1. Health Care Systems

2. Introduction Various health care systems deliver health care Various health care systems deliver health care Health care is one of the largest and fastest growing industries in the United States Health care is one of the largest and fastest growing industries in the United States Employs over 10 million workers in over 200 careers Employs over 10 million workers in over 200 careers Two billion dollar per day business Two billion dollar per day business

3. Hospitals Vary in size and type of service provided Vary in size and type of service provided General hospitals treat wide range of conditions General hospitals treat wide range of conditions Care for certain conditions or age groups Care for certain conditions or age groups Examples: burn, oncology or cancer, pediatric or children, psychiatric, rehabilitation, and orthopaedic Examples: burn, oncology or cancer, pediatric or children, psychiatric, rehabilitation, and orthopaedic Specialty Hospitals

4. Government Hospitals Operated by federal, state, and local government agencies Operated by federal, state, and local government agencies World-wide facilities for government service personnel and their dependents World-wide facilities for government service personnel and their dependents Veteran’s Administration hospitals Veteran’s Administration hospitals State psychiatric hospitals State psychiatric hospitals State rehabilitation centers State rehabilitation centers

5. University or College Medical Centers Provide services, research and education Provide services, research and education Can be funded by private or government sources Can be funded by private or government sources

6. Hospitals one of the major types of health care facilities. Vary in size and type of services offered Classification based on funding received A.Private – operated for profit – usually by pt. fees and/or organizations that provide financial support. B.Religious – religious support & Pt. fees C.Nonprofit or voluntary – Pt. fees & donations. D.Government – Tax monies and/or Pt. fees

7. Long Term Care Facilities (LTC or LTCF) Provide care for elderly, individuals with chronic of long-term illness Provide care for elderly, individuals with chronic of long-term illness Individuals receiving care are usually called residents instead of patients (or clients) Individuals receiving care are usually called residents instead of patients (or clients)

8. Long-term care facilities Nursing homes or geriatric homes Provide basic physical and emotional care Provide basic physical and emotional care Usually for individuals who cannot care for themselves Usually for individuals who cannot care for themselves Help individuals with activities or daily living (ADLs), provide a safe and secure environment, and promote opportunities for social interactions Help individuals with activities or daily living (ADLs), provide a safe and secure environment, and promote opportunities for social interactions

9. Extended care or skilled care facilities Provide skilled nursing and rehabilitative care Provide skilled nursing and rehabilitative care Prepare resident for return to home environment or other long-term facility Prepare resident for return to home environment or other long-term facility Some have subacute units: provide rehabilitation services for major illness or surgery, treatment for cancer, or treatments such as dialysis or heart monitoring Some have subacute units: provide rehabilitation services for major illness or surgery, treatment for cancer, or treatments such as dialysis or heart monitoring

10. Extended care or skilled care facilities Independent or assisted living facilities: individuals purchase or rent unit and can receive services such as meals, housekeeping, laundry, transportation, social events, and basic medical care Independent or assisted living facilities: individuals purchase or rent unit and can receive services such as meals, housekeeping, laundry, transportation, social events, and basic medical care

11. Medical Offices Services Diagnosis Diagnosis Treatment Treatment Examinations Examinations Basic laboratory tests Basic laboratory tests Minor Surgery Minor Surgery Specialties (Examples include: Pediatrics, Cardiology, and Obstetrics) Specialties (Examples include: Pediatrics, Cardiology, and Obstetrics)

12. Dental Offices Private offices to dental clinics employing several dentists Private offices to dental clinics employing several dentists Dental clinics now found in major retail/department stores Dental clinics now found in major retail/department stores Can provide general or specialized dental care Can provide general or specialized dental care

13. Clinics Satellite Clinics or Satellite Centers Found in many types of health care Found in many types of health care Can refer to group of medical/dental doctors who share a facility and other personnel Can refer to group of medical/dental doctors who share a facility and other personnel

14. Clinics Other clinics operated by corporation or private groups and provide special care: Other clinics operated by corporation or private groups and provide special care: Surgical clinics or surgicenters Surgical clinics or surgicenters Emergency care clinics Emergency care clinics Rehabilitation clinics Rehabilitation clinics Specialty Clinics: Diabetes or oncology (cancer) clinics Specialty Clinics: Diabetes or oncology (cancer) clinics Hospitals often operate clinics such as outpatient clinics Hospitals often operate clinics such as outpatient clinics

15. Clinics Health Departments offer clinics such as… Health Departments offer clinics such as… –Pediatric care –Sexually transmitted diseases –Respiratory diseases –Immunizations Medical Centers also sponsor clinics Medical Centers also sponsor clinics

16. Optical Centers Can be individually owned by an ophthalmologist (eye doctor) or optometrist (eye specialist) or be part of a large chain of stores Can be individually owned by an ophthalmologist (eye doctor) or optometrist (eye specialist) or be part of a large chain of stores Provide vision examinations Provide vision examinations Prescribe eye glasses or contact lenses Prescribe eye glasses or contact lenses Check for the presence of eye diseases Check for the presence of eye diseases

17. Emergency Care Services Provide special care for accidents or sudden illness Provide special care for accidents or sudden illness Ambulance services: private and governmental Ambulance services: private and governmental Rescue squads: frequently operated by fire departments Rescue squads: frequently operated by fire departments Emergency care clinics Emergency care clinics ERs operated by hospitals ERs operated by hospitals Helicopter or airplanes Helicopter or airplanes

18. Laboratories Can be part of other facility or operated as separate health care service Can be part of other facility or operated as separate health care service Medical laboratories: perform diagnostic tests Medical laboratories: perform diagnostic tests Dental laboratories: prepare dentures and other devices Dental laboratories: prepare dentures and other devices

19. Home Health Care Provide care in patient’s home Provide care in patient’s home Examples of care… Examples of care… Nursing care Nursing care Personal care: bathing dressing, and so forth Personal care: bathing dressing, and so forth Therapy: physical, occupational, speech, respiratory Therapy: physical, occupational, speech, respiratory Homemaking: food preparation, cleaning, washing, and so forth Homemaking: food preparation, cleaning, washing, and so forth

20. Hospice Provide care for terminally ill persons with life expectancy of six months or less Provide care for terminally ill persons with life expectancy of six months or less Care provided in person’s home or hospice facility Care provided in person’s home or hospice facility Allows person to die with dignity and in comfort Allows person to die with dignity and in comfort Provides psychological, social, spiritual, and financial counseling for both patient and family Provides psychological, social, spiritual, and financial counseling for both patient and family

21. Mental Health Facilities Deal with mental diseases and disorders Deal with mental diseases and disorders Examples… Examples… Guidance and counseling centers Guidance and counseling centers Psychiatric clinics and hospitals Psychiatric clinics and hospitals Chemical abuse treatment centers for alcohol/drug abuse Chemical abuse treatment centers for alcohol/drug abuse Physical abuse treatment centers (child or spouse abuse) Physical abuse treatment centers (child or spouse abuse)

22. Genetic Counseling Centers Perform prenatal (before birth) screening tests Perform prenatal (before birth) screening tests Checking for genetic abnormalities and birth defects Checking for genetic abnormalities and birth defects Explaining the results of the tests Explaining the results of the tests Identifying medical options when a birth defect is present Identifying medical options when a birth defect is present Helping individuals cope with the psychological issues caused by a genetic disorder Helping individuals cope with the psychological issues caused by a genetic disorder

23. Rehabilitation Centers Provide care directed at helping patient with physical or mental disabilities obtain maximum self-care and function Provide care directed at helping patient with physical or mental disabilities obtain maximum self-care and function Can include hospitals, clinics, and/or private centers Can include hospitals, clinics, and/or private centers Services can include physical, occupational, recreational, speech, and hearing therapies Services can include physical, occupational, recreational, speech, and hearing therapies

24. Industrial Health Care Centers Located in large industries or companies Located in large industries or companies Provide care for employees of the industry Provide care for employees of the industry Services: basic exams, teach accident prevention/safety, provide emergency care Services: basic exams, teach accident prevention/safety, provide emergency care

25. School Health Service Found in schools and colleges and provide the following services… Found in schools and colleges and provide the following services… Emergency care for accidents and sudden illness Emergency care for accidents and sudden illness Tests to check for health conditions: speech, vision, hearing, and so forth Tests to check for health conditions: speech, vision, hearing, and so forth Promote health education Promote health education Maintain safe and sanitary school environment Maintain safe and sanitary school environment Counseling Counseling

26. Government Agencies World Health Organization World Health Organization International agency sponsored by United Nations International agency sponsored by United Nations Compiles statistics and information on disease Compiles statistics and information on disease Publishes health information Publishes health information Investigates and deals with serious health problems throughout the world Investigates and deals with serious health problems throughout the world

27. United States Department of Health and Human Services 1.National Institutes of Health (NIH): research on disease 2.Centers for Disease Control and Prevention (CDC): causes, spread and control of diseases in populations 3.Food and Drug Administration (FDA): regulates food and drug products sold to the public

28. United States Department of Health and Human Services 4.Agency for Health Care Policy and Research (AHCPR): established in 1990 to research the quality of health care delivery and identify the standards of treatment that should by provided by health care facilities 5.Occupational Safety and Health Administration (OSHA): establishes and enforces standards that protect workers from job-related injuries and illnesses

29. Health Departments Provide specific services needed by state or local community Provide specific services needed by state or local community Immunization for disease control Immunization for disease control Inspections for environmental health and sanitation Inspections for environmental health and sanitation Health education Health education Collection of statistics and health records Collection of statistics and health records

30. Nonprofit / Volunteer Agencies Supported by donations, membership fees, fundraisers, and federal or state grants Supported by donations, membership fees, fundraisers, and federal or state grants Provide health services at national, state, and local levels Provide health services at national, state, and local levels March of Dimes March of Dimes March of Dimes March of Dimes

31. Nonprofit / Volunteer Agencies Examples… Examples… American Cancer Society American Cancer Society American Heart Association American Heart Association American Respiratory Disease Association American Respiratory Disease Association American Diabetes Association American Diabetes Association National Association of Mental Health National Association of Mental Health National Foundation of March of Dimes National Foundation of March of Dimes American Red Cross American Red Cross HOSA HOSA

32. Health Insurance Plans Premium – the payment a customer must make to an insurance company Premium – the payment a customer must make to an insurance company Deductibles – amounts that must be paid by the pt for medical services before the policy begins to pay Deductibles – amounts that must be paid by the pt for medical services before the policy begins to pay

33. Co-insurance – requires that specific percentages of expenses be shared by the pt & insurance company Co-insurance – requires that specific percentages of expenses be shared by the pt & insurance company Example: 80/20 – company pays 80% and pt pays 20% of covered expenses Example: 80/20 – company pays 80% and pt pays 20% of covered expenses Co-payment – a specific amount of money a pt pays for a particular service Co-payment – a specific amount of money a pt pays for a particular service Example: $20 co-pay means pt must pay $20 for each physician visit Example: $20 co-pay means pt must pay $20 for each physician visit

34. Health Insurance Plans Health Maintenance Organizations (HMO) Health Maintenance Organizations (HMO) Preferred Provider Organization (PPO) Preferred Provider Organization (PPO) Medicare Medicare –Type A –Type B Medicaid Medicaid Workers’ Compensation Workers’ Compensation TRICARE TRICARE Using textbook pgs 33-34, provide a brief description of each type of insurance plan

35. Health Maintenance Organizations Preventive health care Preventive health care Examinations Examinations Basic medical services Basic medical services Health Education Health Education Hospitalization Hospitalization Rehabilitation services Rehabilitation services

36. Preferred Provider Organization (PPO) Type of health insurance plan provided by large industries or companies to their employees. Type of health insurance plan provided by large industries or companies to their employees. Companies form contracts with health care agencies to provide certain types of health care at reduced rates. Companies form contracts with health care agencies to provide certain types of health care at reduced rates. Employees are restricted to using the specific agency under contract. Employees are restricted to using the specific agency under contract.

37. Medicare Federal government program that provides health care for almost all individuals 65 and over and for any person with a disability who has received Social Security benefits for at least 2 years Federal government program that provides health care for almost all individuals 65 and over and for any person with a disability who has received Social Security benefits for at least 2 years Type A: hospital services and care provided by an extended care facility or home-health care agency Type A: hospital services and care provided by an extended care facility or home-health care agency Type B: additional coverage for doctors’ services, outpatient treatment, therapy, and other health care Type B: additional coverage for doctors’ services, outpatient treatment, therapy, and other health care

38. Medicare Type A: Medicare pays 80%; patient has to pay the balance Type A: Medicare pays 80%; patient has to pay the balance Type B: patient pays premium for coverage and also has a deductible Type B: patient pays premium for coverage and also has a deductible

39. Medicaid Medical assistance program operated by individual states Medical assistance program operated by individual states Usually pays for health care of low income, children who qualify for public assistance and those physically disabled or blind Usually pays for health care of low income, children who qualify for public assistance and those physically disabled or blind Provides inpatient and outpatient services, surgical, medical, lab, x-rays, well baby and well child care Provides inpatient and outpatient services, surgical, medical, lab, x-rays, well baby and well child care

40. Worker’s Compensation Provides treatment for workers injured on job Provides treatment for workers injured on job Administered by state Administered by state Payments made by employers and state Payments made by employers and state Pays missed wages also Pays missed wages also

41. TRICARE Health insurance for all military personnel Health insurance for all military personnel Active duty member and family, survivors of military personnel, and retired members of Armed Forces Active duty member and family, survivors of military personnel, and retired members of Armed Forces Veterans Administration provides for military veterans Veterans Administration provides for military veterans

42. Managed Care Principle behind managed care is that all health care provided has a purpose Principle behind managed care is that all health care provided has a purpose Second opinion or verification of need required Second opinion or verification of need required Preventative care and early diagnosis of disease provided to prevent high cost of treating disease Preventative care and early diagnosis of disease provided to prevent high cost of treating disease

43. Summary Many different types of health care facilities Many different types of health care facilities Employ many types of health care workers Employ many types of health care workers Important to be aware of facilities and type of services Important to be aware of facilities and type of services Important to be aware of different insurance plans Important to be aware of different insurance plans