Health Care Systems: Private Facilities and Government Agencies

1. Word WallAbrasion -Scraping away a portion of the surface of the skin.Anterior-Directional term meaning near or in the front of the body

2. Chapter 2 Health Care Systems

3. 2:1 Private Health Care Facilities • Health care is one of the largest and fastest-growing industries in the United States • Will employ over 22.1 million workers in over 200 careers by 2020 • 2013 U.S. health care spending was over $2.9 trillion

4. Hospitals • General hospitals • Specialty hospitals • Government hospitals • University or college medical centers

5. Long-Term Care Facilities • LTC or LTCF provide assistance and care for residents • Residential care facilities • Extended care or skilled care facilities • Independent living and assisted living facilities

6. Medical Offices • Vary from offices privately owned by one physician to large complexes • Services include diagnosis, treatment, examination, basic lab testing, minor surgery • May offer general or specialized care

7. Concierge Medicine • Personalized health care • Annual or monthly fee paid to primary care provider for enhanced level of care

8. Dental Offices • Vary in size from privately owned by one or more dentists to dental clinics • Include general care for all ages and specialized care for certain age groups or dental conditions

9. Clinics or Satellite Centers • Surgical clinics or surgicenters • Urgent, walk-in, or emergency care clinics • Rehabilitation clinics • Substance abuse clinics • Not staffed five days a week

10. Clinics or Satellite Centers • Specialty clinics • Outpatient clinics • Health department clinics • Medical center clinics

11. Optical Centers • May be individually owned or part of chain • Services include vision examination, prescription of glasses or contact lenses, screening for eye diseases

12. Emergency Care Services • Special care for accident victims or those with sudden illness • Ambulance services • Rescue squads • Emergency care clinics • Emergency departments

13. Laboratories • May be part of other facilities or stand-alone • Medical laboratories • Diagnostic tests • Dental laboratories • Dentures and other devices

14. Home Health Care • Provide care in a patient’s home • Frequently used by elderly and disabled • Provide nursing care, personal care, therapy, homemaking • Offered by health departments, hospitals, private agencies, government agencies, volunteer groups, nonprofits

15. Hospice • Provide care for terminally ill persons • Care in a patient’s home or in a facility • Palliative care, psychological, social, spiritual, financial counseling to patient and family • Support for family members following patient’s death

16. Mental Health Facilities • Treatment for patients with mental disorders or diseases • Examples include guidance and counseling centers, psychiatric clinics and hospitals, clinical abuse treatment centers, physical abuse treatment centers

17. Genetic Counseling Centers • Independent facilities or located within another facility • Prenatal screening for couples or individuals who are pregnant or considering pregnancy • Check for genetic abnormalities and birth defects, explain results and options

18. Rehabilitation Facilities • Located in hospitals, clinics, private centers • Care for patients with physical or mental disabilities • Therapies include physical, occupational, recreational, speech, hearing

19. Health Maintenance Organizations • Health care delivery system and type of health insurance • Preventive care for a fixed, prepaid fee • Services include examinations, basic medical services, health education, hospitalization, rehabilitation

20. Industrial Health Care Centers • Also called occupational health clinics • Located in large companies or industries • Health care for employees • Services include examinations, accident prevention and safety, emergency care

21. School Health Services • Located in schools and colleges • Provide emergency care in case of accident or illness, tests for health conditions, health education, maintenance of a safe and sanitary environment, counseling

22. Pharmaceutical Services • Prepare and dispense medications • Provide expertise on drug therapy • Found in many settings: hospitals, clinics, nursing homes, online, etc.

23. 2:2 Government Agencies • Government services are tax supported • World Health Organization (WHO) • U.S. Department of Health and Human Services (USDHHS) • National Institutes of Health (NIH) • Centers for Disease Control and Prevention (CDC)

24. 2:2 Government Agencies • Food and Drug Administration (FDA) • Agency for Healthcare Research and Quality (AHRQ) • Occupational Safety and Health Administration (OSHA) • Health departments

25. 2:2 Government Agencies • Office of the National Coordinator for Health Information Technologies (ONC) • Health departments

26. 2:3 Voluntary or Nonprofit Agencies • Supported by donations, membership fees, fund-raisers, and grants • Health services are provided at national, state, and local levels • Examples include American Cancer Society, American Red Cross, Autism Speaks

27. 2:3 Voluntary or Nonprofit Agencies • Organizations often focus on specific diseases • Study the disease • Provide research funding • Educate the public • Provide special services to those with the disease • Staffed by health care workers and volunteers

28. 2:4 Organizational Structure • Line of authority or chain of command • Indicates areas of responsibility • Essential for most efficient operation of facility • Structure determined by size and needs of organization • Refer to Figures 2-4 and 2-5 in text

29. 2:4 Organizational Structure • Lines of authority must be clearly indicated in any organizational structure • Workers must identify and understand their position in the structure • Workers must take problems, reports, and questions to their immediate supervisor

30. 2:5 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 • Without insurance, the cost of an illness can result in financial disaster

31. Insurance Terminology • Deductible • Co-insurance • Co-payment

32. Types of Plans • Employer-sponsored or group insurance plans • Health maintenance organization (HMO) • Preferred provider organization (PPO) • Medicare • Medigap • Medicaid

33. Types of Plans • Children’s Health Insurance Program (CHIP) • Worker’s compensation • TRICARE • U.S. government plans for military personnel and their families • Managed care plans

34. Types of Plans • Fee-for-service compensation • Provider paid a set amount for each service provided • Value-base compensation • Physician paid based upon performance • Paid a certain amount for each disease or diagnosis

35. Health Insurance Portability and Accountability Act (HIPAA) • Five components • Health care access, portability, renewability • Preventing health care fraud/abuse • Tax-related health provisions • Application and enforcement of group health plan requirements • Revenue offsets

36. Patient Protection and Affordable Care Act • Law of 2010 changing health care insurance regulation • Provisions include • Guaranteed issue • Expanded Medicaid eligibility • Improved benefits for Medicare