1. Health Care Facilities

2. Objectives Students will be able to:
Differentiate between private, public, and non-profit facilities.
Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models.
Research the organizational structures and services of various types of health care facilities.
Differentiate between various types of health care insurance plans
Analyze the cause and effect on health care system change based on the influence of technology epidemiology, bio-ethics, socioeconomic and various forms of complimentary medicine

3. Hospitals Vary according to: Size Small Large Ownership
Proprietary / private / for profit
Nonprofit
Government
Religious
Services
General
Specialty

4. Long-Term Care Facilities
Provide long-term care for elderly patients and for patients in rehabilitation.
Levels of long-term care:
A nursing home provides care for patients who can no longer care for themselves.
An independent living facility
allows patients to use only
the services they need, such
as transportation or
housekeeping.

5. Medical Offices
May be operated by one or two doctors or a large groups of health care professionals.
Some medical offices treat a wide range of conditions.
Others are specialized
for specific ages or
medical conditions.

6. Other Types of Facilities
Dental offices
Clinics
Optical centers
Emergency Care Centers
Laboratories
Home Health Care
Hospice
Mental Health
Genetic Counseling Centers
Rehabilitation
Health Maintenance Organizations (HMO’s)
Industrial Care Centers
School Health Services

7. Government Agencies World Health Organization (WHO)
U.S. Department of Health and Human Services (USDHHS)
National Institute of Health (NIH)
Centers for Disease Control and Prevention (CDC)
Food and Drug Administration (FDA)
Agency for Health Care Policy And Research (AHCPR)
Occupational Health and Safety Administration
State and local health departments

8. Volunteer and Nonprofit Agencies
American Cancer Society
American Heart Association
American Red Cross
National Association of Mental Health
National Foundation of the March of Dimes

9. Health
Insurance Plans

10. Health Care Systems
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 systems.

11. Public / National Health Care Systems
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

12. 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

13. Mixed Systems
Very few countries have a purely public or private system
Most countries create a mixed system by using various funding sources to cover health care expenses.
Example: Canada and the United States

14. Health Insurance
The rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families.
In the 1920’s, the United States developed a system of health insurance to help cover the cost of medical expenses.

15. Health Insurance Terms
Premium – the amount paid to an insurance agency for a health insurance policy
Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments
Co-payment - an amount paid by the patient for a certain service
Out-of-pocket - a medical bill that must be paid by the patient

16. Individual and Group Insurance
Individual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage.
Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.

17. Managed Care Two primary concepts of managed care:
To promote good health
To practice preventive medicine
Managed care plans offer medical services through a system of health care providers. The system of providers offers services at reduced rates.

18. Managed Care Health Maintenance Organizations
Preferred Provider Organizations
Point of Service

19. Health Maintenance Organizations
Clients must pay a premium, deductible, and co-payments.
Clients must visit in-network doctors and select a primary care physician.
HMOs urge clients to practice healthy living and to receive preventive treatments.

20. Preferred Provider Organization
Clients must pay a premium, deductible, and co-payments.
Clients do not have to choose a primary care physician.
Clients may visit non-network physicians, but coverage is greater with in-network physicians.
PPOs often have other fees and co-payments.

21. Point of Service Clients must pay a premium.
Clients must chose a primary care physician.
For in-network physicians, there is usually no deductible and co-payments are low.
Specialists may be non-network physicians, but coverage may be limited

22. Government Programs
In the 20th century, the United States government began to realize the need for public medical assistance.
In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance.
Medicaid
Medicare

23. Medicaid Income or needs based program
Designed by the federal government, but administered by state governments
Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled.

24. Medicare Program for any citizen age 65 or older
Administered by the federal government
After an individual pays a deductible, Medicare will cover 80% of all medical expenses.

25. Medicare Services Part A: Hospital Care Part B: Outpatient Services
Hospitalization
Skilled nursing facilities
Home health care
Hospice care
Long-term care facilities
Part B: Outpatient Services
Medical expenses, including therapy, medical equipment, and testing
Preventive Care

26. Worker’s Compensation
Provides treatment for workers injured on the job
Administered by the state
Reimburses the worker for wages lost because of on-the-job injury

27. Trends in Today’s Health Care Systems
Advances in technology
Epidemiology
Bio-ethics
Socioeconomics
Complementary (nontraditional) medicine

28. Organizational Structure
An tool designed to help a facility operate smoothly by outlining responsibilities
It describes the line of
authority that
establishes levels
of responsibility
and supervision

29. The End!