1. Understanding Health Care Systems
Chapter 2

2. Health Care Providers
Section 2.1

3. Background
It is the responsibility of every health care worker to help patients/clients solve their health problems. Since the health care industry has many delivery systems, it is important for future health care workers to be aware of health care agencies and facilities, their delivery systems, their organization, and some of their major services. When you understand how health care facilities and agencies serve the public, you will become a resource person for members of your community.
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4. Objectives Match key terms with their correct meanings.
Research a volunteer agency.
Define managed care.
Define ambulatory care.
Evaluate how managed care and ambulatory care meet the needs of the changing health care system.
Understand the role of government agencies in providing health care.
List six types of outpatient care and the type of treatment given.
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5. Objectives Define wellness and preventive care.
Contrast the current trends with health care in the twentieth century.
Be able to use or read an organizational chart.
Give two reasons why the organization of health care facilities is important.
Explain a chain of command.
List and define the major services in health care.
Identify two departments in each major service.
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6. Types of Health Care Providers
General hospitals
Patients stay for a short period of time
Specialty hospitals
Provide longer term care for those with complex or chronic conditions
Convalescent care
Geriatric care or long-term convalescence
Nursing homes
Residences for those who require constant care
Physician and dental facilities
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7. Types of Health Care Providers
Rehabilitation centers
Outpatient care for physical or occupational therapies
Industrial health care centers
School health services
Health Maintenance Organizations (HMOs)
Home health care agencies
Senior day care
World Health Organization (WHO)
Hospices
End-of-life care for terminally ill patients (life expectancy is 6 months or less)
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8. Government Agencies Veteran’s Administration hospitals
U.S. Public Health Department
State psychiatric hospitals
State university medical centers
State public health services
U.S. Department of Health and Human Services (USDHHS)
National Institute of Health (NIC)
Centers for Disease Control (CDC)
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9. Government Agencies Food and Drug Administration (FDA)
Occupational and Safety Health Administration (OSHA)
Agency for Health Care Policy and Research (AHCPR)
County hospitals
Laboratories
May be government or private facilities
Local public health departments
Senior centers
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10. Volunteer Agencies
Receive money from donations, endowments, membership and fundraising efforts
Use funds for research and public education
Often support a specific disease or medical condition, such as:
American Cancer Society
National Foundation of the March of Dimes
American Red Cross
American Heart Association
…and many others
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11. Managed Care: Quality Care and Managed Costs
Goal is to provide quality care at reasonable costs
Policies include:
Focus on preventive care, such as routine physicals and well-baby care
Use of primary care providers─the “family doctor”─as first contact in undiagnosed illness
Can refer patients to specialist, as needed
Use of emergency and urgent care facilities
Require preadmission authorization requirement for hospitalization
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12. Ambulatory Care Part of trend to provide managed care
Uses non-hospital facilities for care, whenever possible, including:
Rehabilitation centers
Outpatient surgery
Outpatient medical centers/clinics
Physicians’ offices
Day care
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13. Organization Efficient health care centers are well organized
Organization chart:
shows how each department fits into the system
Identifies the line of authority
Chain of command is critical
Tells you to take questions and problems to your immediate supervisor
Provides efficient problem-solving structure
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14. Major Services in Health Care
Therapeutic services
Provide care over time
Diagnostic services
Such as x-rays or blood tests
Used to identify a particular condition or illness
Informational services
Document and process information
Environmental services
Help to create a relaxing and healing environment for patients
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15. Key Terms ambulatory audiology chiropractic chronic communicable
convalescence
diagnostic
endowments
environmental sanitation
facilities
geriatric
hydroptherapy
hypertension
immunizations
licensing
managed care
maternal
obstetrics
occupational therapy
orthopedics
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16. Key Terms outpatients podiatry prosthetics psychiatric radiology
recreational therapy
refer
rehabilitation
specialties
surgical
therapeutic
trend
urology
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17. Health Care Systems
Section 2.1

18. Background
The cost of health care has increased significantly over the years. It is important to understand the causes for the increase as well as methods providers use to help contain the costs. Every health care worker should also know the health care systems that help patients/clients afford the services they need. When patients/clients receive regular and complete care, they live healthier and happier lives.
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19. Objectives Match key terms with their correct meanings.
Explain how health care providers have modified their practices to provide patients quality health care at a lower cost.
Explain the purpose of the Health Plan Employer Data and Information Set.
Identify and differentiate the various health care systems.
Compare and contrast health maintenance organizations and preferred provider organizations.
Analyze and predict where and how certain factors such as cost, managed care, technology, an aging population, etc. may affect various health care delivery system models.
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20. Quality Health Care Costs
Costs driven up by:
Technological advances
Health-related lawsuits
Aging population
New equipment
Cost containment:
Government legislation passed in 1983 to regulate health costs
Developed DRGs―Diagnostic-related groupings―with standard treatment and reasonable costs for each
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21. Quality Health Care Costs
Health Plan Employer Data Information Set (HEDIS) provides guidelines and a report card that:
Measures health care performance
Identifies physicians who provide high quality medical care to their patients
Helps to identify physicians who do not meet health care guidelines
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22. Quality Health Care Costs
Health insurance―third party payers
Each insurer determines how much it will pay for specific services
Co-payments
Deductibles
Co-insurance
HMOs―must use a member physician or service provider and pay a co-pay
PPO―physicians and hospitals that band together to provide lower cost services to various large companies
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23. Quality Health Care Costs
Medicaid
Provided by state and federal government to disabled and low income people
Medicare
Health insurance for those over 65
TRICARE
Health care for active duty service members, retirees, and their families
Workers’ Compensation
Employees who are injured, have workplace-related illness or die covered by state worker’s compensation
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24. National Health Plan
Because of increasing number of uninsured people, a national health plan is under discussion
Goal is to provide good, comprehensive health care to everyone
Emphasis on preventive care, immunizations, education and behavior modification (such as stopping smoking)
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25. Key Terms benefits bulk co-insurance compensation co-payment
deductible
eligibility
intervention
lawsuits
legislations
premium
preventative
systems
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