1. 1.4 Our Healthcare System
Health 1 & 2: Life Management Skills/Personal Health
MAST at Homestead

2. Discussion Preview Healthcare Services Health Insurance
Healthcare Costs
Regular Checkups/Screenings

3. Healthcare in the United States
Focus shift: from treatment to prevention
Healthcare field employs more people than any other business field in the US
Industry Services
Diagnosis: identification of a disease, disorder, disability
Treatment: use of medicine, surgery, counseling or other therapy to try and correct a condition
Rehabilitation: recovery of function following surgery, disease or injury
Prevention: reducing potential causes of diseases, disorders, injuries
Education: teaching of self-care, health promotion, first aid and disease prevention
Research: scientific study of causes, treatments and prevention of diseases and disorders

4. Primary Healthcare Primary Care Physician: a person’s regular doctor
Provides checkups, screenings, treatments and prescriptions
Practices the full scope of medicine: diagnosis, prescription, medical treatment
Doctor of Medicine (MD) or Osteopathic Doctor (DO)
Physician Assistants: work under the supervision of physicians
Nurse Practitioners: provides many of the same services as a doctor

5. Medical Specialists
Specialists: possess extensive training and experience in a focused area of health/medicine
Need a referral from your primary care physician
Common Specializations
Cardiologist
Gastroenterologist
Neurologist
Oncologist
Orthopedist
Pediatrician
Psychiatrist
Surgeon

6. Healthcare Settings
Inpatient Facilities: patients reside/stay overnight during diagnosis, treatment, surgery, therapy/rehabilitation
Outpatient Facilities: patients receive diagnosis and treatment services but do not stay overnight
Doctor’s offices
Healthcare clinics
Private
Walk-in/urgent care
High schools/colleges
County/public
Emergency rooms
Counseling centers

7. Government Role
U.S. Department of Health & Human Services: Public Health Service
Provides leadership, funding and oversight of the healthcare system
Does not provide healthcare services
Special Exceptions
Veterans Administration (VA): healthcare for military veterans
Military Health System: healthcare for active military personnel & families
Indian Health Service: healthcare for Native American Indians

8. Health Insurance Healthcare services = EXPENSIVE
3-day hospital stay = $30,000 (average)
Broken leg = $7,500
Medicines = $100/month
Counseling = $100+/hour
Health Insurance: an agreement by which a person pays a company and the company promises to pay money if the person becomes injured or sick
Employers offer insurance as a benefit by splitting the cost of the insurance plan with their employees

9. Health Insurance Plan Basics
Premium: a regular fee paid in exchange for insurance services
Usually paid monthly
The insurance company pools premiums from all customers to cover healthcare costs
Deductible: amount the customer is required to pay before the insurance company begins to cover the remaining cost
Co-Payment: The portion of the bill you are responsible for each time you receive a service

10. Deductible vs. Co-Pay
If you have a $500 deductible per year, and each doctor's visit costs you $100, your insurance may not kick in until you've been to the doctor five times.
When you go to the doctor after you've reached your deductible, you may no longer have to pay the full $100; instead you may pay a $25 co-pay, while your insurance picks up the other $75.

11. Types of Health Insurance
Source:
Kidshealth.org
Health Maintenance Organization (HMO): consumer chooses a primary care doctor in the company’s network
doctor coordinates all medical care: annual physicals to hospitalizations.
co-pay for these services is fairly low
Consumer can't see any kind of specialist without a written referral
Preferred Provider Organization (PPO): consumer chooses any doctor
More flexibility/options
More expensive

12. Health Insurance Assistance
Medicaid: health insurance available to those disabled, unable to work and/or impoverished
Funded by US government and individual states
Medicare: health insurance available to people 65 years and older
Funded by paycheck taxes

13. Health Insurance Legislation
Patient Protection and Affordable Care Act (2010)
AKA Affordable Care Act or Obamacare
4 key elements
Expanded Access to Insurance
No denial based on pre-existing conditions
Parents can cover young adult children up to 26 YO
Businesses required to provide a health insurance option
No sudden drops
Cost Reduction & Affordability
Increased premiums must be publicly explained
“Open Marketplace”: publishes costs from all insurance companies
Improved Health Care
Preventive healthcare is covered
Emergency healthcare available anywhere
Patient Bill of Rights: fair treatment and appropriate information

14. Patient Bill of Rights
On your handouts, read each protection and highlight key terms:
Words/short phrases that convey the most meaning about the topic

15. Controlling Healthcare Costs
PREVENTION!!
Generic Drugs vs. Brand Name
Explore health insurance options
Health savings account

16. Regular Checkups & Screenings
Annual physical exams can identify health issues and prevent them from worsening
Discuss family medical history
Make the most of your doctor visit:
List questions you have
Ask about options
Write down important information
Compliance