1 / 28

Organization of Care

Organization of Care. M6920 October 16, 2001. Basic Policy (scope & goal) Organizational Structure Economic Support Staffing. Facilities Supplies Delivery Patterns Preventive Services Regulations. Comparing Health Systems*. * Adapted from Roemer, Comparative Health Systems.

hea
Download Presentation

Organization of Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Organization of Care M6920 October 16, 2001

  2. Basic Policy (scope & goal) Organizational Structure Economic Support Staffing Facilities Supplies Delivery Patterns Preventive Services Regulations Comparing Health Systems* * Adapted from Roemer, Comparative Health Systems M6920, Fall, 2001

  3. Basic Policy (scope & goal) • Who will be served? • Intended to • cure the ill? • prevent disease? • meet economic goals of participants? M6920, Fall, 2001

  4. Organizational Structure • Ministry of health • Competition among components • National or regional M6920, Fall, 2001

  5. Economic Support • Personal finances • Taxation • Pooled funding (insurance) • Voluntary (charity) M6920, Fall, 2001

  6. Staffing • Highly professionalized • trained in-country • imported • Many paraprofessionals • Volunteers M6920, Fall, 2001

  7. Facilities • Hospitals • community • referral • tertiary • Clinics • Solo practitioner offices • Health posts/outreach centers M6920, Fall, 2001

  8. Supplies • Centrally managed? • Locally produced or imported? • Global budget? M6920, Fall, 2001

  9. Delivery Patterns • Entry point for care • Continuity of care • Gatekeepers • Decision-makers M6920, Fall, 2001

  10. Preventive Services • Priority • Inclusion in personal care • Funding M6920, Fall, 2001

  11. Regulations • National or regional • Scope • Support for enforcement M6920, Fall, 2001

  12. No overarching policy Decentralized structure Mixed economic support Physician-led hierarchy Hospital based ? Supplies from private sector Mixed delivery pattern Increasing preventive services State-based regulation The US non-system M6920, Fall, 2001

  13. Organizational questions: • How are the various portions of the system of care-giving connected to one another? • Who connects the system and facilitates or controls access? M6920, Fall, 2001

  14. Special concerns • Vulnerable groups • Physical, social, economic, psychological reason • Feared bad outcome • a condition, a treatment failure, some other problem? • Size of a population group M6920, Fall, 2001

  15. Healthy family? Family with chronic condition? Primary care provider? Specialist? Hospital? Insurer? Employer/ purchaser? Perspectives on an ideal system M6920, Fall, 2001

  16. entry point practitioner clinic E.R. time of entry routine/maintenance specific symptom traumatic event payment source self indemnity insurance capitated plan structure of system independent units vertically integrated Major axes of comparison M6920, Fall, 2001

  17. Hospitals • originally charity or public entities • 6500 community hospitals in US • 1400 are city, state, county • proprietary • multi-hospital systems (horizontal integration) • vertically integrated systems M6920, Fall, 2001

  18. individual entrepreneur contract railroads mining companies unions multi-specialty groups salaried fee for service capitated institutionally based Practitioners M6920, Fall, 2001

  19. Special populations • Frontier Nursing Service • community mental health centers • public health department clinics • family planning clinics--4000 clinics • Ryan White programs • Health care for homeless M6920, Fall, 2001

  20. Migrant/community health centers • 600 at 2500 sites • 14% of eligible migrants served M6920, Fall, 2001

  21. We reorganize when • A new technology is discovered • A new type of worker enters the process • Another method is more financially viable or more profitable M6920, Fall, 2001

  22. New York City Hospitals Operating Margins, 1999 M6920, Fall, 2001

  23. New York City Hospitals Payer Mix and Use, 1999 M6920, Fall, 2001

  24. Reimbursement • Fee for service--payment per procedure • can be provider or hospital • Fee for service--payment per episode • Payment per day • hospitals • private duty RN M6920, Fall, 2001

  25. Reimbursement, cont. • Salary--payment per hour/week/month • staff model HMO • typical nurse payment • Capitation • could go to hospital via HMO contract • with and without risk • Global budget--for hospital M6920, Fall, 2001

  26. Setting level of payment • payment for procedures • limits via fee setting haven't worked • payment for intellectual activity • RBRVS • what the market will bear • Bargained collectively--union model • Open competition • Professional agreement M6920, Fall, 2001

  27. Managed care can be socially responsible if it • enrolls a representative segment of the population • identifies and acts on opportunities to improve community health • participates in community-wide data sharing • includes community in governance M6920, Fall, 2001

  28. and it. . . • participates in health professions education • collaborates with public health infrastructure • advocates publicly for health promotion/disease prevention policies M6920, Fall, 2001

More Related