Chapter 02 Health Care Systems Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:1 Private Health Care Facilities • Health care is one of the largest and fastestgrowing industries in the United States • Will employ over 22.1 million workers in over 200 careers by 2020 • 2013 U.S. health care spending was over $2.9 trillion Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hospitals ARE CLASSIFIED AS : • • • • General hospitals Specialty hospitals Government hospitals University or college medical centers DEPENDING ON THE SOURCE OF INCOME IT RECEIVES Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Long-Term Care Facilities pg 32 • LTC or LTCF provide assistance and care for residents • Residential care facilities • Extended care or skilled care facilities • Independent living and assisted living facilities Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Medical Offices pg 32 • Vary from offices privately owned by one physician to large complexes • Services include diagnosis, treatment, examination, basic lab testing, minor surgery • May offer general or specialized care Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Concierge Medicine pg 32 • Personalized health care • Annual or monthly fee paid to primary care provider for enhanced level of care Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Dental Offices pg 32 • Vary in size from privately owned by one or more dentists to dental clinics • Include general care for all ages and specialized care for certain age groups or dental conditions Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Clinics or Satellite Centers pg 32 • • • • Surgical clinics or surgicenters Urgent, walk-in, or emergency care clinics Rehabilitation clinics Substance abuse clinics Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Clinics or Satellite Centers pg 32-33 • • • • Specialty clinics Outpatient clinics Health department clinics Medical center clinics Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Optical Centers pg 33 • May be individually owned or part of chain • Services include vision examination, prescription of glasses or contact lenses, screening for eye diseases Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Emergency Care Services pg 33 • Special care for accident victims or those with sudden illness • Ambulance services • Rescue squads • Emergency care clinics • Emergency departments Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Laboratories pg 33 • May be part of other facilities or stand-alone • Medical laboratories – Diagnostic tests • Dental laboratories – Dentures and other devices Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Home Health Care pg 33 • Provide care in a patient’s home • Frequently used by elderly and disabled • Provide nursing care, personal care, therapy, homemaking • Offered by health departments, hospitals, private agencies, government agencies, volunteer groups, nonprofits Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Hospice pg 33 • Provide care for terminally ill persons • Care in a patient’s home or in a facility • Palliative care, psychological, social, spiritual, financial counseling to patient and family • Support for family members following patient’s death Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Mental Health Facilities pg 33 • Treatment for patients with mental disorders or diseases • Examples include guidance and counseling centers, psychiatric clinics and hospitals, clinical abuse treatment centers, physical abuse treatment centers Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Genetic Counseling Centers pg 34 • Independent facilities or located within another facility • Prenatal screening for couples or individuals who are pregnant or considering pregnancy • Check for genetic abnormalities and birth defects, explain results and options Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Rehabilitation Facilities pg 34 • Located in hospitals, clinics, private centers • Care for patients with physical or mental disabilities • Therapies include physical, occupational, recreational, speech, hearing Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Health Maintenance Organizations • Health care delivery system and type of health insurance • Preventive care for a fixed, prepaid fee • Services include examinations, basic medical services, health education, hospitalization, rehabilitation Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Industrial Health Care Centers • • • • Also called occupational health clinics Located in large companies or industries Health care for employees Services include examinations, accident prevention and safety, emergency care Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. School Health Services • Located in schools and colleges • Provide emergency care in case of accident or illness, tests for health conditions, health education, maintenance of a safe and sanitary environment, counseling Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Pharmaceutical Services • Prepare and dispense medications • Provide expertise on drug therapy • Found in many settings: hospitals, clinics, nursing homes, online, etc. Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:2 Government Agencies • Government services are tax supported • World Health Organization (WHO) • U.S. Department of Health and Human Services (USDHHS) • National Institutes of Health (NIH) • Centers for Disease Control and Prevention (CDC) Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:2 Government Agencies • Food and Drug Administration (FDA) • Agency for Healthcare Research and Quality (AHRQ) • Occupational Safety and Health Administration (OSHA) • Health departments Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:2 Government Agencies • Office of the National Coordinator for Health Information Technologies (ONC) • Health departments Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:3 Voluntary or Nonprofit Agencies • Supported by donations, membership fees, fund-raisers, and grants • Health services are provided at national, state, and local levels • Examples include American Cancer Society, American Red Cross, Autism Speaks Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:3 Voluntary or Nonprofit Agencies • Organizations often focus on specific diseases – Study the disease – Provide research funding – Educate the public – Provide special services to those with the disease • Staffed by health care workers and volunteers Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:4 Organizational Structure • • • • Line of authority or chain of command Indicates areas of responsibility Essential for most efficient operation of facility Structure determined by size and needs of organization • Refer to Figures 2-4 and 2-5 in text Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:4 Organizational Structure • Lines of authority must be clearly indicated in any organizational structure • Workers must identify and understand their position in the structure • Workers must take problems, reports, and questions to their immediate supervisor • **The healthcare worker should understand the functions and goals of an employing organization Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. 2:5 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 • Without insurance, the cost of an illness can result in financial disaster Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Insurance Terminology • Deductible • Co-insurance • Co-payment Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Plans • • • • • • Employer-sponsored or group insurance plans Health maintenance organization (HMO) Preferred provider organization (PPO) Medicare Medigap Medicaid Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Plans • Children’s Health Insurance Program (CHIP) • Worker’s compensation • TRICARE – U.S. government plans for military personnel and their families • Managed care plans Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Types of Plans • Fee-for-service compensation – Provider paid a set amount for each service provided • Value-base compensation – Physician paid based upon performance – Paid a certain amount for each disease or diagnosis Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Health Insurance Portability and Accountability Act (HIPAA) • Five components – Health care access, portability, renewability – Preventing health care fraud/abuse – Tax-related health provisions – Application and enforcement of group health plan requirements – Revenue offsets Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Patient Protection and Affordable Care Act • Law of 2010 changing health care insurance regulation • Provisions include – Guaranteed issue – Expanded Medicaid eligibility – Improved benefits for Medicare Copyright © 2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
