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 plans Analyze 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

 Vary according to:  Size ▫Small ▫Large  Ownership ▫Proprietary / private / for profit ▫Nonprofit ▫Government ▫Religious  Services ▫General ▫Specialty

 They often provide diagnostic and treatment services that were previously performed in hospitals  Surgical clinics (surgicenters) outpatient surgery  Urgent care centers  Outpatient clinics  Optical centers  Genetic counseling centers (fertility clinics)

 Mainly care for elderly patients (residents)  May also care for individuals with disabilities or handicaps  Residential care (nursing homes) – basic physical care  Extended care (skilled nursing) facilities – provide skilled nursing care and rehabilitation services  Assisted (independent) living facilities – provide basic services (meals, housekeeping, etc.) and basic medical care.

 Became more common in late 1980s – now an area of tremendous growth  Nurse or other skilled professional visits patient in the home to provide treatment and/or education  Less expensive than admission to hospital or long term care facility  States require licensing of home health agencies to assure the quality of care

 Medical and Dental Offices  Vary from small (one doctor) to large complexes with multiple specialties and other healthcare professionals  Some treat a wide variety of illnesses and conditions, others specialize  Mental Health Services  Counseling centers  Psychiatric clinics and hospitals  Chemical (drug and alcohol) abuse treatment centers  Physical abuse treatment centers, dealing with child abuse, spouse abuse and elderly abuse

 World Health Organization (WHO)  Centers for Disease Control and Prevention (CDC)  Food and Drug Administration (FDA)  Veterans Administration  Federally supported  Hospitals and other services  Care for veterans who served in the armed forces  Occupational Health and Safety Administration  State and local health departments  Immunizations  Environmental health and sanitation  Collection of health statistics and records  Health education  Clinics for health care and prevention

 They research that thing their name implies  American Cancer Society  American Heart Association  March of Dimes  Their funds come from donations, dues, fundraisers, etc.  Hospice  Provides palliative care (relieves but does not cure) to dying patients and their families  Involves healthcare professionals and volunteers  Emphasis is to make patient’s last days as pain- free and meaningful as possible

Health Insurance Plans

 Nearly 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.

 Public/National Care 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.  Private Care 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. Most countries have a mixed system

 Technology is a good thing, but it is a costly thing.  In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses.

 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.  You usually have lower premiums when you take out insurance through your job

 Two primary concepts of managed care: ▫ To promote good health ▫ To practice preventive medicine  Managed care plans offer medical services through a system of health care providers.  The system of providers offers services at reduced rates.  Makes sure there is no duplication of services  cost saving  Health Maintenance Organization  Preferred Provide Organization

 Clients must pay a premium, deductible, and co-payments.  Disadvantage  Clients must visit in-network doctors and select a primary care physician.  Advantage  HMOs urge clients to practice healthy living and to receive preventive treatments  usually paid for at 100%

 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  Coverage (co-insurance) is greater with in- network physicians  PPOs often have other fees and co-payments.

 In 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. ▫ Medicaid ▫ Medicare

 Income or needs based program  Designed by the federal government, but administered by state governments  Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled.

 Program for any citizen age 65 or older or those who are disabled for 2+ years  After an individual meets their deductible, Medicare will cover 80% of medical expenses.  Three types of coverage:  Type A for hospital insurance  Type B for medical insurance  Type D for pharmaceutical expenses  Individuals pay a premium and deductible for Type B coverage

 Part A: Hospital Care ▫ Hospitalization ▫ Skilled nursing facilities ▫ Home health care ▫ Hospice care ▫ Long-term care facilities  Part B: Outpatient Services ▫ Medical expenses ▫ therapy ▫medical equipment ▫Testing ▫ Preventive Care

 Government effort to control costs for Medicare and Medicaid  Patients with certain diagnoses classified in one payment group  Limit placed on cost of care  Agency only gets the set amount, so makes every effort to stay within the expense limit allowed

 Provides treatment for workers injured on the job  Administered by the state  Paid for by employer and state  Reimburses the worker for wages lost because of on-the-job injury

 Premium – the amount paid to an insurance agency for a health insurance policy  Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments  Co-payment - an amount paid by the patient for a certain service  Co-Insurance – amount you and your insurance company share once deductible has been met  Out-of-pocket - a medical bill that must be paid by the patient

 Surgery in 2011=$6,  You have not met your $500 deductible yet  You must pay this amount first  $6,750-$500=$6250  You have 80/20 co-insurance  $6250 x 80% (6250 x.8)=$5000 your insurance company pays  $6250 x 20% (6250 x.2)=$1250 you pay

 Procedure cost: $9,  Deductible: $500-has been met for the year  Co-insurance: 80/20  How much do you pay?  How much does your insurance company pay?

 Deductible has been met-you do not pay it again  $9250 x.2 = $1850 you pay  $9250 x.8 = $7400 your insurance company pays

 An tool designed to help a facility operate smoothly by outlining responsibilities  It describes the line of authority that establishes levels of responsibility and supervision

 Advances in technology  ical-advances-in-health/ ical-advances-in-health/  Epidemiology  Bio-ethics  Socioeconomics  Complementary (nontraditional) medicine

Foundation Standard Explain the impact of emerging issues such as technology, epidemiology, bioethics, and socioeconomics on healthcare delivery systems.

 Epidemiology is the study of health and disease in human populations.  It’s all about public health. Photo courtesy of CDC/ Dr. David M. Morens, Dr. Steve Thacker, from the Public Health Image Library.

 Epidemiologists study  Communicable disease  Cardiovascular disease  Cancer  Mental illness  Accidents  And more….  Literally – they “count”!

 For example, they count the number of times a condition (disease) occurs in relation to the total number of people.  We call that PREVALENCE  So, if we counted the number of children with asthma in a community and determined that 5% had asthma, we could say that the PREVALENCE of asthma is 5% in this specific community.

 Epidemiologists investigate disease outbreaks.  They determine where an outbreak came from, and how to prevent it.  Think if them as “disease detectives.”  What if…a number of students at your school become sick with a strange illness. What questions would you ask if you wanted to “investigate” the disease outbreak?

 Police watch a suspect or location to determine what is taking place.  Epidemiologists also practice SURVEILLANCE, but they are searching for and documenting disease.  SURVEILLANCE keeps track of a number of public health concerns, including abuse, violence, sexually transmitted diseases, and communicable disease outbreaks.

 MONITORING uses surveillance data to determine changes in the number of affected (or infected) people.  MONITORING tells us if there is more or less of a particular disease/condition.  These measurements are used to create a picture of how a disease is affecting society. Photo courtesy of CDC/ Edward Baker, M.D., M.P.H. from the Public Health Image Library.

 INCIDENCE is the number of new cases of a disease or event in a specific population. For example, epidemiologists might measure the incidence of influenza in children. Is there anything you could measure the INCIDENCE of in your school? Photo courtesy of CDC/ Barbara Rice, from the Public Health Image Library.

 The number of cases of a specific disease in a specific period of time per unit of population, usually described as a number per  During an influenza epidemic, influenza MORBIDITY may reach 300/1000 in children. Photo courtesy of CDC/ Dr. John Noble, Jr, from the Public Health Image Library.

 A measure of the number of deaths in a given population.  The Infant Mortality rate in America is 6.4 deaths per 1,000 live births.  Is the data in this chart important? Why? Infant Mortality Rates 2007 Angola184.4 Austria4.5 Nigeria95.5 Spain4.3 Sweden2.8 Switzerland4.3 Syria27.7 United Kingdom5.0 United States6.4 Venezuela20.9 Zimbabwe51.1 Photo courtesy of CDC, from the Public Health Image Library.

 RISK is the likelihood that someone will become infected or develop a condition.  RELATIVE RISK may change relevant to a specific factor.  A study reports that smokers face a relative risk of dying from lung cancer 24 times higher than non-smokers. Photo courtesy of CDC, Perry, from the Public Health Image Library.

 Epidemiology  Prevalence  Surveillance  Monitoring  Incidence  Morbidity  Mortality  Risk  Relative Risk

 What is the impact of epidemiology on the healthcare delivery system? Photo courtesy of CDC/ Hsi Liu, Ph.D., MBA, James Gathany, from the Public Health Image Library.