2 Objectives Students will be able to: Differentiate between private, public, and non-profit facilities.Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models.Research the organizational structures and services of various types of health care facilities.Differentiate between various types of health care insurance plansAnalyze the cause and effect on health care system change based on the influence of technology epidemiology, bio-ethics, socioeconomic and various forms of complimentary medicine
3 Hospitals Vary according to: Size Small Large Ownership Proprietary / private / for profitNonprofitGovernmentReligiousServicesGeneralSpecialty
4 Long-Term Care Facilities Provide long-term care for elderly patients and for patients in rehabilitation.Levels of long-term care:A nursing home provides care for patients who can no longer care for themselves.An independent living facilityallows patients to use onlythe services they need, suchas transportation orhousekeeping.
5 Medical OfficesMay be operated by one or two doctors or a large groups of health care professionals.Some medical offices treat a wide range of conditions.Others are specializedfor specific ages ormedical conditions.
6 Other Types of Facilities Dental officesClinicsOptical centersEmergency Care CentersLaboratoriesHome Health CareHospiceMental HealthGenetic Counseling CentersRehabilitationHealth Maintenance Organizations (HMO’s)Industrial Care CentersSchool Health Services
7 Government Agencies World Health Organization (WHO) U.S. Department of Health and Human Services (USDHHS)National Institute of Health (NIH)Centers for Disease Control and Prevention (CDC)Food and Drug Administration (FDA)Agency for Health Care Policy And Research (AHCPR)Occupational Health and Safety AdministrationState and local health departments
8 Volunteer and Nonprofit Agencies American Cancer SocietyAmerican Heart AssociationAmerican Red CrossNational Association of Mental HealthNational Foundation of the March of Dimes
10 Health Care SystemsNearly 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.
11 Public / National Health Care Systems Mainly funded by taxes and social security insurance.Advantage – Every citizen is guaranteed health care regardless of economic status.Disadvantages – Health care is not always comprehensive, and taxes may be higher.Norway, France, the United Kingdom, and Canada
12 Private Health Care Systems 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.Disadvantage – Not every citizen is guaranteed health care.United States and Switzerland
13 Mixed SystemsVery few countries have a purely public or private systemMost countries create a mixed system by using various funding sources to cover health care expenses.Example: Canada and the United States
14 Health InsuranceThe 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.
15 Health Insurance Terms Premium – the amount paid to an insurance agency for a health insurance policyDeductible - the amount that must be paid by the patient before the insurance agency will begin to make paymentsCo-payment - an amount paid by the patient for a certain serviceOut-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.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: To promote good healthTo practice preventive medicineManaged 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 Preferred Provider OrganizationsPoint of Service
19 Health Maintenance Organizations Clients must pay a premium, deductible, and co-payments.Clients must visit in-network doctors and select a primary care physician.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 do not have to choose a primary care physician.Clients may visit non-network physicians, but coverage is greater with in-network physicians.PPOs often have other fees and co-payments.
21 Point of Service Clients must pay a premium. Clients must chose a primary care physician.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
22 Government ProgramsIn 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.MedicaidMedicare
23 Medicaid Income or needs based program Designed by the federal government, but administered by state governmentsUsually 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 Administered by the federal governmentAfter an individual pays a deductible, Medicare will cover 80% of all medical expenses.
25 Medicare Services Part A: Hospital Care Part B: Outpatient Services HospitalizationSkilled nursing facilitiesHome health careHospice careLong-term care facilitiesPart B: Outpatient ServicesMedical expenses, including therapy, medical equipment, and testingPreventive Care
26 Worker’s Compensation Provides treatment for workers injured on the jobAdministered by the stateReimburses the worker for wages lost because of on-the-job injury
27 Trends in Today’s Health Care Systems Advances in technologyEpidemiologyBio-ethicsSocioeconomicsComplementary (nontraditional) medicine
28 Organizational Structure An tool designed to help a facility operate smoothly by outlining responsibilitiesIt describes the line ofauthority thatestablishes levelsof responsibilityand supervision