Unit 1 Health Care Systems Pages 2 – 18

1. Unit 1 Health Care SystemsPages 2 – 18

2. Introduction • Health care is one of the largest and fastest-growing industry in the US • Expenditures – it is a two billion dollar per day business and growing • Over 12 million health care workers in US • 80% of health care work force are women *Data from obtained from CDC

3. 1.1 Health Care Facilities • Many different types of facilities • Employ many types of health care workers • Individual facilities can vary in: • Size (individual doctor or complex of doctors facility for a community or for a county, etc) • Service provided (general or specific to disease, age, gender) • Sources of income (public, private, religious, nonprofit, government) • Important to be aware of facilities and type of services

4. Types of Health Care Facilities • Rehabilitation facilities • Genetic counseling centers • Health Maintenance Organizations • Industrial health care centers • School health services • Government agencies • World Health Organization • U.S. Department of Health and Human Services • Occupational Safety and Health Administration • Voluntary and nonprofit agencies • Hospitals • Long-term care facilities • Medical offices • Dental offices • Clinics • Optical centers • Emergency care services • Laboratories • Home health care • Hospice agencies • Mental health facilities

5. Health Care Facilities • HOSPITALS • One of the major types of facilites • Most hospitals are general hospitals that treat a wide range of conditions • Specialty hospitals include: • Burn, oncology, pediatric, psychiatric, orthopedic, rehabilitative, government

6. Health Care Facilities LONG-TERM CARE FACILITIES (LTCs) Patients live at facility and are known as residents May care for elderly, disabled patients, individuals with chronic or long-term illnesses Extended Care Facilities – rehabilitative care to prepare patients to return home Subacute Units – rehabilitative care for patients recovering from major illness, intensive medical treatments or surgery Independent Living – residents can care for themselves, but live in the facility. The facility provides residents with food, housekeeping, transportation and basic medical care 6

7. Health Care Facilities MEDICAL OFFICE Can offer a variety of services: Diagnosis, treatment, exams, lab tests, minor surgery CLINICS Usually a group of doctors that share a facility and personnel Many hospitals have outpatient clinics EMERGENCY CARE SERVICES Special care for victims of accidents, sudden illness or patients without a general physician LABORATORIES Often part of other facilities, but occasionally a separate facility Run blood tests, urine tests, can prepare dentures, etc 7

8. Health Care Facilities HOME HEALTH CARE Provide care in patient’s home Usually used by elderly or disabled patients HOSPICE Provides care for terminally ill patients with a life expectancy of less than 6 months MENTAL HEALTH FACILITIES Treat patients with mental disorders and diseases Counseling center, psychiatric hospitals, abuse treatment centers REHABILITATION Can be found in hospitals, clinics or a private center Can be inpatient or outpatient 8

9. Health Care Facilities • GENETIC COUNSELING • Provides individuals or perspective parents information on their genetic background and disposition to passing on genetic disorders • If an individual or couple has a certain likelihood of being a carrier for a disorder, a blood test will be recommended to screen for a particular gene • HEALTH MAINTENANCE ORGANIZATIONS (HMOs) • Provide total health care directed towards preventative health care • INDUSTRIAL HEALTH CARE CENTER • Occupational health clinics, found in large companies to provide health care for the employees

10. Health Care Facilities SCHOOL HEALTH SERVICES Provides students with emergency treatment as well as health education and counseling GOVERNMENT AGENCIES Provides facilities for government personnel and their dependents Hospitals, psychiatric treatment, rehabilitation, etc WORLD HEALTH ORGANIZATION (WHO) Sponsored by the United Nations Addresses and studies health problems throughout the world 10

11. Health Care Facilities U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) National agency that deals with US health problems NATIONAL INSTITUTE OF HEALTH (NIH) - Researches diseases CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) – studies causes, spread and control of diseases in the population FOOD AND DRUG ADMINISTRATION (FDA) – regulates food and drugs sold to the public OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) – establishes and enforces job safety standards 11

12. Health Care Facilities NONPROFIT Also known as voluntary agencies Supported by donations, grants, fundraising, etc Usually focuses on one type of disease American Cancer Society American Red Cross March of Dimes 12

13. 1:4 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

14. Insurance Terminology You Should Know: • Deductible • Co-insurance • Co-payment • Preferred provider • Monthly fee or premium • Managed care

15. Types of Services • Inpatient services (e.g., hospitals, long-term care) • Outpatient services (e.g., clinics, provider offices) • Specialty services (e.g., laboratories, mental health)

16. Types of Plans • Health insurance plans • Health maintenance organizations (HMO) • Preferred provider organizations (PPO) • Medicare • Medicaid • Worker’s Compensation • Managed Care

17. Types of Plans • HEALTH INSURANCE PLAN • Insurance company pays for some or all of services (depends on plan, deductible, out-of-pocket expense, etc.) • HEALTH MAINTENANCE ORGANIZATIONS (HMO) • Person pays a monthly fee for the membership • Plan covers regular exams and check-ups • PREFERRED PROVIDER ORGANIZATIONS (PPO) • Provided to employees by their company • The company works with certain health care agencies to provide the employees with health care at a reduced rate • Employees can only go to the selected agencies

18. Types of Plans • MEDICARE • Insurance provided by the government to people over 65 or disabled persons on Social Security • Type A coverage – hospital insurance, extended care or home care • Type B coverage – medical insurance, doctor services, therapy • Covers 80% of medical bills • MEDICAID • Government provided medical assistance program • Operated on a state level, benefits vary from state to state

19. Types of Plans • WORKER’S COMPENSATION • Health insurance for people injured on the job • MANAGED CARE • One approach to health care in response to the rising costs • Insurance covers wellness exams and check-ups, but need to prove the necessity • Need referrals to see specialty doctors

20. Summary • Health insurance plans do not solve all the problems of health care costs • Do help many people pay for all or part of cost • Important for individuals to understand what plan covers • Also need understanding of co-insurance and other restrictions plan may have

21. 1:5 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 • To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor

22. 1:6 History of Health Care • Beliefs and Developments • Beliefs about health care and cause of disease has changed greatly from ancient times • This has also caused drastic changes in the treatment of patients

23. Future of Health Care Questions you should be able to answer: • When did most of the significant changes in health care occur? • Why were the greatest advances made in this time period? • What are some possibilities for the future of health care?

24. 1:7 Trends in Health Care • Changes in Health Care • Many events lead to changes in health care • Changes in health care are inevitable and occur rapidly • Health care workers must be flexible to face and keep pace with the rapid changes

25. Some Current Issues • Cost containment • Home health care • Geriatric care • Wellness • Alternative and complementary health care • National health care plans

26. Cost Containment • Purpose: control the rising cost of health care and achieve maximum benefit for every dollar spent • Necessity: costs increasing with technological advances, improved survival rates, aging population, and lawsuits • Issues: need to keep high quality of care, workers can decrease costs, consumers can decrease their own health care costs

27. Cost Containment Methods • Diagnostic related groups (DRGs) • Patients with certain diagnoses put into a payment group • Agency sets limit of amount to be spent on care • If care is below the limit, agency keeps the money • If care costs are above the limit, agency is responsible • Combination of services • Outpatient services • Mass or bulk purchasing • Early intervention and preventive services • Energy conservation

28. Home Health Care • Industry grew rapidly when DRGs initiated • Services provided in patient’s home • Visits must be pre-authorized by insurance agency (unless private pay) • Often necessary to teach family members to perform care since visits are limited • Emphasis on cost containment also applies to Home Health • Allows for shorter hospital stays

29. Geriatric Care • Care for the elderly • Percentage of elderly population growing • Need for more facilities • Omnibus Budget Reconciliation Act (OBRA) • Requires states to establish geriatric care, continuing education for staff, evaluation and retraining of staff • Wellness of patient is monitored • Physical, emotional, social, mental, spiritual wellness

30. Wellness • State of optimal health • Increase awareness of maintaining health and preventing disease • Emphasis on preventative measures • Different facilities will develop to meet needs of wellness emphasis

31. Holistic Health • Treat the whole body, mind, and spirit • Each person is unique with different needs • Use many methods of diagnosis and treatment • Emphasis on protection and restoration • Promote body’s natural healing processes • Patient responsible for choosing care and worker respects the choice

32. Alternative and Complementary Methods of Treatment • Increasingly used to replace or supplement traditional medical treatment • Holistic approach: belief that the effect on one part effects the whole person • Based on belief that the person has a life force or energy that can be used in the healing process

33. Alternative and Complementary Methods of Treatment • May vary by cultural values or beliefs • Often less expensive than traditional treatments • Nonjudgmental attitude is essential – patients have right to choose treatment • Increased use requires increased awareness by health care workers

34. Types of Practitioners • Ayurvedic • Chinese medicine • Chiropractors • Homeopaths • Hypnotists • Naturopaths

35. Office of Alternative Medicine (OAM) • Established in 1992 at the National Institutes of Health (federal government) • Purpose: research therapies and establish standards of quality care • Many states have passed laws • Know your state’s law regarding the legal requirements of alternative therapies

36. National Health Care Plan • Goal: All Americans have health coverage • Various plan proposals • Federal government pays for health care, money would come from taxes • Health care cooperatives – consumer purchases health care at a lower cost • Managed care – employers provide coverage, government provides coverage for poor • What are some potential problems?

37. Summary • Health care has changed and will continue to change • Workers must be constantly aware of changes that occur • Workers must make every attempt to learn about trends