Chapter 2 Health Care Systems

Largest and fastest growing industry in the US Over 13 million workers Expenditures-4 billion dollar per day business and growing

Hospitals General Hospitals-treat a wide range of conditions Specialty hospitals-special conditions or age groups are treated Government hospitals-operated by gov. agencies University or college medical centers-provide services along with research and education

2.2 Government Agencies

World Health Organization (WHO) Compiles statistics and information on disease, addresses serious health problems throughout the world

US Department of health and Human services (USDHHS) A National agency that deals with the health problems in the United States

National Institute of Health (NIH) Involved in disease research

Centers for Disease Control and Prevention (CDC) Concerned with causes, spread and control of diseases

Food and Drug Administration (FDA) A federal agency Responsible for regulating food and drug products sold to the public

Agency for Health Care Policy and Research (AHCPR) Research the quality of health care and identify standards of treatment to be provided

Occupational Safety and Health Administration OSHA) Provide for a safe work environment

Health Departments Under the direction of the USDHHS Sanitation, inspections for environmental health, clinics for health care

2.3 Voluntary or Nonprofit Agencies Funding-donations, grants, membership fees Function-provide funding for research, public education, provide equipment for patients in need Examples-Lion’s Club, American Cancer Society, American Heart Association

2.4 Health Insurance Plans Why-pay for health care Deductible-amount that must be paid BEFORE the policy begins to pay Co-Insurance-a specific percentage of expenses is paid by the insurance company and the patient. Ex: 70-30, 70% is paid by ins. Co. and 30% by patient If the expenses total $2000, how much will you owe? Co-Payment-a specific amount the patient pays for a particular service.

Health Maintenance Organization (HMO) A managed care plan in which the payments stay the same each month. The advantage of this is that it covers routine examinations and preventive care. You must see HMO-affiliated providers to have coverage.

Preferred Provider Organization (PPO) You have to go to the preferred hospital and pay a co-payment and a deductible.

Medicare A federal government program that provides health care for almost all individuals over the age of 65, for any person with a disability who has received social security benefits for at least 2 years. 3 kinds of coverage a.) Hospital Insurance B.) Medical Insurance C.) Pharmaceutical (Medication) Expenses.

Medigap Policy which covers expenses not covered by Medicare.

Medicaid Medicaid is a medical assistance program that is jointly funded by the federal government and state government. Medicaid pays for health care of individuals with low incomes. State Children’s Health Insurance Program SCHIP)-healthcare for uninsured children

Worker’s Compensation Is a health insurance plan providing treatment for workers injured on the job.

Tricare U.S government health insurance plan for all military personnel. Provides care for all active duty members and their families, and survivors of the military personnel.

Managed Care All health care must have a purpose. A second opinion is frequently required. HMOs and PPOs are examples of Managed Care

Health Insurance Portability and Accountability Act (HIPAA) Provided consumers with more access to health care Greater confidentiality in regards to medical records Standardized electronic health care records