Health Care Systems

1. Health Care Systems Structure and Funding

2. Health Care System: Hospitals • General Hospitals • Specialty Hospitals: cancer, psychiatric, orthopedic, rehabilitation • Government Hospitals: county, VA, • University Medical Centers: research and education like UAB

3. Health Care System: Long term care facilitates • Residential care: nursing homes where patient live out their lives • Extended care (skilled care): provide care to prepare person to return home • Independent and assisted living centers: provide services to assist in independent living such as provide meals, medication, housekeeping

4. Health Care System: other options Medical office Dental office Clinic Vision/Hearing/ Splints/Artificial limbs/Braces Emergency care Laboratories Home health agencies Hospice 9. Mental Health 10. Rehabilitation 11. Occupation health (work) 12. School health

5. Government Agency • UN World Health Organization (WHO) • US Department of Health and Human Services (HHS): in the president’s cabinet • National Institute of Health: (NIH) research • Centers for Disease Control (CDC) • Food and Drug Administration (FDA) • Occupational Safety and Health Administration (OSHA): job safety • Local Health Departments: teach, treat, inspect restaurants, collect data

6. What is Insurance? • Pooled/ or shared risk • History • Ancient Chinese farmers and their grain • Roman burial clubs • Medieval European guilds • Lloyd’s Coffee House London • 1st health insurance plan: California physicians start pre-paid plan for their services 1934

7. Traditional Health Insurance Company • The same monthly premium (fee) • Deductible is the amount that must be paid by the patient before insurance begins to pay • Co-insurance describes the specific percentage of expenses that are shared by the patient and the insurance company after the deductible has been paid (80:20) • Co-payment is a specific amount a patient pays for each particular service and is not part of the deductible.

8. Solve the following problem Jack’s insurance Premium $50 Deductible $500 Co-insurance 80:20 Co-pay $20 Jack’s hospital bill is $1750 Jack’s hospital bill is $450. How much does Jack pay? How much does his insurance company pay?

9. Health Maintenance Organization (HMO) • Type of health insurance plan • The same monthly fee is paid no matter how many services are used • No deductible or co-pay • Member can only use HMO affiliated providers • Focuses on preventive care

10. Preferred Provider Plan (PPO) • PPO forms a contract with specific doctors or 1 or 2 large hospitals who agree to charge less for increased volume • Usually require a deductible and co-pay • Patients have more choice of providers

11. Medicare • Program of the Federal Government • Health care for a. persons over 65 years old b. persons with a disability who have received Social Security for at least 2 years c. any one with end stage renal (kidney) disease

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13. Medicaid • State and Federally funded program • Managed by the states • Covers • Individuals with low income • Children • Physically disabled not covered by Medicare • Blind

14. Worker's Compensation • Provide treatment for workers injured onthe job • Administered by the state • Premiums are paid by employers and the state • Money is paid out for health care and reimbursement for lost wages

15. What is Managed Care? • An approach that has developed in response to rising costs • Be Efficient and Avoid Waste • Second opinion • Preventive care • Early diagnosis • Wellness education • Limit options in drugs • HMOs and PPOs are examples

16. HIPAA provisions about insurance • Limits the use of pre-existing conditions to deny insurance • Guarantees renewability in employer's plan • Special options for those who lose insurance due to losing one’s job • Strict confidentiality of records