3 - 1 Introduction to Health Care HS230 Health Care Administration Kaplan University Unit 3 Chapter 3 & Chapter 4 Kathy Lantz, MHS, MBA

3 - 2 Introduction to US Health Care Chapter 3 Health Care Provision

3 - 3 Types of Care 1.Primary 2.Secondary 3.Tertiary

Types of Care Models Primary: general preventive and curative care that is provided to a person over an extended period of time. Coordinates all the care that the patient receives Secondary: care by medical specialists Tertiary: specialized consultative care, generally delivered in teaching hospitals to handle rare and complicated illnesses 3 - 4

3 - 5 Comparing Care Models Consult with primary care provider first Send difficult problems to secondary or tertiary Benefits –Quality of care –Cost containment –Public sentiment Primary Care Model Specialty Care Model

Benefits of Primary Care Model Quality of Care: continuity of care is more likely to exist when care given by primary care physician Cost Containment: model led to great use of preventive services and reduction in overall health care costs Public Sentiment: according to survey 94 percent of Americans want primary care 3 - 6

3 - 7 Comparing Care Models More dispersed model Does not require patient to consult first with primary care provider Contributed to the rising cost of health care Primary Care Model Specialty Care Model

3 - 8 Managed Care Model Health organizations control costs by funneling all medical necessities through the PCP

3 - 9 Effective Primary Care Systems Accessibility Continuity Comprehensiveness Coordination Accountability

Primary Care Team Approach Primary Care Team Health Educators Medical Assistants ReceptionistClinicians Medical Assistant Physicians Nurse Practitioner

Population-Based Medicine PCP accountable to the community PCP is concerned with every patient, not only those who seek health care. PCP may have their clinical practice made public through report cards and the Internet Medicare, health plans, hospitals

Primary Care Specialties Family Physicians General Internists General Pediatricians

“Nonphysician” Clinicians Nurse Practitioners Physician Assistant

Access to Health Care Too few generalists Lack of health insurance Misdistribution of PCPs - (HPSAs) Two-thirds of all HPSAs are in rural regions *Rural *Inner City

HPSA Describe HPSA, Health Profession Shortage Area

HPSAs Health Profession Shortage Areas A federal designation meaning that the population lacks adequate access to health care. Criteria is having fewer than one PCP for every 3,500 residents Lack of access to medical services are primarily in rural and inner-city areas

Strategies to Improve Distribution National Health Service Corps and Loan Repayment Program Grants Focused Recruiting of Medical Students

National Health Services Corps and Loan Repayment Program Administered by the Federal Bureau of Primary Health Care Provides scholarships to medical students and loan repayment to recent residency graduates in exchange of medical service in Health Profession Shortage Areas (HPSAs)

Vocabulary Quiz Chronic care model Evidence-based medicine Managed care model Population-based medicine Primary care model Secondary care model Tertiary care model

QUIZ: Short Answer Name the primary care specialists

Primary Care Specialties Family Practice Pediatrics Internists

QUIZ: Short Answer The three generalist specialties make up what percentage of physicians?

Primary Care Specialists Three generalist specialties…… family physician general internist general pediatrician ……make up 1/3 of physicians

True or False In a primary care model, the primary care provider serves as a gatekeeper for care. Population-based medicine is focused on the patient that accesses the health care system

True or False Tertiary care is general preventative care. Primary care reforms resulted in the creation of family medicine specialty. Managed care plans are not comprehensive, integrated services packages

Critical Thinking Which of the following is not an access problem for the US? 1)Shortage of PCPs 2)Continuity of care 3)Specialty care 4)Timeliness of appointments with PCP

Introduction to US Health Care Chapter 4 Financing the U.S. Health Care System

Increased Health Care Expenditures Inflation in economy Inflation in medical component of consumer price index Growth of population Changes in the type and quality of health care service

Insurance Coverage

Factors Affecting Coverage Age Race and Ethnicity Poverty Level Residence Predict Coverage

Voluntary Health Insurance Social Insurance Public Welfare Insurance Types of Health Insurance Indemnity Plan Service Benefit Managed Care Categories…

Critical Thinking List and describe the four types of voluntary insurance

Voluntary Insurance Plans Types of VHI Plans Commercial Blue Cross/Blue Shield Health Maintenance Organizations Self-funded Textbook: Chapter 4 pages

Critical Thinking The burden of paying for private health care is shared by which entities: 1) Households 2) Employers 3) Government 4) All of the above

Critical Thinking Which of the following levels of government help fund health care? 1)Federal 2)State 3)Local 4)All of the above

Unit 3 Quiz Unit 3: Chapter 3 and Chapter 4 10 T/F questions 7 Multiple choice questions 1 Short answer 1 Essay

Vocabulary Quiz Medicaid Providers Medicare Beneficiaries Medicare Part A Medicare Part B Managed Care