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Chapter 2 HEALTH CARE SYSTEMS.

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Presentation on theme: "Chapter 2 HEALTH CARE SYSTEMS."— Presentation transcript:

1 Chapter 2 HEALTH CARE SYSTEMS

2 2:1 Private Health Care Facilities
Today’s healthcare system include the many agencies, facilities and personnel involved in the delivery of heath care. Growth—one of the largest and fastest growing industries in the United States Employment opportunities—employs over 13 million workers in over 200 careers Wide range of ed. Backgrounds because of various career options Expenditures—it is a four-billion-dollar- per-day business and growing (continues)

3 Private Health Care Facilities (continued)
Most PHF require fee for services. In some cases, grants and donations provide financial support. Hospitals Long-term care facilities (LTC or LTCF) Independent living and assisted living

4 Medical offices- diagnosis, treatment, examination, basic lab testing
Medical offices- diagnosis, treatment, examination, basic lab testing. Vary from offices that are privately owned or large complexes. Dental offices Clinics or satellite centers Optical centers

5 Private Health Care Facilities (continued)
Emergency care services Laboratories-Special diagnostic test Home health care-provide care in patients home Hospice agencies-care far terminally ill Mental health facilities Genetic counseling centers Rehabilitation facilities (continues)

6 Private Health Care Facilities (continued)
Health maintenance organizations (HMOs) Provide preventative healthcare Types of health insurance Industrial health care centers or occupational health clinics School health services

7 2:2 Government Agencies Government healthcare facilities are offered at international, national, state, local levels Government services are tax supported World Health Organization (WHO) International level Compiles info of stats and info on disease Investigates and addresses serious health problems throughout the world (continues)

8 2:2 Government Agencies cont.
U.S. Department of Health and Human Services (USDHHS) National Agency that deals with the health problems in the U.S. National Institutes of Health (NIH) Division of the USDHHS involved in research on disease Centers for Disease Control and Prevention (CDC) Another division of the USDHHS Concerned with causes, spread, and control of diseases in populations

9 Government Agencies (continued)
Food and Drug Administration (FDA) Federal Agency responsible for regulating food and drug products sold to the public Agency for Health Care Policy and Research (AHCPR) Federal agency to research the quality of health care delivery Identify and establishes the standards of treatment by a health care facility

10 Government Agencies (continued)
Occupational Safety and Health Administration (OSHA)- establishes and enforces standards that protect workers from job related injuries and illnesses Health Departments Provide health services directed by the USDHHS Provide services needed by the state or local community Ex. of services include Immunization for disease control Health inspections Stats related to health Clinics for health care and prevention

11 2:3 Voluntary or Nonprofit Agencies
Supported by donations, membership fees, fundraisers and grants Health services are provided at various levels Organizations focus on specific diseases Study the disease Provide funding for research Promotes public education Provide special services Purchase medical equipment- for victims of disease Treatment centers (continues)

12 Voluntary or Nonprofit Agencies (continued)
Staffed by many health care workers and volunteers Examples include the American Cancer Society, March of Dimes, American Red Cross and many more

13 2:4 Health Insurance Plans
Nearly every industrialized country has a national health care system. Some countries have public or national health care systems, and other countries have private health care How Does the U.S. Compare with Other Countries?

14 We provide the same medical care
We use the same medical technology But… We have large numbers of uninsured We spend much more We remain the only major country that builds its health care system around private for-profit insurance companies.

15 Public / National Health Care System
Mainly funded by taxes and social security insurance. • Advantage – Every citizen is guaranteed health care regardless of economic status. Disadvantages – Health care is not always comprehensive, and taxes may be higher. Norway, France, the United Kingdom, and Canada Private Health Care Systems • Mainly funded by private insurance agencies and out-of-pocket payments. • Advantages – Coverage is often comprehensive, taxes may be lower, and economic growth is stimulated. • Disadvantage – Not every citizen is guaranteed health care. • United States and Switzerland

16 Private Health Care Systems
Mainly funded by private insurance agencies and out-of-pocket payments. Advantages – Coverage is often comprehensive (covers a wide range of services, taxes may be lower, and economic growth is stimulated. Disadvantage – Not every citizen is guaranteed health care. United States and Switzerland

17 2:4 Health Insurance Plans
Health care costs are rising faster than other costs of living (more than 15% of gross national product/ goods and services) To pay for the cost of healthcare people rely on health insurance plans Offered by thousands of insurance agencies ex. Blue Cross Blue Shield Employer sponsored health insurance Without insurance, the cost of an illness can become a financial disaster

18 Insurance Terminology
Premium- a fee an individual pays for insurance coverage Deductible- Amounts that must be paid by the patient for medical services before the policy begins to pay Co-insurance-requires that specific percentages of expenses are shared by the patient and insurance company Ex percent co-insurance Co-payment- a specific amount of money a patient pays for a particular service

19 THE COST OF CARE CREATES HEALTH PROBLEMS AS WELL AS FINANCIAL PROBLEMS
In nearly 3 in 10 (29%) households, someone skips a medical treatment, cuts pills, or does not fill a prescription because of cost Nearly 1 out of 4 (23%) Americans have problems paying medical bills More than 1 in 5 (21%) Americans had an overdue medical bill at the time of a 2004 survey 1 million people experience medical bankruptcy each year Health Care Costs Survey, USA Today/Kaiser Family Foundation/Harvard School of Public Health, August 2005; D. Himmelstein et al, Health Affairs, 2005 Many people still believe that people without health insurance get the care they need. Its just not true.

20 HIGH COST OF HEALTH INSURANCE PREMIUMS
National Average for Employer-provided Insurance Single Coverage $4,024 per year Family Coverage $10,880 per year Note: Annual income at minimum wage = $10,300 Annual income of average Wal-Mart worker = $17,114 Source: Kaiser Family Foundation/HRET Survey, 2005

21 Types of Plans Health maintenance organization (HMO) Monthly premium
Fee stays the same regardless of the amount of health care used Ready access to health examinations and early treatment and detection of disease Cover routine examinations and preventative care (unlike other insurance companies) Disadvantage: required to only use HMO-affiliated healthcare providers Must pay out of pocket if a non-affiliated provider is used (continues)

22 Types of plans cont. Preferred provider organization (PPOs)
Usually provided by large industries or companies to their employees PPO’s forms a contract with various healthcare agencies (hospitals/ doctors etc.) to provide healthcare at a reduced rate PPO’s require a deductible and a co-payment If using a non-affiliated provider, may require co-payment of percent.

23 Government Insurance Plans
Medicare Medigap

24 Types of Plans (continued)
Medicaid The State Children’s Health Insurance Program (SCHIP) Worker’s Compensation U.S. government plans for all military personnel and their families Managed care plans

25 HIPAA Five components Health care access Preventing health care fraud
Tax-related health provisions Application and enforcement of group health plan requirements Revenue offsets

26 2:5 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 Sample organizational charts (See Figure 2-4 and 2-5 in text) (continues)

27 Organizational Structure (continued)
The line of authority must be clearly indicated in any organizational structure Workers must identify and understand their position in the structure To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor


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