HEALTH
CARE
SYSTEMS
Health care systems include many agencies, facilities, and
people involved in the delivery of health care.
Private facilities:
Require a fee for services. Some use grants and
contributions to provide financial services.
TYPES OF FACILITIES
1.
Hospitals: may be private or proprietary (operated for
profit), non-profit or volunteer, religious or government; vary
in size and services provided
2.
Common types of hospitals
1.
2.
3.
4.
General Hospitals: treat a wide range of conditions and age
groups (provide diagnostic, medical, surgical and emergency
services.
Specialty Hospitals: provide care for only special conditions
or age groups; examples: burn, cancer, pediatric,
psychiatric, orthopedic or rehabilitation.
Government Hospitals: operated by federal, state or local
government agencies; examples: VA (veterans
administration)
University or college medical centers: provide hospital
services along with research hospital services as well as
research and education
Long-Term Care Facilities (LTC/LTCF): provide assistance and
care for elderly patients (referred to as “residents”)
Types of LTCs:
Nursing Homes: provide basic physical and emotional
care to individuals who can no longer care for themselves with
activities of daily living (ADLs)
Extended care facilities or skilled care facilities:
designed to provide skilled nursing care and rehabilitative care
to prepare patients or residents for return to their homes.
Independent living and assisted living facilities:provide
services such as meals, housekeeping, laundry transportation,
social events, and basic medical care (assistance with
medications)
Medical Offices: May be privately owned by one doctor to
large corporations with several doctors. Services include
diagnosis, treatment, examination, basic laboratory tests and
minor surgeries.
Types of medical offices:
Pediatrics (infants and children)
Cardiology (diseases and disorders of the heart)
Obstetrics (care of pregnant female)
Dental Offices: Range from single dentist to clinics that hire
a group of dentists. Provide dental care to all ages or
specialized care to certain age groups or dental conditions.
Clinics or Satellite Centers: May be composed of a group of
doctors or dentists who share the facility, others may by
private and provide specialized care.
Types of Clinics:
Surgical Centers: perform minor surgeries (day
surgeries)
Urgent or emergency care: first aid or emergency
care
Rehabilitation clinics: offer physical, occupational,
speech and other therapies
Types of Clinics Continued:
Specialty clinics: Diabetic or oncology
Outpatient clinics: provide care to outpatients
Health department clinics: pediatric health care,
treatment of sexually transmitted diseases, immunizations,
etc.
Medical center clinics: offer free or reduced charge
treatment from medical students.
Optical Centers: can be individually owned or a part of a
chain. Provide eye exams, prescribe glasses, etc.
Emergency Care Services: Provide care for accident victims
or sudden illness.
Laboratories: may be part of the other facilities but can
operate as separate health care services. Perform diagnostic
tests, blood, urine, etc. Some labs perform dental services
(dentures)
Home Health Care: agencies that provide care in the
patient’s home.
Types of Home Care: Nursing, personal, therapy,
homemaking.
Hospice: provide care for terminally ill
Mental Health Facilities: provide guidance and counseling,
psychiatric clinics and hospitals, chemical abuse treatments,
physical abuse treatment
Genetic Counseling Centers: Work with individuals or
couples considering pregnancy. Provide prenatal screening,
checking for abnormalities and birth defects, explaining test
results, medical options, coping.
Rehabilitation Facilities: help patients with physical or
mental disabilities obtain maximum self-care and function
Health Maintenance Organizations (HMO): provide for
preventive care. HMOs are operated by large industries or
corporations.
Industrial Health Care Centers: provide health care for
employees.
School Health Services: found in schools and colleges.
Provide emergency care, test for speech, vision, hearing
problems & counseling.
GOVERNMENT
AGENCIES
Tax supported agencies.
Examples:
1. World Health Organizations (WHO)- sponsored by the
United Nations. Maintains information and statistics
regarding diseases world-wide.
2. U.S. Department of Health and Human Services
(USDHHS)-deals with health problems in the United
States
3. National Institutes of Health-part of the USDHHS involved
in research on disease.
4. Centers for Disease Control and Prevention (CDC)-part of
the USDHHS, concerned with spread and control of
disease.
5. Food and Drug Administration (FDA)- regulates food and
drugs sold to public.
6. Agency for Health Care Policy and Research (AHCPR)responsible for identify and implementing standards for
health care
7. Occupational Safety and Health Administration (OSHA)enforces standards that protect workers from job related
injuries.
8. Health departments- provide health services directed by
the USDHHS.
Voluntary and Nonprofit Agencies:
1. American Cancer Society
2. American Heart Association
3. American Diabetes Association
4. Many others
HEALTH INSURANCE
PLANS
Terms to Know:
1. Deductible: amount the patient must pay for
health care before the plan will pay.
2. Co-insurance: percentage shared by patient and
insurance plan.
3. Co-payment: amount the patient pays for a service
regardless of the total cost of the visit.
4. Health Maintenance Organization (HMO): a
monthly fee or premium is paid for membership and the fee
stays the same regardless of the amount of health care used.
5. Preferred Provider Organization (PPO): health plan
provided by large companies to their employees. Restrict
treatment to specific health care facilities.
6. Medicare: provides health care for almost all
individuals over the age of 65.
7. Medicaid: usually provided for individuals with low
income.
8. Workers’ Compensation: provides for treatment of
workers injured on the job.
9. TRICARE: provides for care of military personnel.
10. Managed Care: Cost containment process that
requires all health care provided must serve a purpose.
ORGANIZATIONAL
STRUCTURE
All health care systems must have an organizational
structure that includes a chain of command.