Unit 1 Health Care Systems

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.2 1:1 History of Health Care Beliefs and Developments Beliefs and Developments Beliefs about health care from ancient to current times Beliefs about health care from ancient to current times Change in treatment of patients from ancient to current times Change in treatment of patients from ancient to current times Major historical events from 4000 BC to current century Major historical events from 4000 BC to current century

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.3 Future of Health Care When did most of the significant changes in health care occur? When did most of the significant changes in health care occur? Why were the greatest advances made in this time period? Why were the greatest advances made in this time period? What are some possibilities for the future of health care? What are some possibilities for the future of health care?

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.4 Summary Health care has seen many changes over the centuries Health care has seen many changes over the centuries Future changes may be even more dramatic Future changes may be even more dramatic

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.5 1:2/1:3/1:4 Health Care Systems Different Health Care Systems Different Health Care Systems Private health care facilities Private health care facilities Government agencies Government agencies Voluntary or nonprofit agencies Voluntary or nonprofit agencies

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.6 Trends in Health Care Growth – one of the largest and fastest growing industries in the United States Growth – one of the largest and fastest growing industries in the United States Employment opportunities – employs over 10 million workers in over 200 careers Employment opportunities – employs over 10 million workers in over 200 careers Expenditures – it is a two billion dollar per day business and growing Expenditures – it is a two billion dollar per day business and growing

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.7 Types of Services Inpatient services (e.g., hospitals, long-term care) Inpatient services (e.g., hospitals, long-term care) Outpatient services (e.g., clinics, provider offices) Outpatient services (e.g., clinics, provider offices) Specialty services (e.g., laboratories, mental health) Specialty services (e.g., laboratories, mental health)

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.8 Health Care Facilities Hospitals Hospitals Long-term care facilities (LTC or LTCF) Long-term care facilities (LTC or LTCF) Medical offices Medical offices Dental offices Dental offices Clinics Clinics Optical centers Optical centers Emergency care services Emergency care services

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.9 Health Care Facilities (continued) Laboratories Laboratories Home health care Home health care Hospice agencies Hospice agencies Mental health facilities Mental health facilities Genetic counseling centers Genetic counseling centers Rehabilitation facilities Rehabilitation facilities Health maintenance organizations (HMOs) Health maintenance organizations (HMOs)

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.10 Health Care Facilities (continued) Industrial health care centers or occupational health clinics Industrial health care centers or occupational health clinics School health services School health services Government agencies Government agencies U.S. Department of Health and Human Services (USDHHS) U.S. Department of Health and Human Services (USDHHS) State and local departments State and local departments Voluntary and nonprofit agencies Voluntary and nonprofit agencies

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.11 Summary Many different types of health care facilities Many different types of health care facilities Employ many types of health care workers Employ many types of health care workers Important to be aware of facilities and Important to be aware of facilities and type of services

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.12 1:5 Health Insurance Plans Health care costs are rising faster than other costs of living Health care costs are rising faster than other costs of living Most people rely on health insurance plans to pay for health care costs 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 Without insurance, the cost of an illness can become a financial disaster

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.13 Insurance Terminology Deductible Deductible Co-insurance Co-insurance Co-payment Co-payment Preferred provider Preferred provider Monthly fee or premium Monthly fee or premium Managed care Managed care

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.14 Types of Plans Health insurance plans Health insurance plans Health maintenance organizations (HMO) Health maintenance organizations (HMO) Preferred provider organizations (PPO) Preferred provider organizations (PPO) Medicare Medicare Medicaid Medicaid Worker’s Compensation Worker’s Compensation U.S. government plans U.S. government plans

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.15 Summary Health insurance plans do not solve all the problems of health care costs Health insurance plans do not solve all the problems of health care costs Do help many people pay for all or part of cost Do help many people pay for all or part of cost Important for individuals to understand what plan covers Important for individuals to understand what plan covers Also need understanding of co-insurance and other restrictions plan may have Also need understanding of co-insurance and other restrictions plan may have

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.16 1:6 Organizational Structure Line of authority or chain of command Line of authority or chain of command Indicates areas of responsibility Indicates areas of responsibility Goal: most efficient operation of facility Goal: most efficient operation of facility Complex or simple structure determined by size and needs of organization Complex or simple structure determined by size and needs of organization Sample organizational charts – See Figure 1-4 and 1-5 in text Sample organizational charts – See Figure 1-4 and 1-5 in text

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.17 Summary The line of authority must be clearly indicated in any organizational structure The line of authority must be clearly indicated in any organizational structure Workers must identify and understand their position in the organization 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 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.18 1:7 Trends in Health Care Changes in Health Care Changes in Health Care Many events lead to changes in health care Many events lead to changes in health care Changes in health care are inevitable and occur rapidly Changes in health care are inevitable and occur rapidly Health care workers must be flexible Health care workers must be flexible to face and keep pace with the rapid changes

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.19 Some Current Issues Cost containment Cost containment Home health care Home health care Geriatric care Geriatric care Telemedicine Telemedicine Wellness Wellness Alternative and complementary health care Alternative and complementary health care National health care plans National health care plans

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.20 Cost Containment Purpose: control the rising cost of health care and achieve maximum benefit for every dollar spent 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 Necessity: costs increasing with technological advances, improved survival rates, aging population, and lawsuits

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.21 Cost Containment Methods Diagnostic related groups (DRGs) Diagnostic related groups (DRGs) Combination of services Combination of services Outpatient services Outpatient services Mass or bulk purchasing Mass or bulk purchasing Early intervention and preventive services Early intervention and preventive services Energy conservation Energy conservation

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.22 Cost Containment Issues Important not to decrease quality of care 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) 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) 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.23 Home Health Care Industry grew rapidly when DRGs initiated Industry grew rapidly when DRGs initiated Services provided in patient’s home Services provided in patient’s home Visits must be pre-authorized by insurance agency (unless private pay) Visits must be pre-authorized by insurance agency (unless private pay) Often necessary to teach family members to perform care since visits are limited Often necessary to teach family members to perform care since visits are limited Emphasis on cost containment also applies to Home Health Emphasis on cost containment also applies to Home Health

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.24 Geriatric Care Care for the elderly Care for the elderly Percentage of elderly population growing rapidly Percentage of elderly population growing rapidly Need for more facilities Need for more facilities Omnibus Budget Reconciliation Act (OBRA) of 1987 Omnibus Budget Reconciliation Act (OBRA) of 1987

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.25 OBRA Federal law regarding long-term care and home health care 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 States must establish training and competency evaluation programs for nursing/geriatric assistants and maintain registry of qualified individuals Requires compliance with patient’s/ Requires compliance with patient’s/ resident’s rights

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.26 Telemedicine Use of audio, video, and computers to provide health care from a distance Use of audio, video, and computers to provide health care from a distance Interactive services are expected to grow rapidly in the future Interactive services are expected to grow rapidly in the future Increases accessibility to specialty information Increases accessibility to specialty information Decreases need for trip to medical center Decreases need for trip to medical center Decreases need for Home Health visits Decreases need for Home Health visits

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.27 Wellness State of optimal health State of optimal health Increase awareness of maintaining health and preventing disease Increase awareness of maintaining health and preventing disease Emphasis on preventative measures rather than waiting for need for curative intervention Emphasis on preventative measures rather than waiting for need for curative intervention Different facilities will develop to meet needs of wellness emphasis Different facilities will develop to meet needs of wellness emphasis

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.28 Promoting Wellness Physical wellness Physical wellness Emotional wellness Emotional wellness Social wellness Social wellness Mental and intellectual wellness Mental and intellectual wellness Spiritual wellness Spiritual wellness

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.29 Holistic Health Treat the whole body, mind, and spirit Treat the whole body, mind, and spirit Each person is unique with different needs Each person is unique with different needs Use many methods of diagnosis and treatment Use many methods of diagnosis and treatment Emphasis on protection and restoration Emphasis on protection and restoration Promote body’s natural healing processes Promote body’s natural healing processes Patient responsible for choosing care and worker respects the choice Patient responsible for choosing care and worker respects the choice

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.30 Alternative and Complementary Methods of Treatment Increasingly used to replace or supplement traditional medical treatment Increasingly used to replace or supplement traditional medical treatment Holistic approach: belief that the effect on one part effects the whole person 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 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 May vary by cultural values or beliefs

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.31 Types of Practitioners Ayurvedic Ayurvedic Chinese medicine Chinese medicine Chiropractors Chiropractors Homeopaths Homeopaths Hypnotists Hypnotists Naturopaths Naturopaths

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.32 Types of Therapies Refer to Table 1-2 in text Refer to Table 1-2 in text Most are noninvasive and holistic Most are noninvasive and holistic Often less expensive than traditional treatments Often less expensive than traditional treatments Nonjudgmental attitude is essential – patients have right to choose treatment Nonjudgmental attitude is essential – patients have right to choose treatment Increased use requires increased awareness by health care workers Increased use requires increased awareness by health care workers

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.33 Office of Alternative Medicine (OAM) Established in 1992 at the National Institutes of Health (federal government) Established in 1992 at the National Institutes of Health (federal government) Purpose: research therapies and establish standards of quality care Purpose: research therapies and establish standards of quality care Many states have passed laws Many states have passed laws Know your state’s law regarding the legal requirements of alternative therapies Know your state’s law regarding the legal requirements of alternative therapies

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.34 National Health Care Plan Goal: ensure that all Americans can get health coverage Goal: ensure that all Americans can get health coverage Various plan proposals Various plan proposals Costs Costs Potential problems Potential problems

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.35 Past, Present, and Future Trends Advances in the past that impact care today Advances in the past that impact care today Current changes and challenges that are changing the face of health care Current changes and challenges that are changing the face of health care Projected discoveries that will change the future of health care Projected discoveries that will change the future of health care

Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.36 Summary Health care has changed and will continue to change Health care has changed and will continue to change Workers must be constantly aware of changes that occur Workers must be constantly aware of changes that occur Workers must make every attempt to learn about trends Workers must make every attempt to learn about trends