1. Chapter 1- Health Care Systems
History of Health Care

7. Pertinent questions
When did most of the most 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?

8. Health Care Systems Many different types deliver health care
Largest & fastest growing industry
Employs over 10 million workers in over 200 careers
$2,000,000,000 per day industry

9. Hospitals – vary in size & type of services
General hospitals – varied services
Specialty hospitals – certain conditions or ages (burns, pediatrics, cancer, heart, etc)
Government hospitals – fed, state, local (VA, military, state rehab or psychiatric)
University or college medical centers – provide services, RESEARCH, education

10. Classification – based on funding sources
Private or proprietary – for profit (pt. fees & organizational support)
Religious – religious support, pt. fees
Non-profit or voluntary – pt. fees, donations
Government – taxes, pt. fees

11. Long Term Care Facilities (LTC)
Provide care for elderly, physical or mental disabilities, chronic or long term illnesses
Pts are usually called residents
Nursing homes or geriatric homes – provide ADLs for those unable to care for themselves, provide a safe environment, & promote social interactions

12. Extended Care or Skilled Care Facilities
Provide skilled nursing & rehab care
Prepare resident for return to home environment
Subacute units – rehab for surgery, cancer tx, dialysis
Independent or assisted living facilities – individuals receive the help they need (meals, transportation, housekeeping, etc)
Many are associated with LTC facilities, enabling the individual to move from facility to facility as need arises

13. Medical Offices Privately owned offices to large corporations
Services: diagnosis, treatment, examinations, basic lab tests, minor surgery
Some treat wide variety of illness/ages & others specialize

14. Dental Offices Private offices to dental clinics
Can be found in major retail stores
Can provide general or specialized dental care

15. Clinics
Can refer to a group of medical/dental professionals who share a facility & staff
Others specialized – surgery, emergency care clinics, rehab clinics, diabetes or oncology clinics
Can be affiliated with a hospital
Health department – pediatrics, sexually transmitted diseases, immunizations, other special services
Medical centers at universities – frequently free or reduced cost care to provide learning experiences

16. Optical Centers May be individually owned or part of a large chain
Provide vision examinations, prescribe eyeglasses or contacts, check for eye diseases

17. Emergency Care Services
Provide special care for accidents or sudden illness
Examples – ambulance, rescue squads, emergency care clinics, emergency rooms in hospitals, helicopter or airplane

18. Laboratories
Can be part of another facility or separate health care service
Medical labs – perform diagnostic tests
Dental labs – prepare dentures and other devices

19. Home Health Care Provides care in patient’s home
Examples – nursing, personal cares, therapy, homemaking
Offered by health departments, hospitals, private agencies, government agencies, nonprofit agencies, volunteer groups

20. Hospice
Provides care for terminally ill persons with a life expectancy of 6 months or less
Care provided in home or hospice facility
Allows death with dignity & comfort
Provides psychological, social, spiritual, & financial counseling for pt. & family

21. Mental Health Facilities
Deal with mental diseases and disorders
Examples – guidance/counseling centers, psychiatric clinics/hospitals, chemical abuse treatment centers for alcohol or drug abuse, physical abuse treatment centers

22. Genetic Counseling Centers
Can be independent or affiliated
Works with couples or individuals who are pregnant or considering pregnancy
Performs prenatal screening, check for genetic abnormalities & birth defects, explains test results, identify medical options when defect is present, help individuals cope with psychological issues caused by genetic disorder
Used especially for older women, family history of genetic disease, specific race/nationality where genetic disease is prevalent

23. Rehabilitation Facilities
Care directed at helping pt. with mental or physical disability obtain maximum function
Includes hospitals, clinics, private centers
Services – physical, occupational, recreational, speech, & hearing tx

24. Health Maintenance Organizations
Provide total health care directed toward preventive care
Services: examinations, basic medical services, health education, hospitalization, rehabilitation
Mode of operation – large industry/corp, private agencies, uses services of other health care facilities

25. Industrial Health Care Centers or Occupational Health Clinics
Located in large industries or companies
Provides health care for employees
Services – basic exams, teach accident prevention/safety, provide emergency care

26. School Health Services
Found in schools & colleges
Services – emergency care for accidents & sudden illnesses, speech/vision/hearing screenings, promote health education, maintain safe & sanitary school environment, counseling

27. Government Agencies
Offered at international, federal, state, local levels – most tax supported
World Health Organization (WHO) – international agency supported by United Nations that provides statistics & information about disease, publishes health information, & investigates & deals with serious health problems throughout the world

28. United States Department of Health & Human Services (USDHHS)
National Institute of Health (NIH) – researching disease
Centers for Disease Control & Prevention (CDC) – researches causes, spread, & control of diseases in populations
Food & Drug Administration (FDA) – regulates food & drug products sold to the public

29. USDHHS (cont)
Agency for Health Care Policy & Research (AHCPR) – established in 1990 to research quality of health care delivery & identify standards of treatment
Occupational Safety & Health Administration (OSHA) – establishes & enforces standards protecting workers from job-related injuries & illnesses

30. State & Local Health Departments
Provides health services as directed by USDHHS
Provides specific needed services – immunizations, inspections for environmental health & sanitation, communicable disease control, collection of statistics & health records, health education, clinics for health care & prevention

31. Volunteer or Nonprofit Agencies
Supported by donations, membership fees, fundraisers, & grants
Provides health services at national, state, or local levels
Examples – American Cancer Society, American Heart Association, American Diabetes Association, American Red Cross, March of Dimes, etc.
Many deal with one disease or group of diseases to study, provide funding for research, promote education, purchase medical equipment, provide treatment centers, & supply information

32. Health Insurance Plans
Cost of health care a major concern
Cost of health care is >12% of gross national product
Health care costs are increasing faster than other costs of living
Most people rely on health insurance plans to pay for health care costs
Without insurance, cost of illness disastrous

33. Health Insurance Plans
Different plans offered by thousands of agencies
Pay a premium to purchase insurance
If insured person has expenses covered by the plan, the insurance company pays for them
Amount of payment and services vary from plan to plan

34. Insurance terminology
Deductibles – amounts that must be paid by the insured individual before policy begins to pay
Co-insurance – requires specific percentage of expenses to be shared by individual & company ( % paid by company, 20% paid by individual)
Co-payment – specific amount of money patient pays for a particular service (example - $20 per doctor’s appointment regardless of total cost)

35. Insurance Plans Many people have insurance from place of employment
Private policies can be purchased by individuals

36. Health Maintenance Organizations
Special type of insurance plan
Monthly fee is paid for membership & price remains same, regardless of number of visits
Premium paid either by employer or individual
Most pay for total health care – routine visits & exams & preventive health care (not usually covered by private insurance)

37. Health Maintenance Organizations
Advantages – provides ready access to health care, early detection & treatment of disease, individual usually maintains better health
Disadvantages – individual can only use HMO affiliated providers for health care. If choose a provider outside of HMO, individual pays for all costs

38. Preferred Provider Organizations (PPO)
Usually provided by large company
Company contracts with health care agency
Employee must use specific health care agency
Industry/company can provide health care at lower rates

39. Medicare Federal government health care plan
Provides health care to those over 65 years of age or persons with a disability who have had social security benefits for at least 2 years
Type A coverage – hospital services & LTC facility after hospitalization
Type B coverage – Dr. services, outpatient therapy, other health care. Individual pays premium for this coverage co-insurance – Medicare pays 80%, individual or insurance pays 20%

40. Medicaid (MediCal)
Medical assistance program offered by states (vary from state to state)
Covers individuals with low incomes, children who qualify for public assistance, the physically disabled or blind
State Children’s Health Insurance Program (SCHIP) – established 1997 to provide health care to uninsured children of working families who earn too much to qualify for Medicaid

41. Worker’s Compensation
Provides treatment for workers injured on the job
Administered by the state
Payments made by employers & state
Provides payment for health care & lost wages

42. United States Government Plans
Provides health care for all military personnel
TRICARE
Cares for all active duty members & families
Cares for survivors of military personnel & retirees & their families
Veteran’s Administration provides for military veterans with service connected disability

43. Managed Care
Developed because of rising health care costs & need to spend money efficiently
All health care must have a purpose
Second opinion or verification of need often required
Includes preventive care, physical exams, well-baby care, immunizations, wellness education (good nutrition, exercise, weight control, healthy living)
Usually provided by HMOs & PPOs by setting up network of providers – restricted usage

44. Organizational Structure
Often called line of authority or chain of command
Indicates area of responsibility
Leads to efficient operation of facility

46. Hospital Organizational Chart
Shows organization by departments
Notes various divisions of departments
Each department can have an individual organization

47. Medical Office Organizational Chart
Simpler organizational chart
Even with fewer people, lines of authority are clearly shown & easy to follow

49. Summary In both cases, chain of command is clearly indicated
Health care workers must identify & understand their position in the organizational structure
Allows workers to know the line of authority & understand who is their immediate supervisor
Questions/concerns/problems – go to immediate supervisor
If supervisor is unable to solve the problem, go to the next level in the chain.

50. Trends in Health Care
Many events lead to changes in health care (example AIDS)
Changes occur almost daily
1st trend is cost containment
Cost containment – trying to control the rising cost of health care & achieving the maximum benefit for every dollar spent.
1. High costs due to technology - transplants, artificial hearts, computer body parts, surviving serious illness, premature infants, etc.
2. Aging population – increased used of pharmaceuticals
more chronic diseases
need for frequent health services
3. Health related lawsuits – malpractice insurance expensive
Increase in ordering diagnostic tests
Defensive health care
4. Costs could be so expensive that individuals are limited to the care they can afford – what happens to equal access for all?

51. Methods Used to Contain Costs
Diagnostic related groups – DRGs
Attempt by Congress to control costs
Payment based on diagnosis
Certain amount paid for each disease/condition
Agencies that provide care for less keep the money
Agencies accept loss if care costs exceed payment allowed

52. Combination of Services
Agencies combine services to avoid duplication
Share clinics, labs, etc
HMO & PPO examples
Provides care to larger number of people at a decrease in cost per person

53. Outpatient Services
Patients receive care without being admitted to hospitals
Reducing length of stay or decreasing need for hospitalization lowers costs
Often use less expensive home care or skilled nursing care
Examples – outpatient surgery, xrays, diagnostic tests

54. Mass or Bulk Purchasing
Buying equipment & supplies in larger quantities at reduced prices
Often combines department or agency orders
Computerized inventories can be used to determine when supplies are needed & to prevent overstocking & waste

55. Early Intervention & Preventive Services
Providing care before acute or chronic disease occurs
Prevention is ALWAYS more cost effective
Methods – immunization, patient education, regular physical exams, easy access to health care, incentives for prevention
Studies show people with limited access to health care use emergency departments

56. Energy Conservation
Monitoring use of energy to control costs & conserve resources
Electricity, water, gas
Energy efficient buildings
Recycling

57. Agency for Health Care Policy & Research (AHCPR)
Federal agency developed in 1990
Purpose – to research quality of health care delivery & identify standards of treatment that should be provided
Quality of health care should not be lowered simply to contain costs
Need to provide quality care while be attentive to avoiding waste & controlling costs
Consumers need to be responsible as well

58. Home Health Care
Rapidly growing field due to insurance regulating hospital stays
Less expensive to perform
All aspects involved – nursing, physical & occupational therapy, respiratory therapy, social services, nutritional services, homemaking services
What are advantages to home care?

59. Geriatric Care Care of the elderly
Rapid growth due to longer life spans & “baby boomers”
Lead to growth of facilities – adult day care, retirement communities, assisted & independent living facilities, LTC facilities

60. Geriatric Care Omnibus Budget Reconciliation Act (OBRA) of 1987
Federal law creating regs regarding LTC and home health
Requires state to establish training & competency programs for assistants
Requires nursing assistants to:
Complete mandatory state-approved training
Pass written & competency exams
Obtain certificate or registration

61. Geriatric Care Other OBRA requirements States must maintain registry
Continuing education
Periodic performance evaluations
Retraining/retesting if CNA does not work in a facility for more than 2 years
States must maintain registry
Requires compliance with patients’ rights to ensure certain standards of care

62. Telemedicine
Uses video, audio, & computer systems to provide health care services
Allows interaction even though workers are in different locations
EMTs at scene of accident
Surgeons using remote control arms
Watching procedures by video
May allow people to receive tx in homes

63. Wellness
State of being in optimum health with balanced relationship between physical, mental, & social health
Recognizes importance of
Good nutrition
Exercise
Weight control
Healthy living habits
What are examples of facilities stressing this?

64. 5 Ways to Promote Wellness
Physical wellness
Well-balanced diet
Regular exercise
Routine physical exams/immunizations
Regular dental/vision care
Avoidance of alcohol, tobacco, caffeine, drugs, environmental contaminants, & risky sexual behaviors

65. 5 Ways to Promote Wellness
Emotional Wellness
Understanding feelings & expressing them appropriately
Accepting one’s limitations
Adjusting to change
Coping with stress
Enjoying life
Remaining optimistic

66. 5 Ways to Promote Wellness
Social Wellness
Showing concern, fairness, affection, tolerance, & respect for others
Communicating & interacting well
Sharing thoughts & ideas
Practicing honesty & loyalty

67. 5 Ways to Promote Wellness
Mental & Intellectual Wellness
Being creative, logical, curious, & open-minded
Using common sense
Obtaining continual learning
Questions/evaluating information & situations
Learning from life experiences
Using flexibility & creativity to problem solve

68. 5 Ways to Promote Wellness
Spiritual Wellness
Using values, ethics & morals to find meaning, direction, & purpose in life

69. Alternative & Complementary Methods of Health Care
Most health care in the U.S. is biomedical or “Western” system
Based on evaluating physical signs & symptoms, determining cause of disease, & treatment
Major trend towards other methods
Alternative therapy – in place of biomedical
Complementary – Used with biomedical

70. Holistic Health Care Part of alternative/complementary tx
Consider the whole person & recognizes that the health of each part has an effect on total health status
Life force or energy helps with healing
Many therapies based on culture
Skilled practitioners, rituals, specialized practices part of therapy

71. Examples of Alternative or Complementary Practitioners
Ayurvedic practitioners – Indian philosophy to maintain harmony by diet, exercise, yoga, & living practices
Chinese medicine – Life energy flows through the person through pathways that link the organs together: use acupressure & accupuncture, tai chi, herbs to maintain energy flow

72. Examples continued
Chiropractors – brain sends vital energy through nerves in spinal cord, misalignment causes pain: use spinal manipulation, massage, & exercise
Homeopaths – body has ability to heal itself through the immune system: use drugs from plants, animals, & minerals to cause symptoms & activate immunity

73. Examples cont.
Hypnotists – help people achieve a trance-like state to become receptive to verbal suggestions to change behaviors
Naturopaths – use only natural therapies like fasting, special diets, lifestyle changes & avoid surgery or medicine

74. Alternative/Complementary Medicine
Most therapies are holistic & noninvasive
Most are less expensive than traditional treatments
Office of Alternative Medicine (OAM) – established by NIH to research therapies & determine standards of quality care. Practioners may required education or licenses before practicing. Also labels therapy as experimental.

75. Remember Patients have the right to choose their own type of care
Be non-judgmental
Important for health care providers to be aware of alternative treatments

76. National Health Care Plan
High costs of health care + large number of uninsured people = need for this plan
No current plan, many have been proposed
Problems – cost of creating, who pays more, lack of free choice, new regulations need to be created

77. Past & Current Trends Polio vaccine Antibiotic development
Cancer & AIDS drugs
Computers
Test tube babies
Cloning
Health care will continue to change – be aware!