab Centers – outpatient care for physical, occupational, recreational, speech, or hydrotherapy • Industrial Healthcare facilities – located in large companies and industrial facilities to provide care to staff • School Health Services – provide emergency care of accidents, illnesses in a school setting. Provide care of chronic conditions that need monitoring • HMOs – mananged care organization that stresses wellness as preventative care. Provides immunizations, check-ups, education, basic medical services

6. Other Types of Facilities • Home Health Agencies – provide care in home that don’t need hospitalization; includes nursing, PT, personal care, and homemaking • World Health Organization (WHO) – funded by the United Nations; concerned with world health problems and publishes public health information • Hospices – end of life care to patients expected to live 6 months or less.

7. Government Agencies • Veterans Administration hospitals – provides care to veterans • US Public Health Department • State Psychiatric hospitals – serve the mentally ill • State Public Health Services – provide health education materials • US Department of Health and Human Services (USDHHS) – protects health of all Americans by providing vital human services • National Institute of Health (NIH) – agency for conducting and supporting medical research • FDA – safety of foods, cosmetics, pharmaceuticals, biological products • OSHA – safety to prevent injury, illness, and death in the workplace

8. Volunteer and Nonprofit Agencies • American Cancer Society • American Heart Association • American Red Cross • National Association of Mental Health • National Foundation of the March of Dimes • American Diabetes Association • National Association of Mental Health • National Coalition Against Domestic Violence

9. Health Insurance Plans

10. Health Care Systems • Nearly every industrialized country has a national health care system. • Some countries have public or national health care systems, and other countries have private health care systems.

11. Public / NationalHealth Care Systems • Mainly funded by taxes and social security insurance. • Advantage – Every citizen is guaranteed health care regardless of economic status. • Disadvantages – Health care is not always comprehensive, and taxes may be higher. • Norway, France, the United Kingdom, and Canada

12. Private Health Care Systems • Mainly funded by private insurance agencies and out-of-pocket payments. • Advantages – Coverage is often comprehensive, taxes may be lower, and economic growth is stimulated. • Disadvantage – Not every citizen is guaranteed health care. • United States and Switzerland

13. Mixed Systems • Very few countries have a purely public or private system • Most countries create a mixed system by using various funding sources to cover health care expenses. • Example: Canada and the United States

14. Health Insurance • The rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families. • In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses.

15. Health Insurance Terms • Premium – the amount paid to an insurance agency for a health insurance policy • Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments • Co-payment - an amount paid by the patient for a certain service • Out-of-pocket - a medical bill that must be paid by the patient

16. Individual and Group Insurance • Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage. • Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.

17. Managed Care • Two primary concepts of managed care: • To promote good health • To practice preventive medicine • Managed care plans offer medical services through a system of health care providers. The system of providers offers services at reduced rates.

18. Managed Care • Health Maintenance Organizations • Preferred Provider Organizations • Point of Service

19. Health Maintenance Organizations • Clients must pay a premium, deductible, and co-payments. • Clients must visit in-network doctors and select a primary care physician. • HMOs urge clients to practice healthy living and to receive preventive treatments.

20. Preferred Provider Organization • Clients must pay a premium, deductible, and co-payments. • Clients do not have to choose a primary care physician. • Clients may visit non-network physicians, but coverage is greater with in-network physicians. • PPOs often have other fees and co-payments.

21. Point of Service • Clients must pay a premium. • Clients must chose a primary care physician. • For in-network physicians, there is usually no deductible and co-payments are low. • Specialists may be non-network physicians, but coverage may be limited

22. Government Programs • In the 20th century, the United States government began to realize the need for public medical assistance. • In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance. • Medicaid • Medicare

23. Medicaid • Income or needs based program • Designed by the federal government, but administered by state governments • Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled.

24. Medicare • Program for any citizen age 65 or older • Administered by the federal government • After an individual pays a deductible, Medicare will cover 80% of all medical expenses.

25. Medicare Services • Part A: Hospital Care • Hospitalization • Skilled nursing facilities • Home health care • Hospice care • Long-term care facilities • Part B: Outpatient Services • Medical expenses, including therapy, medical equipment, and testing • Preventive Care

26. Worker’s Compensation • Provides treatment for workers injured on the job • Administered by the state • Reimburses the worker for wages lost because of on-the-job injury