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Chapter 02 Health Care Systems
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2:1 Private Health Care Facilities
Health care is one of the largest and fastest-growing industries in the United States Will employ over 22.1 million workers in over 200 careers by 2020 2013 U.S. health care spending was over $2.9 trillion Query to editor: here and throughout, okay that complete sentences do not end in a period? “2.9 trillion dollars” changed to “$2.9 trillion”
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Hospitals General hospitals Specialty hospitals Government hospitals
University or college medical centers
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Long-Term Care Facilities
LTC or LTCF provide assistance and care for residents Residential care facilities Extended care or skilled care facilities Independent living and assisted living facilities
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Medical Offices Vary from offices privately owned by one physician to large complexes Services include diagnosis, treatment, examination, basic lab testing, minor surgery May offer general or specialized care
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Concierge Medicine Personalized health care
Annual or monthly fee paid to primary care provider for enhanced level of care
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Dental Offices Vary in size from privately owned by one or more dentists to dental clinics Include general care for all ages and specialized care for certain age groups or dental conditions
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Clinics or Satellite Centers
Surgical clinics or surgicenters Urgent, walk-in, or emergency care clinics Rehabilitation clinics Substance abuse clinics
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Clinics or Satellite Centers
Specialty clinics Outpatient clinics Health department clinics Medical center clinics
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Optical Centers May be individually owned or part of chain
Services include vision examination, prescription of glasses or contact lenses, screening for eye diseases
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Emergency Care Services
Special care for accident victims or those with sudden illness Ambulance services Rescue squads Emergency care clinics Emergency departments
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Laboratories May be part of other facilities or stand-alone
Medical laboratories Diagnostic tests Dental laboratories Dentures and other devices
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Home Health Care Provide care in a patient’s home
Frequently used by elderly and disabled Provide nursing care, personal care, therapy, homemaking Offered by health departments, hospitals, private agencies, government agencies, volunteer groups, nonprofits
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Hospice Provide care for terminally ill persons
Care in a patient’s home or in a facility Palliative care, psychological, social, spiritual, financial counseling to patient and family Support for family members following patient’s death
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Mental Health Facilities
Treatment for patients with mental disorders or diseases Examples include guidance and counseling centers, psychiatric clinics and hospitals, clinical abuse treatment centers, physical abuse treatment centers
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Genetic Counseling Centers
Independent facilities or located within another facility Prenatal screening for couples or individuals who are pregnant or considering pregnancy Check for genetic abnormalities and birth defects, explain results and options
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Rehabilitation Facilities
Located in hospitals, clinics, private centers Care for patients with physical or mental disabilities Therapies include physical, occupational, recreational, speech, hearing
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Health Maintenance Organizations
Health care delivery system and type of health insurance Preventive care for a fixed, prepaid fee Services include examinations, basic medical services, health education, hospitalization, rehabilitation
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Industrial Health Care Centers
Also called occupational health clinics Located in large companies or industries Health care for employees Services include examinations, accident prevention and safety, emergency care
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School Health Services
Located in schools and colleges Provide emergency care in case of accident or illness, tests for health conditions, health education, maintenance of a safe and sanitary environment, counseling
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Pharmaceutical Services
Prepare and dispense medications Provide expertise on drug therapy Found in many settings: hospitals, clinics, nursing homes, online, etc. Changed “Prepares” to “Prepare.” Changed “Provides” to “Provide.” Added period to “etc.”
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2:2 Government Agencies Government services are tax supported
World Health Organization (WHO) U.S. Department of Health and Human Services (USDHHS) National Institutes of Health (NIH) Centers for Disease Control and Prevention (CDC)
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2:2 Government Agencies Food and Drug Administration (FDA)
Agency for Healthcare Research and Quality (AHRQ) Occupational Safety and Health Administration (OSHA) Health departments
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2:2 Government Agencies Office of the National Coordinator for Health Information Technologies (ONC) Health departments
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2:3 Voluntary or Nonprofit Agencies
Supported by donations, membership fees, fund-raisers, and grants Health services are provided at national, state, and local levels Examples include American Cancer Society, American Red Cross, Autism Speaks
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2:3 Voluntary or Nonprofit Agencies
Organizations often focus on specific diseases Study the disease Provide research funding Educate the public Provide special services to those with the disease Staffed by health care workers and volunteers
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2:4 Organizational Structure
Line of authority or chain of command Indicates areas of responsibility Essential for most efficient operation of facility Structure determined by size and needs of organization Refer to Figures 2-4 and 2-5 in text
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2:4 Organizational Structure
Lines of authority must be clearly indicated in any organizational structure Workers must identify and understand their position in the structure Workers must take problems, reports, and questions to their immediate supervisor “Text” changed to lowercase
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2:5 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 Without insurance, the cost of an illness can result in financial disaster
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Insurance Terminology
Deductible Co-insurance Co-payment
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Types of Plans Employer-sponsored or group insurance plans
Health maintenance organization (HMO) Preferred provider organization (PPO) Medicare Medigap Medicaid
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Types of Plans Children’s Health Insurance Program (CHIP)
Worker’s compensation TRICARE U.S. government plans for military personnel and their families Managed care plans
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Types of Plans Fee-for-service compensation Value-base compensation
Provider paid a set amount for each service provided Value-base compensation Physician paid based upon performance Paid a certain amount for each disease or diagnosis
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Health Insurance Portability and Accountability Act (HIPAA)
Five components Health care access, portability, renewability Preventing health care fraud/abuse Tax-related health provisions Application and enforcement of group health plan requirements Revenue offsets
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Patient Protection and Affordable Care Act
Law of 2010 changing health care insurance regulation Provisions include Guaranteed issue Expanded Medicaid eligibility Improved benefits for Medicare
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