1. Unit 1 Health Care Systems Pages 2 – 18

2. Introduction *Data from obtained from CDC
Health care is one of the largest and fastest-growing industry in the US
Expenditures – it is a two billion dollar per day business and growing
Over 12 million health care workers in US
80% of health care work force are women
*Data from obtained from CDC 2

3. 1.1 Health Care Facilities
Many different types of facilities
Employ many types of health care workers
Individual facilities can vary in:
Size (individual doctor or complex of doctors facility for a community or for a county, etc)
Service provided (general or specific to disease, age, gender)
Sources of income (public, private, religious, nonprofit, government)
Important to be aware of facilities and type of services

4. Types of Health Care Facilities
Hospitals
Long-term care facilities
Medical offices
Dental offices
Clinics
Optical centers
Emergency care services
Laboratories
Home health care
Hospice agencies
Mental health facilities
Rehabilitation facilities
Genetic counseling centers
Health Maintenance Organizations
Industrial health care centers
School health services
Government agencies
World Health Organization
U.S. Department of Health and Human Services
Occupational Safety and Health Administration
Voluntary and nonprofit agencies

5. Health Care Facilities
HOSPITALS
One of the major types of facilites
Most hospitals are general hospitals that treat a wide range of conditions
Specialty hospitals include:
Burn, oncology, pediatric, psychiatric, orthopedic, rehabilitative, government

6. Health Care Facilities
LONG-TERM CARE FACILITIES (LTCs)
Patients live at facility and are known as residents
May care for elderly, disabled patients, individuals with chronic or long-term illnesses
Extended Care Facilities – rehabilitative care to prepare patients to return home
Subacute Units – rehabilitative care for patients recovering from major illness, intensive medical treatments or surgery
Independent Living – residents can care for themselves, but live in the facility. The facility provides residents with food, housekeeping, transportation and basic medical care 6

7. Health Care Facilities
MEDICAL OFFICE
Can offer a variety of services:
Diagnosis, treatment, exams, lab tests, minor surgery
CLINICS
Usually a group of doctors that share a facility and personnel
Many hospitals have outpatient clinics
EMERGENCY CARE SERVICES
Special care for victims of accidents, sudden illness or patients without a general physician
LABORATORIES
Often part of other facilities, but occasionally a separate facility
Run blood tests, urine tests, can prepare dentures, etc 7

8. Health Care Facilities
HOME HEALTH CARE
Provide care in patient’s home
Usually used by elderly or disabled patients
HOSPICE
Provides care for terminally ill patients with a life expectancy of less than 6 months
MENTAL HEALTH FACILITIES
Treat patients with mental disorders and diseases
Counseling center, psychiatric hospitals, abuse treatment centers
REHABILITATION
Can be found in hospitals, clinics or a private center
Can be inpatient or outpatient 8

9. Health Care Facilities
GENETIC COUNSELING
Provides individuals or perspective parents information on their genetic background and disposition to passing on genetic disorders
If an individual or couple has a certain likelihood of being a carrier for a disorder, a blood test will be recommended to screen for a particular gene
HEALTH MAINTENANCE ORGANIZATIONS (HMOs)
Provide total health care directed towards preventative health care
INDUSTRIAL HEALTH CARE CENTER
Occupational health clinics, found in large companies to provide health care for the employees

10. Health Care Facilities
SCHOOL HEALTH SERVICES
Provides students with emergency treatment as well as health education and counseling
GOVERNMENT AGENCIES
Provides facilities for government personnel and their dependents
Hospitals, psychiatric treatment, rehabilitation, etc
WORLD HEALTH ORGANIZATION (WHO)
Sponsored by the United Nations
Addresses and studies health problems throughout the world 10

11. Health Care Facilities
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS)
National agency that deals with US health problems
NATIONAL INSTITUTE OF HEALTH (NIH) - Researches diseases
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) – studies causes, spread and control of diseases in the population
FOOD AND DRUG ADMINISTRATION (FDA) – regulates food and drugs sold to the public
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) – establishes and enforces job safety standards 11

12. Health Care Facilities
NONPROFIT
Also known as voluntary agencies
Supported by donations, grants, fundraising, etc
Usually focuses on one type of disease
American Cancer Society
American Red Cross
March of Dimes 12

13. 1:4 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 costs
Without insurance, the cost of an illness can become a financial disaster

14. Insurance Terminology You Should Know:
Deductible
Co-insurance
Co-payment
Preferred provider
Monthly fee or premium
Managed care

15. Types of Services Inpatient services (e.g., hospitals, long-term care)
Outpatient services (e.g., clinics, provider offices)
Specialty services (e.g., laboratories, mental health)

16. Types of Plans Health insurance plans
Health maintenance organizations (HMO)
Preferred provider organizations (PPO)
Medicare
Medicaid
Worker’s Compensation
Managed Care

17. Types of Plans HEALTH INSURANCE PLAN
Insurance company pays for some or all of services (depends on plan, deductible, out-of-pocket expense, etc.)
HEALTH MAINTENANCE ORGANIZATIONS (HMO)
Person pays a monthly fee for the membership
Plan covers regular exams and check-ups
PREFERRED PROVIDER ORGANIZATIONS (PPO)
Provided to employees by their company
The company works with certain health care agencies to provide the employees with health care at a reduced rate
Employees can only go to the selected agencies

18. Types of Plans MEDICARE
Insurance provided by the government to people over 65 or disabled persons on Social Security
Type A coverage – hospital insurance, extended care or home care
Type B coverage – medical insurance, doctor services, therapy
Covers 80% of medical bills
MEDICAID
Government provided medical assistance program
Operated on a state level, benefits vary from state to state

19. Types of Plans WORKER’S COMPENSATION MANAGED CARE
Health insurance for people injured on the job
MANAGED CARE
One approach to health care in response to the rising costs
Insurance covers wellness exams and check-ups, but need to prove the necessity
Need referrals to see specialty doctors

20. Summary
Health insurance plans do not solve all the problems of health care costs
Do help many people pay for all or part of cost
Important for individuals to understand what plan covers
Also need understanding of co-insurance and other restrictions plan may have

21. 1:5 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
To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor

22. 1:6 History of Health Care
Beliefs and Developments
Beliefs about health care and cause of disease has changed greatly from ancient times
This has also caused drastic changes in the treatment of patients

23. Future of Health Care Questions you should be able to answer:
When did most of the significant changes in health care occur?
Why were the greatest advances made in this time period?
What are some possibilities for the future of health care?

24. 1:7 Trends in Health Care Changes in Health Care
Many events lead to changes in health care
Changes in health care are inevitable and occur rapidly
Health care workers must be flexible
to face and keep pace with
the rapid changes

25. Some Current Issues Cost containment Home health care Geriatric care
Wellness
Alternative and complementary health care
National health care plans

26. Cost Containment
Purpose: control the rising cost of health care and achieve maximum benefit for every dollar spent
Necessity: costs increasing with technological advances, improved survival rates, aging population, and lawsuits
Issues: need to keep high quality of care, workers can decrease costs, consumers can decrease their own health care costs

27. Cost Containment Methods
Diagnostic related groups (DRGs)
Patients with certain diagnoses put into a payment group
Agency sets limit of amount to be spent on care
If care is below the limit, agency keeps the money
If care costs are above the limit, agency is responsible
Combination of services
Outpatient services
Mass or bulk purchasing
Early intervention and preventive services
Energy conservation

28. Home Health Care Industry grew rapidly when DRGs initiated
Services provided in patient’s home
Visits must be pre-authorized by insurance agency (unless private pay)
Often necessary to teach family members to perform care since visits are limited
Emphasis on cost containment also applies to Home Health
Allows for shorter hospital stays

29. Geriatric Care Care for the elderly
Percentage of elderly population growing
Need for more facilities
Omnibus Budget Reconciliation Act (OBRA)
Requires states to establish geriatric care, continuing education for staff, evaluation and retraining of staff
Wellness of patient is monitored
Physical, emotional, social, mental, spiritual wellness

30. Wellness State of optimal health
Increase awareness of maintaining health and preventing disease
Emphasis on preventative measures
Different facilities will develop to meet needs of wellness emphasis

31. Holistic Health Treat the whole body, mind, and spirit
Each person is unique with different needs
Use many methods of diagnosis and treatment
Emphasis on protection and restoration
Promote body’s natural healing processes
Patient responsible for choosing care and worker respects the choice

32. Alternative and Complementary Methods of Treatment
Increasingly used to replace or supplement traditional medical treatment
Holistic approach: belief that the effect on one part effects the whole person
Based on belief that the person has a life force or energy that can be used in the healing process

33. Alternative and Complementary Methods of Treatment
May vary by cultural values or beliefs
Often less expensive than traditional treatments
Nonjudgmental attitude is essential – patients have right to choose treatment
Increased use requires increased awareness by health care workers

34. Types of Practitioners
Ayurvedic
Chinese medicine
Chiropractors
Homeopaths
Hypnotists
Naturopaths

35. Office of Alternative Medicine (OAM)
Established in 1992 at the National Institutes of Health (federal government)
Purpose: research therapies and establish standards of quality care
Many states have passed laws
Know your state’s law regarding the legal requirements of alternative therapies

36. National Health Care Plan
Goal: All Americans have health coverage
Various plan proposals
Federal government pays for health care, money would come from taxes
Health care cooperatives – consumer purchases health care at a lower cost
Managed care – employers provide coverage, government provides coverage for poor
What are some potential problems?

37. Summary Health care has changed and will continue to change
Workers must be constantly aware of changes that occur
Workers must make every attempt to learn about trends