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Unit 1 Health Care Systems Pages 2 – 18

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1 Unit 1 Health Care Systems Pages 2 – 18

2 Introduction *Data from obtained from CDC
Health care is one of the largest and fastest-growing industry in the US Expenditures – it is a two billion dollar per day business and growing Over 12 million health care workers in US 80% of health care work force are women *Data from obtained from CDC 2

3 1.1 Health Care Facilities
Many different types of facilities Employ many types of health care workers Individual facilities can vary in: Size (individual doctor or complex of doctors facility for a community or for a county, etc) Service provided (general or specific to disease, age, gender) Sources of income (public, private, religious, nonprofit, government) Important to be aware of facilities and type of services

4 Types of Health Care Facilities
Hospitals Long-term care facilities Medical offices Dental offices Clinics Optical centers Emergency care services Laboratories Home health care Hospice agencies Mental health facilities Rehabilitation facilities Genetic counseling centers Health Maintenance Organizations Industrial health care centers School health services Government agencies World Health Organization U.S. Department of Health and Human Services Occupational Safety and Health Administration Voluntary and nonprofit agencies

5 Health Care Facilities
HOSPITALS One of the major types of facilites Most hospitals are general hospitals that treat a wide range of conditions Specialty hospitals include: Burn, oncology, pediatric, psychiatric, orthopedic, rehabilitative, government

6 Health Care Facilities
LONG-TERM CARE FACILITIES (LTCs) Patients live at facility and are known as residents May care for elderly, disabled patients, individuals with chronic or long-term illnesses Extended Care Facilities – rehabilitative care to prepare patients to return home Subacute Units – rehabilitative care for patients recovering from major illness, intensive medical treatments or surgery Independent Living – residents can care for themselves, but live in the facility. The facility provides residents with food, housekeeping, transportation and basic medical care 6

7 Health Care Facilities
MEDICAL OFFICE Can offer a variety of services: Diagnosis, treatment, exams, lab tests, minor surgery CLINICS Usually a group of doctors that share a facility and personnel Many hospitals have outpatient clinics EMERGENCY CARE SERVICES Special care for victims of accidents, sudden illness or patients without a general physician LABORATORIES Often part of other facilities, but occasionally a separate facility Run blood tests, urine tests, can prepare dentures, etc 7

8 Health Care Facilities
HOME HEALTH CARE Provide care in patient’s home Usually used by elderly or disabled patients HOSPICE Provides care for terminally ill patients with a life expectancy of less than 6 months MENTAL HEALTH FACILITIES Treat patients with mental disorders and diseases Counseling center, psychiatric hospitals, abuse treatment centers REHABILITATION Can be found in hospitals, clinics or a private center Can be inpatient or outpatient 8

9 Health Care Facilities
GENETIC COUNSELING Provides individuals or perspective parents information on their genetic background and disposition to passing on genetic disorders If an individual or couple has a certain likelihood of being a carrier for a disorder, a blood test will be recommended to screen for a particular gene HEALTH MAINTENANCE ORGANIZATIONS (HMOs) Provide total health care directed towards preventative health care INDUSTRIAL HEALTH CARE CENTER Occupational health clinics, found in large companies to provide health care for the employees

10 Health Care Facilities
SCHOOL HEALTH SERVICES Provides students with emergency treatment as well as health education and counseling GOVERNMENT AGENCIES Provides facilities for government personnel and their dependents Hospitals, psychiatric treatment, rehabilitation, etc WORLD HEALTH ORGANIZATION (WHO) Sponsored by the United Nations Addresses and studies health problems throughout the world 10

11 Health Care Facilities
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) National agency that deals with US health problems NATIONAL INSTITUTE OF HEALTH (NIH) - Researches diseases CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) – studies causes, spread and control of diseases in the population FOOD AND DRUG ADMINISTRATION (FDA) – regulates food and drugs sold to the public OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) – establishes and enforces job safety standards 11

12 Health Care Facilities
NONPROFIT Also known as voluntary agencies Supported by donations, grants, fundraising, etc Usually focuses on one type of disease American Cancer Society American Red Cross March of Dimes 12

13 1:4 Health Insurance Plans
Health care costs are rising faster than other costs of living 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

14 Insurance Terminology You Should Know:
Deductible Co-insurance Co-payment Preferred provider Monthly fee or premium Managed care

15 Types of Services Inpatient services (e.g., hospitals, long-term care)
Outpatient services (e.g., clinics, provider offices) Specialty services (e.g., laboratories, mental health)

16 Types of Plans Health insurance plans
Health maintenance organizations (HMO) Preferred provider organizations (PPO) Medicare Medicaid Worker’s Compensation Managed Care

Insurance company pays for some or all of services (depends on plan, deductible, out-of-pocket expense, etc.) HEALTH MAINTENANCE ORGANIZATIONS (HMO) Person pays a monthly fee for the membership Plan covers regular exams and check-ups PREFERRED PROVIDER ORGANIZATIONS (PPO) Provided to employees by their company The company works with certain health care agencies to provide the employees with health care at a reduced rate Employees can only go to the selected agencies

18 Types of Plans MEDICARE
Insurance provided by the government to people over 65 or disabled persons on Social Security Type A coverage – hospital insurance, extended care or home care Type B coverage – medical insurance, doctor services, therapy Covers 80% of medical bills MEDICAID Government provided medical assistance program Operated on a state level, benefits vary from state to state

Health insurance for people injured on the job MANAGED CARE One approach to health care in response to the rising costs Insurance covers wellness exams and check-ups, but need to prove the necessity Need referrals to see specialty doctors

20 Summary Health insurance plans do not solve all the problems of health care costs Do help many people pay for all or part of cost Important for individuals to understand what plan covers Also need understanding of co-insurance and other restrictions plan may have

21 1:5 Organizational Structure
Line of authority or chain of command Indicates areas of responsibility Goal: most efficient operation of facility Complex or simple structure determined by size and needs of organization To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor

22 1:6 History of Health Care
Beliefs and Developments Beliefs about health care and cause of disease has changed greatly from ancient times This has also caused drastic changes in the treatment of patients

23 Future of Health Care Questions you should be able to answer:
When did most of the significant changes in health care occur? Why were the greatest advances made in this time period? What are some possibilities for the future of health care?

24 1:7 Trends in Health Care Changes in Health Care
Many events lead to changes in health care Changes in health care are inevitable and occur rapidly Health care workers must be flexible to face and keep pace with the rapid changes

25 Some Current Issues Cost containment Home health care Geriatric care
Wellness Alternative and complementary health care National health care plans

26 Cost Containment 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 Issues: need to keep high quality of care, workers can decrease costs, consumers can decrease their own health care costs

27 Cost Containment Methods
Diagnostic related groups (DRGs) Patients with certain diagnoses put into a payment group Agency sets limit of amount to be spent on care If care is below the limit, agency keeps the money If care costs are above the limit, agency is responsible Combination of services Outpatient services Mass or bulk purchasing Early intervention and preventive services Energy conservation

28 Home Health Care Industry grew rapidly when DRGs initiated
Services provided in patient’s home Visits must be pre-authorized by insurance agency (unless private pay) Often necessary to teach family members to perform care since visits are limited Emphasis on cost containment also applies to Home Health Allows for shorter hospital stays

29 Geriatric Care Care for the elderly
Percentage of elderly population growing Need for more facilities Omnibus Budget Reconciliation Act (OBRA) Requires states to establish geriatric care, continuing education for staff, evaluation and retraining of staff Wellness of patient is monitored Physical, emotional, social, mental, spiritual wellness

30 Wellness State of optimal health
Increase awareness of maintaining health and preventing disease Emphasis on preventative measures Different facilities will develop to meet needs of wellness emphasis

31 Holistic Health Treat the whole body, mind, and spirit
Each person is unique with different needs Use many methods of diagnosis and treatment Emphasis on protection and restoration Promote body’s natural healing processes Patient responsible for choosing care and worker respects the choice

32 Alternative and Complementary Methods of Treatment
Increasingly used to replace or supplement traditional medical treatment 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

33 Alternative and Complementary Methods of Treatment
May vary by cultural values or beliefs Often less expensive than traditional treatments Nonjudgmental attitude is essential – patients have right to choose treatment Increased use requires increased awareness by health care workers

34 Types of Practitioners
Ayurvedic Chinese medicine Chiropractors Homeopaths Hypnotists Naturopaths

35 Office of Alternative Medicine (OAM)
Established in 1992 at the National Institutes of Health (federal government) Purpose: research therapies and establish standards of quality care Many states have passed laws Know your state’s law regarding the legal requirements of alternative therapies

36 National Health Care Plan
Goal: All Americans have health coverage Various plan proposals Federal government pays for health care, money would come from taxes Health care cooperatives – consumer purchases health care at a lower cost Managed care – employers provide coverage, government provides coverage for poor What are some potential problems?

37 Summary Health care has changed and will continue to change
Workers must be constantly aware of changes that occur Workers must make every attempt to learn about trends

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