2 2:1 Private Health Care Facilities Growth—one of the largest and fastest growing industries in the United StatesEmployment opportunities—employs over 13 million workers in over 200 careersExpenditures—it is a four-billion-dollar- per-day business and growing(continues)
3 Private Health Care Facilities Hospitals – General, Specialty, Govt. & UniversityClinics or satellite centers – Smaller or Specialty(Pediatrics, Cancer, Radiology, Pharmacy, Outpatient, Surgical)Medical Offices (Dental offices, Optical)Laboratories – Blood & Urine testsEmergency care services - Minor careMental Health Facilities – psychiatric, abuse, alcohol, drugGenetic Counseling Centers – Pregnant or consideringRehabilitation Facilities (PT & OT or Speech Therapy)
4 Private Health Care Facilities (Elderly) Long-Term Care FacilitiesNursing HomeIndependent living and/or assisted livingElderly CommunityHome Health CareCare in the Patients home, usually the elderly or disabled.Hospice agenciesTerminally ill patients have life expectancy of 6 months or less
5 Private Health Care Facilities Health maintenance organizations (HMOs)Proposed by Kaiser PermanenteSigned into Law by President Richard NixonBoth Health care delivery system & Health InsuranceThey provide Total Health CareDirected toward preventative health careFor a fee that is usually fixed & prepaid
6 2:2 Government Agencies Government services are tax supported World Health Organization (WHO)Headquarters in Geneva, SwitzerlandInternational AgencySponsored by the U.N.1.Complies statistics on Disease2.Publishes health Information3.Investigates serious health problemsthroughout the world
7 U.S. Agencies U.S. Department of Health and Human Services (USDHHS) National Agency that deals with health problems of the U.S.National Institutes of Health (NIH)Division of USDHHS involved on research of diseaseCenters for Disease Control and Prevention (CDC)Division Division of USDHHS concerned with causes, spread, and control of disease. Statistic gatheringHealth DepartmentsDivision of USDHHS involved with the community. Statistics gathering. Immunization, and communicable disease control.
8 Government Agencies (continued) Food and Drug Administration (FDA)Drug manufactureOccupational Safety and Health Administration (OSHA)Standards that protect workers from job related injuries
9 Cost Increase to HealthCare Technological AdvancementsAging PopulationHealth-related Lawsuit
10 Reduction of HealthCare Costs Combination of ServicesOutpatient ServicesIntervention or Preventative ServicesEnergy ConservationDiagnostic Related Groups DRG’s
11 Diagnostic Related Groups DRG’s Same diagnoses classified in one payment groupAgency receives a set amountAgency makes every effort to provide care with this set amountExtra money the agency keepsIf cost is more the agency must accept the loss
12 2:4 Health Insurance Plans Health care costs are rising faster than other costs of livingMost people rely on health insurance plans to pay for health care costsWithout insurance, the cost of an illness can become a financial disasterPreferred Provider Organization
13 Preferred Provider Organization Usually provided by large companies to a large group of employeesThe PPO forms a contract with the health care provider (doctor, hospital, clinic) to provide care at a lower rate.The PPO usually requires a deductible & a Co- paymentThe patient is encouraged to use affiliated providers, but may use nonaffiliated provider at a higher Copay
14 Insurance Terminology Premium: an amount to be paid for an insurance policy.Deductible: the amount of money to be paid out of pocket before the insurance will pay.Co-insurance: the percentage that money is paid by the patient and the insurance.Co-payment: a fixed rate paid by the patient.
15 Government Plans Medicare: Medicaid: Medigap 65 yr. older People with ESRD End Stage Renal (kidney) DiseaseDisability & receiving social security for 2 years.Medicaid:Low income individualsChildren who qualify for public assistancePeople that are physically disabled or BlindMedigapHelp pay expenses not covered by MedicareOffered by Private insurance companies
16 More Government PlansThe State Children’s Health Insurance Program (SCHIP) State Children & Infants planUninsured children who earn too little for ins., but too much for MedicaidWorker’s CompensationWorkers injured on the jobU.S. government plans for all military personnel and their families formerly called CHAMPUS now known as TRICARE.
17 HIPAA Health Insurance Portability and Accountability Act Key componentsHealth care accessPreventing health care fraudLimits exclusion on pre-existing conditionsProhibits discrimination of individuals based on health statusMaintain the confidentiality of health care information and medical records