Slide 1 Chapter The Health Care System
Slide 2 Health Care Delivery, Past and Present
Slide 3 Past A health care provider was trained as a generalist, rather than as a specialist Charlatans used to offer ineffective “cures” in exchange for money The home was the primary site for patient care Changes in the Delivery of Health Care
Slide 4 Present Health care professionals have to undergo intensive educational preparation Large facilities provide on-site patient care The family doctor is now called a “general practitioner” and is supported by a team of specialists A holistic approach is now used: focuses on the care of the whole person - physically and emotionally Changes in the Delivery of Health Care
Slide 5 Health Care Organizations
Slide 6
Slide 7 Types of Health Care Organizations Hospitals Probably the best known type of health care organization People who receive the services of a hospital are called patients A patient who has to stay at the hospital for one or more nights receives inpatient care A patient who goes home the same day receives outpatient care
Slide 8 Types of Health Care Organizations Sub-acute care units Also called a skilled nursing unit or a skilled nursing facility Provides care for a patient who has partially recovered but still requires skilled health care
Slide 9 Types of Health Care Organizations Long-term care facilities (nursing homes) For people who are unable to care for themselves at home, yet do not need to be hospitalized Becomes the person’s home, either temporarily or permanently People being cared for in long-term care facilities are called residents
Slide 10 Types of Health Care Organizations Assisted-living facilities For people needing limited help Examples of help: Medications Transportation Meals Housekeeping
Slide 11 Types of Health Care Organizations Home health care agencies Provide skilled care in a person’s home People receiving care in the home health care setting are typically called clients Available for people of all ages with any number of medical needs
Slide 12 Types of Health Care Organizations Hospice organizations People can receive services when they know that they have 3 to 6 months to live Focus: To relieve pain To provide emotional and spiritual support Services are provided for both the dying person and the family
Slide 13 Structure of Health Care Organizations
Slide 14 Structure of Health Care Organizations Usually governed by a board of trustees Has divisions in charge of certain aspects of the organization’s function An administrator or chief executive officer (CEO) is the link between the board and the organization
Slide 15 Government Regulation of the Health Care System
Slide 16 Purpose of Government Regulations Government regulations make sure that: Providers of health care are properly trained and competent Health care facilities meet standards of cleanliness and quality Quality health care is available to everyone
Slide 17 Paying for Health Care
Slide 18 Paying for Health Care Group insurance: insurance purchased at group rates by an employer or corporation Pre-certification (pre-approval) process: health care provider has to prove that a person’s medical condition meets certain criteria before starting treatment
Slide 19 Paying for Health Care Managed care system: arrange contacts with various health care providers Preferred Provider Organization (PPO): health care providers contract with an insurance company to accept a standard payment Health Maintenance Organization (HMO): contract with health care providers to provide health care services for a prepaid fee
Slide 20 Paying for Health Care Medicare People who are 65 years or older are eligible for Medicare Started Diagnosis-related Groups (DRGs): payment is specified according to the diagnosis Due to the DRG system, patients are discharged sooner and sicker
Slide 21 Paying for Health Care Medicaid Designed to help people with low incomes to pay for health care Federally funded and state-regulated plan Medicaid reimbursements are given only to facilities approved by the state agency