Health Care Systems Refer to the Healthcenter21 Course Guide for more information about editing teacher presentations.

Introduction to Systems Theory System – A group of individual parts that work together to form a unified whole. Systems Theory – A way of studying a system as one unit, instead of individual parts. <LS.HS.Systems.Theory.General-P01-01.jpg> Introduction to Systems Theory Any business, organization, or family can be called a system. A system is a group of individual parts that work together to form a unified whole. The systems theory is a way of studying a system as one unit, instead of individual parts. The theory helps to focus on the primary mission, or purpose, of a system. The systems theory applies to any system in life, such as the way a family operates or the way a hospital provides health care services. By examining a system as a whole, it is easier to understand how each part contributes to the overall mission. Additionally, the systems theory makes it easier to pinpoint flaws in the system.

Components of the Systems Theory Input Throughput Output Feedback Loop Controls Environment Goals Mission <LS.HS.Systems.Theory.General-P02-01.jpg> Components of the Systems Theory To understand the systems theory, you must learn the parts, or components, of the theory. The components of the systems theory include: Input Throughput Output Feedback Loop Controls Environment Goals Mission NOTE: Systems theory will be explained to students in greater detail in the Learn and Practice exercise. Students will be presented with a scenario that demonstrates systems theory.

Inputs, Throughputs, and Outputs Input – Anything that enters a system, including money, resources, materials, or effort. Throughput – A process that converts the input into a final product or service. Output – The final product of service that is provided by a system. <LS.HS.Systems.Theory.General-P02-01.jpg> Inputs, Throughputs, and Outputs Input is anything that enters a system. Input could include money, resources, materials, or effort. Throughput is a process that converts the input into a final product or service. An output is the final product or service provided by a system.

Feedback Loop Feedback Loop – A process of monitoring outputs to determine whether or not the system is working. Feedback should be evaluated and then put back into the system to improve future outputs. <LS.HS.Systems.Theory.General-P02-01.jpg> Feedback Loop The feedback loop is a process of monitoring outputs to determine whether or not the system is working. Feedback should be evaluated and then put back into the system to improve future outputs.

Controls and Environment Environment – The circumstance in which the system exists. The system relies on the environment for resources. <LS.HS.Systems.Theory.General-P02-01.jpg> Controls and Environment Controls are anything that pinpoint problems in a system before the output is complete. An environment is the circumstance and condition in which a system exists. The system relies on the environment for resources.

Goals and Mission Goals – A measurable activity that must be completed to ensure that the mission is accomplished. Mission – The specific, stated purpose of a system. <LS.HS.Systems.Theory.General-P02-01.jpg> Goals and Mission A system must have a specific, stated purpose, or mission. In order to reach the mission, a system must define several measurable goals.

Evaluate the System The key to evaluating a system is to determine if the mission is fulfilled. To evaluate a system, look at the “big picture.” <LS.HS.Systems.Theory.General-P02-01.jpg> Evaluate the System Once the specific components of the systems theory are understood, the system can be evaluated. The key to evaluating a system is to determine if the mission is fulfilled. This is sometimes called evaluating the “big picture.”

Examples of other systems Physiological Systems: The digestive system, neurological system, circulatory system

Compare Health care providers within a system must do their part to ensure that every patient receives the best care possible. <LS.HS.Systems.Theory.National-P13-01.jpg> Compare Neither the private system nor the public system is perfect. Each system has some high points and some low points. But all systems must be flexible and able to adapt to the changing needs of a society. Additionally, health care providers within a system must do their part to ensure that every patient receives the best care possible.

Interdependence All members of the health care team are dependent on each other. If one worker does not fulfill the required duties, the entire team is hindered. <LS.HS.Systems.Delivery.Structure-P10-01.jpg> Interdependence Every health care worker is part of the health care team. All members of the team are dependent on each other. This means that if one worker does not fulfill the required duties, the entire team is hindered. Patients do not receive the quality care that they deserve when the team does not function properly. This connection among workers is called interdependence. Imagine what might happen if the secretary at a medical office stopped answering the telephone. Patients would not be able to make appointments, and the team would not be able to perform its duties. Or imagine what could happen if the housekeeping department stopped cleaning. Many patients would feel uncomfortable receiving treatment in a dirty facility. In addition, patients and health care workers would be at risk of getting infections.

Government Programs In the 20th century, the United States government began to realize the need for public medical assistance. In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance. Medicaid Medicare <LS.HS.Systems.Insurance.Government-P03-01.jpg>. Government Programs In the 20th century, the United States government began to realize the need for public medical assistance. In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance. These programs are called Medicaid and Medicare.

Medicaid Need-based program Designed by the federal government, but administered by state governments Provides medical assistance to individuals and families who are determined by the state to be “needy.” Each state must determine its own definition of “needy.” <LS.HS.Systems.Insurance.Government-P04-01.jpg> Medicaid Medicaid is a need-based program that was designed by the federal government. However, it is administered by state governments. Medicaid is a voluntary program, which states may or may not choose to participate in. Medicaid provides medical assistance to individuals and families who are “needy.” Each state must determine its own definition of “needy.” Typically, needy individuals include: Low-income families with young children Pregnant women in low-income families Families with adopted or foster children Blind or disabled adults Adults with certain chronic or debilitating diseases Adults who receive social security benefits

Medicaid Service Services typically include: Hospital services Prenatal care Child vaccines Pediatric services Physician services Diagnostic testing and X-rays Rehabilitation and physical therapy Prescription drugs Home health care <LS.HS.Systems.Insurance.Government-P05-01.jpg> Medicaid Services In addition to deciding who qualifies for Medicaid, states must also define the type, amount, duration, and scope of the services. Services vary from state to state, but they typically include: Inpatient and outpatient hospital services Prenatal care Child vaccines Pediatric services Physician services Diagnostic testing and X-rays Rehabilitation and physical therapy Prescription drug coverage Home health care

Medicaid Limits Medicaid is not guaranteed to every low-income individual. If a low-income individual does not have children or is not disabled, this person may be unable to receive any medical insurance. <LS.HS.Systems.Insurance.Government-P06-01.jpg> Medicaid Limits It is important to know that Medicaid is not guaranteed to every low-income individual. In fact, studies show that 40% to 60% of the poor do not qualify for Medicaid. If a low-income individual does not have children or is not disabled, this person may be unable to receive any medical insurance.

Medicare Entitlement program for any citizen age 65 or older Administered by the federal government After an individual pays a deductible, Medicare will cover 80% of all medical expenses. <LS.HS.Systems.Insurance.Government-P08-01.jpg> Medicare Medicare is a program that is administered by the federal government. Unlike Medicaid, which is a needs-based program, Medicare is an entitlement program. This means everyone age 65 or older is entitled to Medicare insurance. Medicare is also available to some people under the age of 65 with certain disabilities. Medicare will not cover all of an individual’s health care expenses. The insured persons are required to pay a yearly deductible. After the deductible, Medicare will cover 80% of all expenses. This means that insured persons must pay the remaining 20%. Many people cannot afford to pay the 20% charge. An additional form of insurance called Medigap may be purchased to help cover the remaining expenses.

Medicare Services Part A: Hospital Care Part B: Outpatient Services Hospitalization Skilled nursing facilities Home health care Hospice care Long-term care facilities Part B: Outpatient Services Medical expenses, including therapy, medical equipment, and testing Preventive Care <LS.HS.Systems.Insurance.Government-P09-01.jpg> Medicare Services Medicare is divided into Part A and Part B. The following services are provided by these parts: Part A: Hospital Care Hospitalization Skilled nursing facilities Home health care Hospice care Long-term care facilities Part B: Outpatient Services Medical expenses, including physician services, physical therapy, occupational therapy, speech therapy, medical equipment, and diagnostic testing Preventive care

Input--Entry point An efficient healthcare delivery system must have a well defined entry point. Triage (screening to determine priority of treatment) Timely entry into the system

Throughput Throughput is the step where the patient is treated Educational resources Treatment resources Financing mechanism Information and feedback systems

Services provided in throughput Preventive - healthcare services designed to keep the student well Diagnostic - healthcare services to find out what is wrong with the patient Treatment - healthcare services to cure the patient Patient education

Output is the product of the system A healthy patient? A healthy community? Some other definition?

Movement or pressure on one component exerts pressure on others.