Unit 1 Health Care Systems

1:1 History of Health Care Beliefs and Developments Beliefs about health care from ancient to current times Change in treatment of patients from ancient to current times Major historical events from 4000 BC to current century Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Future of Health Care When did most of the 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? Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Summary Health care has seen many changes over the centuries Future changes may be even more dramatic Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

1:2/1:3/1:4 Health Care Systems Different Health Care Systems Private health care facilities Government agencies Voluntary or nonprofit agencies Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Trends in Health Care Growth – one of the largest and fastest growing industries in the United States Employment opportunities – employs over 10 million workers in over 200 careers Expenditures – it is a two billion dollar per day business and growing Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Types of Services Inpatient services (e.g., hospitals, long-term care) Outpatient services (e.g., clinics, provider offices) Specialty services (e.g., laboratories, mental health) Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Health Care Facilities Hospitals Long-term care facilities (LTC or LTCF) Medical offices Dental offices Clinics Optical centers Emergency care services Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Health Care Facilities (continued) Laboratories Home health care Hospice agencies Mental health facilities Genetic counseling centers Rehabilitation facilities Health maintenance organizations (HMOs) Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Health Care Facilities (continued) Industrial health care centers or occupational health clinics School health services Government agencies U.S. Department of Health and Human Services (USDHHS) State and local departments Voluntary and nonprofit agencies Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Summary Many different types of health care facilities Employ many types of health care workers Important to be aware of facilities and type of services Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

1:5 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 Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Insurance Terminology Deductible Co-insurance Co-payment Preferred provider Monthly fee or premium Managed care Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Types of Plans Health insurance plans Health maintenance organizations (HMO) Preferred provider organizations (PPO) Medicare Medicaid Worker’s Compensation U.S. government plans Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Summary Health insurance plans do not solve all the problems of health care costs Do help many people pay for all or part of cost Important for individuals to understand what plan covers Also need understanding of co-insurance and other restrictions plan may have Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

1:6 Organizational Structure Line of authority or chain of command Indicates areas of responsibility Goal: most efficient operation of facility Complex or simple structure determined by size and needs of organization Sample organizational charts – See Figure 1-4 and 1-5 in text Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Summary The line of authority must be clearly indicated in any organizational structure Workers must identify and understand their position in the organization structure To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. 1:7 Trends in Health Care Changes in Health Care Many events lead to changes in health care Changes in health care are inevitable and occur rapidly Health care workers must be flexible to face and keep pace with the rapid changes Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Some Current Issues Cost containment Home health care Geriatric care Telemedicine Wellness Alternative and complementary health care National health care plans Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Cost Containment Purpose: control the rising cost of health care and achieve maximum benefit for every dollar spent Necessity: costs increasing with technological advances, improved survival rates, aging population, and lawsuits Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Cost Containment Methods Diagnostic related groups (DRGs) Combination of services Outpatient services Mass or bulk purchasing Early intervention and preventive services Energy conservation Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Cost Containment Issues Important not to decrease quality of care Workers can decrease costs (e.g., look for areas to control costs and avoid waste, keep expenditures down) Consumers can decrease costs (e.g., take responsibility for their own care, follow preventative measures to decrease need for services, use services appropriately) Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Home Health Care Industry grew rapidly when DRGs initiated Services provided in patient’s home Visits must be pre-authorized by insurance agency (unless private pay) Often necessary to teach family members to perform care since visits are limited Emphasis on cost containment also applies to Home Health Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Geriatric Care Care for the elderly Percentage of elderly population growing rapidly Need for more facilities Omnibus Budget Reconciliation Act (OBRA) of 1987 Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. OBRA Federal law regarding long-term care and home health care States must establish training and competency evaluation programs for nursing/geriatric assistants and maintain registry of qualified individuals Requires compliance with patient’s/ resident’s rights Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Telemedicine Use of audio, video, and computers to provide health care from a distance Interactive services are expected to grow rapidly in the future Increases accessibility to specialty information Decreases need for trip to medical center Decreases need for Home Health visits Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Wellness State of optimal health Increase awareness of maintaining health and preventing disease Emphasis on preventative measures rather than waiting for need for curative intervention Different facilities will develop to meet needs of wellness emphasis Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Promoting Wellness Physical wellness Emotional wellness Social wellness Mental and intellectual wellness Spiritual wellness Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Holistic Health Treat the whole body, mind, and spirit Each person is unique with different needs Use many methods of diagnosis and treatment Emphasis on protection and restoration Promote body’s natural healing processes Patient responsible for choosing care and worker respects the choice Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Alternative and Complementary Methods of Treatment Increasingly used to replace or supplement traditional medical treatment Holistic approach: belief that the effect on one part effects the whole person Based on belief that the person has a life force or energy that can be used in the healing process May vary by cultural values or beliefs Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Types of Practitioners Ayurvedic Chinese medicine Chiropractors Homeopaths Hypnotists Naturopaths Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Types of Therapies Refer to Table 1-2 in text Most are noninvasive and holistic Often less expensive than traditional treatments Nonjudgmental attitude is essential – patients have right to choose treatment Increased use requires increased awareness by health care workers Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Office of Alternative Medicine (OAM) Established in 1992 at the National Institutes of Health (federal government) Purpose: research therapies and establish standards of quality care Many states have passed laws Know your state’s law regarding the legal requirements of alternative therapies Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

National Health Care Plan Goal: ensure that all Americans can get health coverage Various plan proposals Costs Potential problems Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Past, Present, and Future Trends Advances in the past that impact care today Current changes and challenges that are changing the face of health care Projected discoveries that will change the future of health care Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED. Summary Health care has changed and will continue to change Workers must be constantly aware of changes that occur Workers must make every attempt to learn about trends Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.