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Health Care Facilities

Health Care Facilities. Objectives. Students will be able to: Differentiate between private, public, and non-profit facilities.

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Health Care Facilities

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  1. Health Care Facilities

  2. Objectives • Students will be able to: • Differentiate between private, public, and non-profit facilities. • Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models. • Research the organizational structures and services of various types of health care facilities. • Differentiate between various types of health care insurance plans • Analyze the cause and effect on health care system change based on the influence of technology epidemiology, bio-ethics, socioeconomic and various forms of complimentary medicine

  3. Hospitals • Vary according to: • Size • Small • Large • Ownership • Proprietary / private / for profit • Nonprofit • Government • Religious • Services • General • Specialty

  4. 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 allows patients to use only the services they need, such as transportation or housekeeping.

  5. 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.

  6. Dental offices Clinics Optical centers Emergency Care Centers Laboratories Home Health Care Hospice Mental Health Genetic Counseling Centers Rehabilitation Health Maintenance Organizations (HMO’s) Industrial Care Centers School Health Services Other Types of Facilities

  7. Government Agencies • World Health Organization (WHO) • U.S. Department of Health and Human Services (USDHHS) • National Institute of Health (NIH) • Centers for Disease Control and Prevention (CDC) • Food and Drug Administration (FDA) • Agency for Health Care Policy And Research (AHCPR) • Occupational Health and Safety Administration • State and local health departments

  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

  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. Example: • Surgery in 2011=$6,750.00 • You have not met your $500 deductible yet • You must pay this amount first • $6,750-$500=$6250 • You have 80/20 co-insurance • $6250 x 80% (6250 x .8)=$5000 your insurance company pays • $6250 x 20% (6250 x .2)=$1250 you pay

  17. You do this one… • Procedure cost: $9,250.00 • Deductible: $500-has been met for the year • Co-insurance: 80/20 • How much do you pay? • How much does your insurance company pay?

  18. Answer: • $9250 x .2 = $1850 you pay • $9250 x .8 = $7400 your insurance company pays

  19. 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.

  20. 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.

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

  22. 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.

  23. 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.

  24. 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

  25. 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

  26. 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.

  27. 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.

  28. 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

  29. 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

  30. Organizational Structure • An tool designed to help a facility operate smoothly by outlining responsibilities • It describes the line of authority that establishes levels of responsibility and supervision

  31. Trends in Today’s Health Care Systems • Advances in technology • Epidemiology • Bio-ethics • Socioeconomics • Complementary (nontraditional) medicine

  32. Epidemiology Foundation Standard 3 3.14 Explain the impact of emerging issues such as technology, epidemiology, bioethics, and socioeconomics on healthcare delivery systems.

  33. What is epidemiology? • Epidemiology is the study of health and disease in human populations. • It’s all about public health. Photo courtesy of CDC/ Dr. David M. Morens, Dr. Steve Thacker, from the Public Health Image Library.

  34. Epidemiologists • Epidemiologists study • Communicable disease • Cardiovascular disease • Cancer • Mental illness • Accidents • And more…. • Literally – they “count”!

  35. Epidemiologists Count • For example, they count the number of times a condition (disease) occurs in relation to the total number of people. • We call that PREVALENCE • So, if we counted the number of children with asthma in a community and determined that 5% had asthma, we could say that the PREVALENCE of asthma is 5% in this specific community.

  36. Disease Detectives • Epidemiologists investigate disease outbreaks. • They determine where an outbreak came from, and how to prevent it. • Think if them as “disease detectives.” • What if…a number of students at your school become sick with a strange illness. What questions would you ask if you wanted to “investigate” the disease outbreak?

  37. Surveillance • Police watch a suspect or location to determine what is taking place. • Epidemiologists also practice SURVEILLANCE, but they are searching for and documenting disease. • SURVEILLANCE keeps track of a number of public health concerns, including abuse, violence, sexually transmitted diseases, and communicable disease outbreaks.

  38. Monitoring • MONITORING uses surveillance data to determine changes in the number of affected (or infected) people. • MONITORING tells us if there is more or less of a particular disease/condition. • These measurements are used to create a picture of how a disease is affecting society. Photo courtesy of CDC/ Edward Baker, M.D., M.P.H. from the Public Health Image Library.

  39. Incidence • INCIDENCE is the number of new cases of a disease or event in a specific population. Photo courtesy of CDC/ Barbara Rice, from the Public Health Image Library. • For example, epidemiologists might measure the incidence of influenza in children. • Is there anything you could measure the INCIDENCE of in your school?

  40. Morbidity • The number of cases of a specific disease in a specific period of time per unit of population, usually described as a number per 1000. • During an influenza epidemic, influenza MORBIDITY may reach 300/1000 in children. Photo courtesy of CDC/ Dr. John Noble, Jr, from the Public Health Image Library.

  41. Mortality • A measure of the number of deaths in a given population. • The Infant Mortality rate in America is 6.4 deaths per 1,000 live births. • Is the data in this chart important? Why? Photo courtesy of CDC, from the Public Health Image Library.

  42. Risk • RISK is the likelihood that someone will become infected or develop a condition. • RELATIVE RISK may change relevant to a specific factor. • A study reports that smokers face a relative risk of dying from lung cancer 24 times higher than non-smokers. Photo courtesy of CDC, Perry, from the Public Health Image Library.

  43. In Review, What Is ?? • Epidemiology • Prevalence • Surveillance • Monitoring • Incidence • Morbidity • Mortality • Risk • Relative Risk

  44. Now You’re Talking Epidemiology! • What is the impact of epidemiology on the healthcare delivery system? Photo courtesy of CDC/ Hsi Liu, Ph.D., MBA, James Gathany, from the Public Health Image Library.

  45. The End!

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