1. 7 - 1 Introduction to US Health Care Text by Dennis D. Pointer, Stephen J. Williams, Stephen L. Isaacs & James R. Knickman with Tracy Barr PowerPoints by Robin Pickering Eastern Washington University

2. 7 - 2 Introduction to US Health Care Chapter 7 Hospitals in the United States

3. 7 - 3 The Evolution of Hospitals 1.Refuge 2.Physician Workshop 3.Business 4.System

4. 7 - 4 Components of the Modern Hospitals The Board Management Medical Staff Operational Staff

5. 7 - 5 Components of the Modern Hospitals The Board Govern the hospital on behalf of the community, shareholders, or constituents

6. 7 - 6 Components of the Modern Hospitals Management Run the organization day-to-day… (strategically, financially, and operationally)

7. 7 - 7 Components of the Modern Hospitals Medical Staff Independent practitioners who provide clinical care

8. 7 - 8 Components of the Modern Hospitals Operational Staff Staff who perform nonmedical, clinical, and support duties

9. 7 - 9 Hospital Costs Increasing Advancement of medical technologies and treatments Cost of prescription drugs Aging population Lifestyle choices Increased governmental regulations and oversight

10. 7 - 10 General and Specialty Hospitals Offer variety of services Treat those that cannot pay Pass costs onto patients that can pay General Hospitals Specialty Hospitals

11. 7 - 11 General and Specialty Hospitals Treat specific group of patients Focused area of care Only treat those who can pay General Hospitals Specialty Hospitals

12. 7 - 12 Hospital Ownership Designation Nonprofit Propriety Federal State or Local

13. 7 - 13 Effects of Increased Costs… Provide most intense service to the sickest patients Patients often need increased care after discharge Ambulatory care more demanding Primary care physicians less involved Larger role of the hospitalist

14. 7 - 14 Competition in Health Care Competition Increased Costs Decreased Costs

15. 7 - 15 Copyright Notice © 2006 John Wiley & Sons, Inc. All rights reserved. Reproduction or translation of this work beyond that permitted in section 117 of the 1976 United States Copyright Act without express permission of the copyright owner is unlawful. Request for further information should be addressed to the Permissions Department, John Wiley & Sons, Inc. The purchaser may make back-up copies for his/her use only and not for distribution or resale. The Publisher assumes no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information herein. All clipart and photos courtesy of Microsoft.com, unless otherwise noted.

16. 8 - 16 Introduction to US Health Care Chapter 8 Ambulatory Care

17. 8 - 17 Increasing Ambulatory Care Advances in technology Financial incentives Patient convenience

18. 8 - 18 Distribution of Visits *Percentage of visits across specialty

19. 8 - 19 Access to Ambulatory Care *Key predictors of access to care include insurance status, race, and age Adults with No Regular Source of Care

20. 8 - 20 Payment for Ambulatory Care

21. 8 - 21 Ambulatory Care Settings * Defined by service, not setting Physician Offices Emergency Rooms/ Outpatient Departments Urgent Care Facilities Same-Day Surgery Centers Community Health Centers / Clinics Student Health Centers Occupational Health Programs

22. 8 - 22 Ambulatory Care Providers Clinical Social Workers Physicians Physician Assistants NursesDentistsPharmacistsChiropractorsPodiatrists Physical Therapists OptometristsPsychologists

23. 8 - 23 Physician Offices Solo Practices Individual physician and other personnel Group Practices Three or more physicians, other professionals Share resources…

24. 8 - 24 Home Health Care Services Skilled Nursing Aide Care Physical Therapy Speech Therapy Occupational Therapy

25. 8 - 25 Social Workers / Home Health Care Education and Referral Financial Assistance Information Psychosocial Assessment Psychosocial Interventions Crisis Intervention / Trauma Support

26. 8 - 26 Copyright Notice © 2006 John Wiley & Sons, Inc. All rights reserved. Reproduction or translation of this work beyond that permitted in section 117 of the 1976 United States Copyright Act without express permission of the copyright owner is unlawful. Request for further information should be addressed to the Permissions Department, John Wiley & Sons, Inc. The purchaser may make back-up copies for his/her use only and not for distribution or resale. The Publisher assumes no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information herein. All clipart and photos courtesy of Microsoft.com, unless otherwise noted.

27. 9 - 27 Introduction to US Health Care Chapter 9 Long-Term Care

28. 9 - 28 Long-Term Care Services Ambulatory medical services Inpatient medical services Mental-behavioral services Social services Daily living support services

29. 9 - 29 Primary Users of Long-Term Care People with temporary disabilities People with chronic health problems

30. 9 - 30 Personal Care Facilities Assisted living facilities Continuing care retirement communities Congregate care facilities Nursing homes Alzheimer’s /dementia facilities

31. 9 - 31 Personal Care Facilities Assisted living facilities Continuing care retirement communities Congregate care facilities Nursing homes Alzheimer’s /dementia facilities Board-and-care facilities Adult foster care Licensed by the state

32. 9 - 32 Personal Care Facilities Assisted living facilities Continuing care retirement communities Congregate care facilities Nursing homes Alzheimer’s /dementia facilities Self-sufficient communities All personal and medical services Generally only accept healthy seniors

33. 9 - 33 Personal Care Facilities Assisted living facilities Continuing care retirement communities Congregate care facilities Nursing homes Alzheimer’s /dementia facilities Similar to CCRCs but offer no health care services

34. 9 - 34 Personal Care Facilities Assisted living facilities Continuing care retirement communities Congregate care facilities Nursing homes Alzheimer’s /dementia facilities Intermediate-level nursing and personal services Serve those who are temporarily or permanently unable to care for themselves All states require nursing homes

35. 9 - 35 Nursing Home Staffing Nursing aids Social workers and case managers Dietitians, rehabilitation therapists, and other health professionals Administrative personnel Licensed nurses

36. 9 - 36 Personal Care Facilities Assisted living facilities Continuing care retirement communities Congregate care facilities Nursing homes Alzheimer’s /dementia facilities Independent unit or component of assisted living facility Provide constant supervision Help with ADLs and personalized care

37. 9 - 37 Home Health Care Agencies Voluntary nonprofit Government Proprietary Medicare Certified?

38. 9 - 38 Community-Based Care Adult day care Respite care Senior centers Transportation Meals on Wheels Telephone reassurance Area Agencies on Aging

39. 9 - 39 Hospice Care Provide physical care and counseling to terminally ill patients and families Medical personnel Social workers and counselors Clergy Therapists Volunteers

40. 9 - 40 Copyright Notice © 2006 John Wiley & Sons, Inc. All rights reserved. Reproduction or translation of this work beyond that permitted in section 117 of the 1976 United States Copyright Act without express permission of the copyright owner is unlawful. Request for further information should be addressed to the Permissions Department, John Wiley & Sons, Inc. The purchaser may make back-up copies for his/her use only and not for distribution or resale. The Publisher assumes no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information herein. All clipart and photos courtesy of Microsoft.com, unless otherwise noted.

41. Check Your Understanding 1. Who owns governmental hospitals? A. the board of directors B. taxpayers C. the government D. physicians who work there 7 - 41

42. Check Your Understanding 2. How does a specialty hospital differ from a general hospital? A it focuses on a particular health issue or a special population B. it generally requires greater length of stays C. its staff is comprised solely of specialists D. all of the above 7 - 42

43. Check Your Understanding 3. The next phase of hospital evolution trends toward a shift from hospital care to outpatient care. What is one of the reasons for this shift? A. overburdened hospital medical staff B. creation of independent emergency care facilities C. rising health care costs D. falling numbers of community hospitals 7 - 43

44. Check Your Understanding 4. How is the role of the acute care hospital changing? A. the role of hospitals is growing as more people seek medical care in the hospital setting B. the role of hospitals is diminishing as more people seek medical care in outpatient settings C. the role of hospitals is diminishing due in part because of the expense of hospital care. D. B and C 7 - 44

45. Check Your Understanding 5.What is the greatest source of payment for ambulatory care? A. Medicare B. Medicaid C. Private insurances D. Individual out-of-pocket 7 - 45

46. Check Your Understanding 6. In which healthcare setting are the majority of ambulatory care services provided? A. hospital outpatient departments B. physician’s offices C. community health clinics D. emergency rooms and urgent care clinics 7 - 46

47. Check Your Understanding 7. General practitioners and family physicians are the primary providers of ambulatory care. True or False? 7 - 47

48. Check Your Understanding 8. What kind of ambulatory services to community health centers offer? A. general medical care B. emergency care C. prenatal care D. A and B E. All of the above 7 - 48

49. Check Your Understanding 9. Home health and visiting nurses agencies are most likely to serve which patients? A. the elderly and those who are homebound B. those with chronic conditions C. those just released form the hospital D. A and C E. All of the above 7 - 49

50. Check Your Understanding 10. What is the most common reason for accessing ambulatory care? A. preventive care B. symptoms of illness C. obstetric care D. follow-up care 7 - 50

51. Check Your Understanding 11. Long-term care is healthcare provided only to those suffering from lengthy illness or disabling accidents. True or False? 7 - 51

52. Check Your Understanding 12. Assisted living facilities offer what types of services? A. skilled medical care B. emergency care C. help with certain activities of daily living D. care for Alzheimer’s patients 7 - 52

53. Check Your Understanding 13. A potential resident of a continuing care retirement community must meet which of the following criteria? A. be referred to the facility by a doctor B. be healthy C. have no assets greater than an amount specified by the state in which the retirement community exists D. have private insurance 7 - 53

54. Check Your Understanding 14. Alzheimer’s facilities are highly regulated by state health departments because of the vulnerability of the population they serve. True or False? 7 - 54

55. Check Your Understanding 15. The most common type of rehabilitation centers focus are: A. fitness facilities B. mental health facilities C. drug rehabilitation facilities D. none of the above 7 - 55

56. Check Your Understanding 16. Because of the complex nature of the conditions they treat, all rehabilitation centers are residential facilities. True or False? 7 - 56

57. Check Your Understanding 17. Hospice care is end-of-life care for patients who are terminally ill. True or False? 7 - 57

58. Check Your Understanding 18. The counseling component is a large part of hospice care. True or False? 7 - 58

59. Check Your Understanding 19. Because of the debilitating nature of many conditions requiring rehab, most rehab patients participate in rehab for years. True or False? 7 - 59