1. Chapter 2
Health Care Systems

2. 2:1 Private Health Care Facilities
Growth—one of the largest and fastest growing industries in the United States
Employment opportunities—employs over 13 million workers in over 200 careers
Expenditures—it is a four-billion-dollar- per-day business and growing
(continues)

3. Private Health Care Facilities
Hospitals – General, Specialty, Govt. & University
Clinics or satellite centers – Smaller or Specialty
(Pediatrics, Cancer, Radiology, Pharmacy, Outpatient, Surgical)
Medical Offices (Dental offices, Optical)
Laboratories – Blood & Urine tests
Emergency care services - Minor care
Mental Health Facilities – psychiatric, abuse, alcohol, drug
Genetic Counseling Centers – Pregnant or considering
Rehabilitation Facilities (PT & OT or Speech Therapy)

4. Private Health Care Facilities (Elderly)
Long-Term Care Facilities
Nursing Home
Independent living and/or assisted living
Elderly Community
Home Health Care
Care in the Patients home, usually the elderly or disabled.
Hospice agencies
Terminally ill patients have life expectancy of 6 months or less

5. Private Health Care Facilities
Health maintenance organizations (HMOs)
Proposed by Kaiser Permanente
Signed into Law by President Richard Nixon
Both Health care delivery system & Health Insurance
They provide Total Health Care
Directed toward preventative health care
For a fee that is usually fixed & prepaid

6. 2:2 Government Agencies Government services are tax supported
World Health Organization (WHO)
Headquarters in Geneva, Switzerland
International Agency
Sponsored by the U.N.
1.Complies statistics on Disease
2.Publishes health Information
3.Investigates serious health problems
throughout the world

7. U.S. Agencies U.S. Department of Health and Human Services (USDHHS)
National Agency that deals with health problems of the U.S.
National Institutes of Health (NIH)
Division of USDHHS involved on research of disease
Centers for Disease Control and Prevention (CDC)
Division Division of USDHHS concerned with causes, spread, and control of disease. Statistic gathering
Health Departments
Division of USDHHS involved with the community. Statistics gathering. Immunization, and communicable disease control.

8. Government Agencies (continued)
Food and Drug Administration (FDA)
Drug manufacture
Occupational Safety and Health Administration (OSHA)
Standards that protect workers from job related injuries

9. Cost Increase to HealthCare
Technological Advancements
Aging Population
Health-related Lawsuit

10. Reduction of HealthCare Costs
Combination of Services
Outpatient Services
Intervention or Preventative Services
Energy Conservation
Diagnostic Related Groups DRG’s

11. Diagnostic Related Groups DRG’s
Same diagnoses classified in one payment group
Agency receives a set amount
Agency makes every effort to provide care with this set amount
Extra money the agency keeps
If cost is more the agency must accept the loss

12. 2:4 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
Preferred Provider Organization

13. Preferred Provider Organization
Usually provided by large companies to a large group of employees
The PPO forms a contract with the health care provider (doctor, hospital, clinic) to provide care at a lower rate.
The PPO usually requires a deductible & a Co- payment
The patient is encouraged to use affiliated providers, but may use nonaffiliated provider at a higher Copay

14. Insurance Terminology
Premium: an amount to be paid for an insurance policy.
Deductible: the amount of money to be paid out of pocket before the insurance will pay.
Co-insurance: the percentage that money is paid by the patient and the insurance.
Co-payment: a fixed rate paid by the patient.

15. Government Plans Medicare: Medicaid: Medigap 65 yr. older
People with ESRD End Stage Renal (kidney) Disease
Disability & receiving social security for 2 years.
Medicaid:
Low income individuals
Children who qualify for public assistance
People that are physically disabled or Blind
Medigap
Help pay expenses not covered by Medicare
Offered by Private insurance companies

16. More Government Plans
The State Children’s Health Insurance Program (SCHIP) State Children & Infants plan
Uninsured children who earn too little for ins., but too much for Medicaid
Worker’s Compensation
Workers injured on the job
U.S. government plans for all military personnel and their families formerly called CHAMPUS now known as TRICARE.

17. HIPAA Health Insurance Portability and Accountability Act
Key components
Health care access
Preventing health care fraud
Limits exclusion on pre-existing conditions
Prohibits discrimination of individuals based on health status
Maintain the confidentiality of health care information and medical records