Health-Care Providers Structure/Operation

Health-Care Facilities Primary Care – General Practice – General paediatrics – Dental Care – Visiting Nurses Secondary Care – Ambulatory Specialists Tertiary Care – Hospitals/Long Term Care Providers

General Practice Population wide care Registration Prevention/Treatment Social Role of Physician Density per 1000 population – CZ 0,7; Germany 0,65; Greece 0,28; – Norway 0,81; Sweden 0,62; UK 0,79; USA 0.3

Challenges Aging population Changing competencies – Nursing care – Physiotherapy GP + Technology

Reimbursement Salaried GP Fee for service Capitation payment

Ambulatory Specialists Position – Hospitalits – Independent Reimbursement – Salaried – Fee for service – Payment per case

Hospitals Beds/1000 populEmployee/bedNurse/bed CZ7,111,870,76 Germany8,251,810,81 Netherlands4,693,611,01 Norway3,356,392,55 UK3,346,45NA USA3,086,252,27

Hospital structure Local ( Internal medicine +) Regional ( average 10 specialties) University Hospitals Special Hospitals Ownership – State/Municipality – Church – Private non for profit – Private for profit

Hospital department Outpatient – Acute – Clinics Inpatient – ICU – centralised/decentralised – Standard wards

Director CMO Head of Dept. Ward Physician Physicians CNO Head Nurse – Dept. Ward Sister Nurses/Porters Head Therapists Unit therapists COO/CFO

Outpatient Care No formal limitation to patients Low level of centralisation of Acute Care Time management

Hospital reimbursement Budgeting FFS Case mix - DRG

Long Term Care Beds/1000 population Beds/1000 seniors Employees/ 1000 population Employees /1000 seniors CZ6,543,33,62,4 Germany10,350,37,83,8 Netherlands 10,468,511,77,7 Norway9,362,919,213 UK8,855,4NA USA5,441,915,411,9

Medical Records vs. Medical Students Legal protection of contents – confidentiality Only with the patient´s consent Electronic/paper Entries to be signed and confirmed by a hospital employee High level of protection – Patients ID (personal number) – Dg + treatment

Infection Prevention Vaccination Clothing Hand Hygiene – Hospital obliged to arrange – Hand + stethoscopes Special situations – Face masks – Pregnant students

Hospital Security and Patient Safety Individual badges Doors Awareness – strangers Special precautions – Psychiatry – Paediatrics, neonatology – Infectious diseases