1. Unit C Health Team Relations
Health Care Systems
Unit C
Health Team Relations

2. Introduction Various health care systems deliver health care
Health care is one of the largest and fastest growing industries in the United States
Employs over 10 million workers in over 200 careers
Two billion dollar per day business

3. Hospital Classification
based on funding received
Private – operated for profit – usually by pt. fees and/or organizations that provide financial support.
Religious – religious support & Pt. fees
Nonprofit or voluntary – Pt. fees & donations.
Government – Tax monies and/or Pt. fees

4. General hospitals treat wide variety of conditions and age groups
Provide diagnostic, medical, surgical and emergency care services.

5. Specialty Hospitals Care for certain conditions or age groups
Examples: burn, oncology or cancer, pediatric or children, psychiatric, rehabilitation, and orthopaedic

6. Government Hospitals
Operated by federal, state, and local government agencies
World-wide facilities for government service personnel and their dependents
Veteran’s Administration hospitals
State psychiatric hospitals
State rehabilitation centers

7. University or College Medical Centers
Provide services, research and education
Can be funded by private or government sources

8. Long Term Care Facilities (LTC or LTCF)
Provide care for elderly, individuals with chronic of long-term illness
Individuals receiving care are usually called residents instead of patients (or clients)

9. Nursing homes or geriatric homes
Provide basic physical and emotional care
Usually for individuals who cannot care for themselves
Help individuals with activities or daily living (ADLs), provide a safe and secure environment, and promote opportunities for social interactions

10. Extended or skilled care facilities
Provide skilled nursing and rehabilitative care
Prepare resident for return to home environment or other long-term facility
Some have subacute units: provide rehabilitation services for major illness or surgery, treatment for cancer, or treatments such as dialysis or heart monitoring

11. Extended or skilled care facilities
Independent or assisted living facilities:
individuals purchase or rent unit and can receive services such as meals, housekeeping, laundry, transportation, social events, and basic medical care

12. Medical Offices/clinics
Services
Diagnosis, tx, exams, labs, minor surgery
Specialties (Examples include: Pediatrics, Cardiology, and Obstetrics)
May be privately owned

13. Dental Offices/clinics
Private offices to dental clinics employing several dentists
Dental clinics now found in major retail/department stores
Can provide general or specialized dental care

14. Clinics Satellite Clinics or Satellite Centers
Found in many types of health care
Can refer to group of medical/dental doctors who share a facility and other personnel
Can be operated by corporation or private groups and provide special care

15. Clinic Types Surgical clinics or surgicenters: minor surgery
Emergency care clinics: first aid to injured or ill pts.
Rehabilitation clinics: physical, speech, occupational and etc..
Specialty Clinics: Diabetes or oncology (cancer) clinics
Hospitals often operate clinics such as outpatient clinics

16. Clinics Health Departments offer clinics such as… Pediatric care
Sexually transmitted diseases
Respiratory diseases
Immunizations
Medical Centers also sponsor clinics

17. Optical Centers
Can be individually owned by an ophthalmologist (eye doctor) or optometrist (eye specialist) or be part of a large chain of stores
Provide vision examinations
Prescribe eye glasses or contact lenses
Check for the presence of eye diseases

18. Emergency Care Services
Provide special care for accidents or sudden illness
Ambulance services: private and governmental
Rescue squads: frequently operated by fire departments
Emergency care clinics
ERs operated by hospitals
Helicopter or airplanes

19. Laboratories
Can be part of other facility or operated as separate health care service
Medical laboratories: perform diagnostic tests
Dental laboratories: prepare dentures and other devices

20. Home Health Care Provide care in patient’s home
Services frequently used by the elderly and disabled
Can be offered by health depts., hospitals, private, nonprofit & government agencies and volunteer groups

21. Examples Nursing care Personal care: bathing dressing, and so forth
Therapy: physical, occupational, speech, respiratory
Homemaking: food preparation, cleaning, washing, and so forth

22. Hospice
Provide care for terminally ill persons with life expectancy of six months or less
Care provided in person’s home or hospice facility
Allows person to die with dignity and in comfort
Provides psychological, social, spiritual, and financial counseling for both patient and family

23. Mental Health Facilities
Deal with mental diseases and disorders
Examples…
Guidance and counseling centers
Psychiatric clinics and hospitals
Chemical abuse treatment centers for alcohol/drug abuse
Physical abuse treatment centers (child or spouse abuse)

24. Genetic Counseling Centers
Can be independent facility or within another facility.
Consult with high risk families/pts
Work with couples or individuals who are pregnant or considering a pregnancy.

25. Genetic Counseling Centers
Perform prenatal (before birth) screening tests
Checking for genetic abnormalities and birth defects
Explaining the results of the tests
Identifying medical options when a birth defect is present
Helping individuals cope with the psychological issues caused by a genetic disorder

26. Rehabilitation Centers
Provide care directed at helping patient with physical or mental disabilities obtain maximum self-care and function
Can include hospitals, clinics, and/or private centers
Services can include physical, occupational, recreational, speech, and hearing therapies

27. Industrial Health Care Centers
Located in large industries or companies
Provide care for employees of the industry
Services: basic exams, teach accident prevention/safety, provide emergency care

28. School Health Service
Found in schools and colleges and provide the following services…
Emergency care for accidents and sudden illness
Tests to check for health conditions: speech, vision, hearing, and so forth
Promote health education
Maintain safe and sanitary school environment
Counseling, emergency care

29. 3.02 Government agencies

30. 1.03 Understand healthcare agencies, finances, and trends
GHA International
World Health Organization (WHO)
founded in 1948
assess health trends
compile statistics related to disease
investigate health problems worldwide
publish health information
Government agencies are supported by taxes.
Sponsored by the United Nations
Compile statistics related to disease
Publish health information
Investigate health problems worldwide
1.03 Understand healthcare agencies, finances, and trends

31. GHA National U. S. Department of Health and Human Services (USDHHS)
investigate health problems in the United States
prevent disease by immunizations
provide comprehensive health services
publish health information
compile statistics related to disease
1.03 Understand healthcare agencies, finances, and trends

32. National Institutes of Health (NIH)
GHA National
National Institutes of Health (NIH)
World’s leading research organization
Research includes
AIDS cancer
Alzheimer’s diabetes
arthritis heart disease
1.03 Understand healthcare agencies, finances, and trends

33. Centers for Disease Control and Prevention (CDC)
GHA National -
Centers for Disease Control and Prevention (CDC)
disease control
disease prevention
1.03 Understand healthcare agencies, finances, and trends

34. GHA National - (USDHHS)
Food and Drug Administration (FDA)
- regulates safety of food and cosmetics
- regulates safety and efficacy of drugs, biological
products and medical devices
1.03 Understand healthcare agencies, finances, and trends

35. GHA National - (USDHHS)
Agency for Healthcare Research and Quality (AHRQ)
Formerly called: Agency for Healthcare Policy and Research (AHCPR)
investigate quality of healthcare delivery
establish standards for healthcare treatment
Established in 1991
Research quality of healthcare delivery
Identify standards of treatment
1.03 Understand healthcare agencies, finances, and trends

36. Occupational Safety and Health Administration (OSHA)
GHA National
ABC
Occupational Safety and Health Administration (OSHA)
Division of the US Department of Labor
- create job safety standards
- implement job safety standards
1.03 Understand healthcare agencies, finances, and trends

37. Government Healthcare Agencies - State - (USDHHS)
N. C. Department of Health and Human Services
(NCDHHS)
Functions to provide many services:
Adoption Medicaid
Deaf/blind services Mental health services
Emergency services Pregnancy services
Food and nutrition services Senior centers
In-Homes Aides Vital records
1.03 Understand healthcare agencies, finances, and trends

38. GHA State - (USDHHS)
N. C. Department of Health and Human Services - (NCDHHS)
Functions to provide information:
Disease and health information Safety
End of life issues Teen issues
Environmental health Wellness
Minority health
1.03 Understand healthcare agencies, finances, and trends

39. GHA Local - (USDHHS, NCDHHS)
County Health Department
Services provided:
Communicable disease control Laboratory services
Health inspections Oral health
Immunizations Woman and child health
Provides information
Health education
Statistics related to health, birth and death
1.03 Understand healthcare agencies, finances, and trends

40. Private Healthcare Agencies Non-Profit
Supported by
donations
fees
fundraisers
grants
Usual focus:
one disease or condition
related group of disorders
Examples
Non-Profit Agencies are supported by donations, fees, fundraisers and grants. They usually focus on one disease or a related group of disorders. Non-profit agencies participate in research, public awareness and patient services.
1.03 Understand healthcare agencies, finances, and trends

41. Private Healthcare Agencies Non-Profit
Participate in:
Non-Profit Agencies are supported by donations, fees, fundraisers and grants. They usually focus on one disease or a related group of disorders. Non-profit agencies participate in research, public awareness and patient services.
services
education
research
1.03 Understand healthcare agencies, finances, and trends

42. Nonprofit / Volunteer Agencies
Examples…
American Cancer Society
American Heart Association
American Respiratory Disease Association
American Diabetes Association
National Association of Mental Health
National Foundation of March of Dimes
American Red Cross
HOSA

43. 3.03 Health Insurance Plans

44. Insurance Terms
Deductible: amount the patient must pay before the insurance starts to pay for services
co-insurance: the percentage of the bill for services that the policy holder must pay
co-payment (co-pay): a specific amount paid by the patient for each medical service, such as $15.00 for each doctor visit or each prescription filled

45. Healthcare Trends Cost Containment Measures
Managed Care
Designed to reduce the cost of healthcare
Contacts with a specific group of providers
Requires prior approval to see a specialist
1.03 Understand healthcare agencies, finances, and trends

46. Health Maintenance Organizations
Provide total health care directed toward preventive care.
Services: Preventive health care, basic medical services, health education, hospitalizations, rehabilitation.

47. Health Maintenance Organizations
Mode of operation
By large industries or corporations
By private agencies
Use services of other healthcare facilities including mental/dental offices, hospitals, rehab centers, home health care, clinics and laboratories.

48. Health Maintenance Organization (HMO) - Private
Provide HC services for prepaid fee
Stress prevention
Cheaper to prevent than treat
Disadvantage is limitations placed on which doctors and facilities can be used

49. Preferred Provider Organization (PPO) - private
A group of doctors or hospital that agrees to provide HC at a reduced rate
Usually offered by large companies
Offers more flexibility to patients
Pts pay lower rates if they select participating physician and facility

50. Medicaid Govt.
Federally-funded health insurance
low income, children, blind or disabled.

51. Medicare
pts over age 65
Disabled people >2yrs social Security benefits
End stage renal failure
There are several types of Medicare
Type A Type B
Type C Type D

52. Type A Medicare Hospital Insurance
Inpatient care, skilled nursing care and home health care.
funded by Social Security taxes.

53. Type B Medicare Medical Insurance
physician services, outpatient care, etc.
Patient pays premium and 20%
Medicare pays 80% for services.

54. Tricare AKA Champus
Provides care for military dependents and retired members of the armed service.

55. Veterans Health Administration
Mission Statement
To fulfill President Lincoln's promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s veterans.

56. Worker’s Compensation
Administered by the state
Pays both the medical bills and the wages for employee injured on the job
Payments are made by employers and the state

57. 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
Important to be aware of different insurance plans