1. Health Care Facilities

2. Hospitals Vary according to: Vary according to: Size Size ▫ Small ▫ Large Ownership Ownership ▫ Proprietary / private / for profit ▫ Nonprofit ▫ Government ▫ Religious Services Services ▫ General (Diagnostic, medical, surgical, and emergency care) ▫ Specialty (Patients needing long-term stays; chronic diseases, psychiatric problems, pulmonary rehab)

3. Provide long-term care for elderly patients and for patients in rehabilitation. Provide long-term care for elderly patients and for patients in rehabilitation. Levels of long-term care: Levels of long-term care: ▫ A nursing home provides care for patients who can no longer care for themselves. ▫ An independent living facility (assisted living) allows patients to use only allows patients to use only the services they need, such the services they need, such as transportation or as transportation or housekeeping. housekeeping. Long-Term Care Facilities

4. Medical Offices May be operated by one or two doctors or a large groups of health care professionals. May be operated by one or two doctors or a large groups of health care professionals. Some medical offices treat a wide range of conditions. Some medical offices treat a wide range of conditions. Others are specialized Others are specialized for specific ages or for specific ages or medical conditions. medical conditions.

5. Other Types of Facilities Physician and dental facilities – illness dx, simple surgery, counseling, diagnostic services, x-rays, admin of drugs Physician and dental facilities – illness dx, simple surgery, counseling, diagnostic services, x-rays, admin of drugs Rehab Centers – outpatient care for physical, occupational, recreational, speech, or hydrotherapy Rehab Centers – outpatient care for physical, occupational, recreational, speech, or hydrotherapy Industrial Healthcare facilities – located in large companies and industrial facilities to provide care to staff Industrial Healthcare facilities – located in large companies and industrial facilities to provide care to staff School Health Services – provide emergency care of accidents, illnesses in a school setting. Provide care of chronic conditions that need monitoring School Health Services – provide emergency care of accidents, illnesses in a school setting. Provide care of chronic conditions that need monitoring HMOs – mananged care organization that stresses wellness as preventative care. Provides immunizations, check-ups, education, basic medical services HMOs – mananged care organization that stresses wellness as preventative care. Provides immunizations, check-ups, education, basic medical services

6. Other Types of Facilities Home Health Agencies – provide care in home that don’t need hospitalization; includes nursing, PT, personal care, and homemaking Home Health Agencies – provide care in home that don’t need hospitalization; includes nursing, PT, personal care, and homemaking World Health Organization (WHO) – funded by the United Nations; concerned with world health problems and publishes public health information World Health Organization (WHO) – funded by the United Nations; concerned with world health problems and publishes public health information Hospices – end of life care to patients expected to live 6 months or less. Hospices – end of life care to patients expected to live 6 months or less.

7. Government Agencies Veterans Administration hospitals – provides care to veterans Veterans Administration hospitals – provides care to veterans US Public Health Department US Public Health Department State Psychiatric hospitals – serve the mentally ill State Psychiatric hospitals – serve the mentally ill State Public Health Services – provide health education materials State Public Health Services – provide health education materials US Department of Health and Human Services (USDHHS) – protects health of all Americans by providing vital human services US Department of Health and Human Services (USDHHS) – protects health of all Americans by providing vital human services National Institute of Health (NIH) – agency for conducting and supporting medical research National Institute of Health (NIH) – agency for conducting and supporting medical research FDA – safety of foods, cosmetics, pharmaceuticals, biological products FDA – safety of foods, cosmetics, pharmaceuticals, biological products OSHA – safety to prevent injury, illness, and death in the workplace OSHA – safety to prevent injury, illness, and death in the workplace

8. Volunteer and Nonprofit Agencies American Cancer Society American Cancer Society American Heart Association American Heart Association American Red Cross American Red Cross National Association of Mental Health National Association of Mental Health National Foundation of the March of Dimes National Foundation of the March of Dimes American Diabetes Association American Diabetes Association National Association of Mental Health National Association of Mental Health National Coalition Against Domestic Violence National Coalition Against Domestic Violence

9. Health Insurance Plans

10. Health Care Systems Nearly every industrialized country has a national health care system. Nearly every industrialized country has a national health care system. Some countries have public or national health care systems, and other countries have private health care systems. Some countries have public or national health care systems, and other countries have private health care systems.

11. Public / National Health Care Systems Mainly funded by taxes and social security insurance.Mainly funded by taxes and social security insurance. Advantage – Every citizen is guaranteed health care regardless of economic status.Advantage – Every citizen is guaranteed health care regardless of economic status. Disadvantages – Health care is not always comprehensive, and taxes may be higher.Disadvantages – Health care is not always comprehensive, and taxes may be higher. Norway, France, the United Kingdom, and CanadaNorway, France, the United Kingdom, and Canada

12. Private Health Care Systems Mainly funded by private insurance agencies and out-of-pocket payments.Mainly funded by private insurance agencies and out-of-pocket payments. Advantages – Coverage is often comprehensive, taxes may be lower, and economic growth is stimulated.Advantages – Coverage is often comprehensive, taxes may be lower, and economic growth is stimulated. Disadvantage – Not every citizen is guaranteed health care.Disadvantage – Not every citizen is guaranteed health care. United States and SwitzerlandUnited States and Switzerland

13. Mixed Systems Very few countries have a purely public or private systemVery few countries have a purely public or private system Most countries create a mixed system by using various funding sources to cover health care expenses.Most countries create a mixed system by using various funding sources to cover health care expenses. Example: Canada and the United StatesExample: Canada and the United States

14. Health Insurance The rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families. The rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families. In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses. In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses.

15. Health Insurance Terms Premium – the amount paid to an insurance agency for a health insurance policy Premium – the amount paid to an insurance agency for a health insurance policy Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments Co-payment - an amount paid by the patient for a certain service Co-payment - an amount paid by the patient for a certain service Out-of-pocket - a medical bill that must be paid by the patient Out-of-pocket - a medical bill that must be paid by the patient

16. Individual and Group Insurance Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage. Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage. Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured. Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.

17. Managed Care Two primary concepts of managed care: Two primary concepts of managed care: ▫ To promote good health ▫ To practice preventive medicine Managed care plans offer medical services through a system of health care providers. The system of providers offers services at reduced rates. Managed care plans offer medical services through a system of health care providers. The system of providers offers services at reduced rates.

18. Managed Care Health Maintenance Organizations Health Maintenance Organizations Preferred Provider Organizations Preferred Provider Organizations Point of Service Point of Service

19. Health Maintenance Organizations Clients must pay a premium, deductible, and co-payments. Clients must pay a premium, deductible, and co-payments. Clients must visit in-network doctors and select a primary care physician. Clients must visit in-network doctors and select a primary care physician. HMOs urge clients to practice healthy living and to receive preventive treatments. HMOs urge clients to practice healthy living and to receive preventive treatments.

20. Preferred Provider Organization Clients must pay a premium, deductible, and co-payments. Clients must pay a premium, deductible, and co-payments. Clients do not have to choose a primary care physician. Clients do not have to choose a primary care physician. Clients may visit non-network physicians, but coverage is greater with in-network physicians. Clients may visit non-network physicians, but coverage is greater with in-network physicians. PPOs often have other fees and co-payments. PPOs often have other fees and co-payments.

21. Point of Service Clients must pay a premium. Clients must pay a premium. Clients must chose a primary care physician. Clients must chose a primary care physician. For in-network physicians, there is usually no deductible and co-payments are low. For in-network physicians, there is usually no deductible and co-payments are low. Specialists may be non-network physicians, but coverage may be limited Specialists may be non-network physicians, but coverage may be limited

22. Government Programs In the 20th century, the United States government began to realize the need for public medical assistance. 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. In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance. ▫ Medicaid ▫ Medicare

23. Medicaid Income or needs based program Income or needs based program Designed by the federal government, but administered by state governments Designed by the federal government, but administered by state governments Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled. Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled.

24. Medicare Program for any citizen age 65 or older Program for any citizen age 65 or older Administered by the federal government Administered by the federal government After an individual pays a deductible, Medicare will cover 80% of all medical expenses. After an individual pays a deductible, Medicare will cover 80% of all medical expenses.

25. Medicare Services Part A: Hospital Care Part A: Hospital Care ▫ Hospitalization ▫ Skilled nursing facilities ▫ Home health care ▫ Hospice care ▫ Long-term care facilities Part B: Outpatient Services Part B: Outpatient Services ▫ Medical expenses, including therapy, medical equipment, and testing ▫ Preventive Care

26. Worker’s Compensation Provides treatment for workers injured on the job Provides treatment for workers injured on the job Administered by the state Administered by the state Reimburses the worker for wages lost because of on-the-job injury Reimburses the worker for wages lost because of on-the-job injury