1. Unit 1 Health Care Systems

2. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.2 Trends in Health Care  Growth – one of the largest and fastest growing industries in the United States  Employment opportunities – employs over 10 million workers in over 200 careers  Expenditures – it is a two billion dollar per day business and growing

3. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.3 Health Care Systems  Different Health Care Systems –Private health care facilities –Government agencies –Voluntary or nonprofit agencies

4. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.4 Types of Services  Inpatient services -hospitals, long-term care  Outpatient services -clinics, provider offices  Specialty services -laboratories, mental health

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6. 6 Health Care Facilities  Hospitals  Long-term care facilities (LTC or LTCF)  Medical offices  Dental offices  Clinics  Optical centers  Emergency care services

7. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.7 Health Care Facilities (continued)  Laboratories  Home health care  Hospice agencies  Mental health facilities  Genetic counseling centers  Rehabilitation facilities

8. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.8 Health Care Facilities (continued)

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10. 10 Summary  Many different types of health care facilities  Employ many types of health care workers  Important to be aware of facilities and type of services https://youtu.be/tqOqO3a1W5Q

11. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.11 1:5 Health Insurance Plans  Health care costs are rising faster than other costs of living  Most people rely on health insurance plans to pay for health care costs  Without insurance, the cost of an illness can become a financial disaster

12. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.12 Insurance Terminology  Deductible  Co-insurance  Co-payment  Preferred provider  Monthly fee or premium  Managed care

13. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.13 Types of Plans  Health insurance plans  Health maintenance organizations (HMO)  Preferred provider organizations (PPO)  Medicare  Medicaid  Worker’s Compensation  U.S. government plans

14. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.14 Summary  Health insurance plans do not solve all the problems of health care costs  Do help many people pay for all or part of cost  Important for individuals to understand what plan covers  Also need understanding of co-insurance and other restrictions plan may have  -Video

15. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.15 1:6 Organizational Structure  Line of authority or chain of command  Indicates areas of responsibility  Goal: most efficient operation of facility  Complex or simple structure determined by size and needs of organization

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17. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.17 Summary  The line of authority must be clearly indicated in any organizational structure  Workers must identify and understand their position in the organization structure  To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor

18. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.18 1:7 Trends in Health Care  Changes in Health Care –Many events lead to changes in health care –Changes in health care are inevitable and occur rapidly –Health care workers must be flexible to face and keep pace with the rapid changes

19. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.19 Some Current Issues  Cost containment  Home health care  Geriatric care  Telemedicine  Wellness  Alternative and complementary health care  National health care plans

20. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.20 Cost Containment  Purpose: control the rising cost of health care and achieve maximum benefit for every dollar spent  Necessity: costs increasing with technological advances, improved survival rates, aging population, and lawsuits

21. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.21 Cost Containment Methods  Diagnostic related groups (DRGs)  Combination of services  Outpatient services  Mass or bulk purchasing  Early intervention and preventive services  Energy conservation

22. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.22 Cost Containment Issues  Important not to decrease quality of care  Workers can decrease costs (e.g., look for areas to control costs and avoid waste, keep expenditures down)  Consumers can decrease costs (e.g., take responsibility for their own care, follow preventative measures to decrease need for services, use services appropriately)

23. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.23 Home Health Care  Industry grew rapidly when DRGs initiated  Services provided in patient’s home  Visits must be pre-authorized by insurance agency (unless private pay)  Often necessary to teach family members to perform care since visits are limited  Emphasis on cost containment also applies to Home Health

24. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.24 Geriatric Care  Care for the elderly  Percentage of elderly population growing rapidly  Need for more facilities  Omnibus Budget Reconciliation Act (OBRA) of 1987

25. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.25 OBRA  Federal law regarding long-term care and home health care  States must establish training and competency evaluation programs for nursing/geriatric assistants and maintain registry of qualified individuals  Requires compliance with patient’s/ resident’s rights

26. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.26 Telemedicine  Use of audio, video, and computers to provide health care from a distance  Interactive services are expected to grow rapidly in the future  Increases accessibility to specialty information  Decreases need for trip to medical center  Decreases need for Home Health visits

27. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.27 Wellness  State of optimal health  Increase awareness of maintaining health and preventing disease  Emphasis on preventative measures rather than waiting for need for curative intervention  Different facilities will develop to meet needs of wellness emphasis

28. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.28 Promoting Wellness  Physical wellness  Emotional wellness  Social wellness  Mental and intellectual wellness  Spiritual wellness

29. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.29 Holistic Health  Treat the whole body, mind, and spirit  Each person is unique with different needs  Use many methods of diagnosis and treatment  Emphasis on protection and restoration  Promote body’s natural healing processes  Patient responsible for choosing care and worker respects the choice

30. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.30 Alternative and Complementary Methods of Treatment  Increasingly used to replace or supplement traditional medical treatment  Holistic approach: belief that the effect on one part effects the whole person  Based on belief that the person has a life force or energy that can be used in the healing process  May vary by cultural values or beliefs

31. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.31 Types of Practitioners  Ayurvedic  Chinese medicine  Chiropractors  Homeopaths  Hypnotists  Naturopaths

32. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.32 Types of Therapies  Most are noninvasive and holistic  Often less expensive than traditional treatments  Nonjudgmental attitude is essential – patients have right to choose treatment  Increased use requires increased awareness by health care workers

33. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.33 Office of Alternative Medicine (OAM)  Established in 1992 at the National Institutes of Health (federal government)  Purpose: research therapies and establish standards of quality care  Many states have passed laws  Know your state’s law regarding the legal requirements of alternative therapies

34. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.34 National Health Care Plan  Goal: ensure that all Americans can get health coverage  Various plan proposals  Costs  Potential problems

35. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.35 Past, Present, and Future Trends  Advances in the past that impact care today  Current changes and challenges that are changing the face of health care  Projected discoveries that will change the future of health care

36. Copyright © 2004 by Thomsom Delmar Learning. ALL RIGHTS RESERVED.36 Summary  Health care has changed and will continue to change  Workers must be constantly aware of changes that occur  Workers must make every attempt to learn about trends