1. Unit 1 Health Care Systems

2. 1:1 History of Health Care
Beliefs and Developments
Beliefs about health care from ancient to current times
Change in treatment of patients from ancient to current times
Major historical events from 4000 BC to current century
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Future of Health Care
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?
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Summary
Health care has seen many changes over the centuries
Future changes may be even more dramatic
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5. 1:2/1:3/1:4 Health Care Systems
Different Health Care Systems
Private health care facilities
Government agencies
Voluntary or nonprofit agencies
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Trends in Health Care
Growth – one of the largest and fastest growing industries in the United States
Employment opportunities – employs over 10 million workers in over 200 careers
Expenditures – it is a two billion dollar per day business and growing
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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)
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8. Health Care Facilities
Hospitals
Long-term care facilities (LTC or LTCF)
Medical offices
Dental offices
Clinics
Optical centers
Emergency care services
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9. Health Care Facilities (continued)
Laboratories
Home health care
Hospice agencies
Mental health facilities
Genetic counseling centers
Rehabilitation facilities
Health maintenance organizations (HMOs)
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10. Health Care Facilities (continued)
Industrial health care centers or occupational health clinics
School health services
Government agencies
U.S. Department of Health and Human Services (USDHHS)
State and local departments
Voluntary and nonprofit agencies
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Summary
Many different types of health care facilities
Employ many types of health care workers
Important to be aware of facilities and
type of services
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12. 1:5 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 costs
Without insurance, the cost of an illness can become a financial disaster
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13. Insurance Terminology
Deductible
Co-insurance
Co-payment
Preferred provider
Monthly fee or premium
Managed care
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Types of Plans
Health insurance plans
Health maintenance organizations (HMO)
Preferred provider organizations (PPO)
Medicare
Medicaid
Worker’s Compensation
U.S. government plans
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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
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16. 1:6 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 1-4 and 1-5 in text
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Summary
The line of authority must be clearly indicated in any organizational structure
Workers must identify and understand their position in the organization structure
To follow proper channels of communication, workers must take problems, reports, and questions to their immediate supervisor
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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
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Some Current Issues
Cost containment
Home health care
Geriatric care
Telemedicine
Wellness
Alternative and complementary health care
National health care plans
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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
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21. Cost Containment Methods
Diagnostic related groups (DRGs)
Combination of services
Outpatient services
Mass or bulk purchasing
Early intervention and preventive services
Energy conservation
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22. Cost Containment Issues
Important not to decrease quality of care
Workers can decrease costs (e.g., look for areas to control costs and avoid waste, keep expenditures down)
Consumers can decrease costs (e.g., take responsibility for their own care, follow preventative measures to decrease need for services, use services appropriately)
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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
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Geriatric Care
Care for the elderly
Percentage of elderly population growing rapidly
Need for more facilities
Omnibus Budget Reconciliation Act (OBRA) of 1987
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OBRA
Federal law regarding long-term care and home health care
States must establish training and competency evaluation programs for nursing/geriatric assistants and maintain registry of qualified individuals
Requires compliance with patient’s/
resident’s rights
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Telemedicine
Use of audio, video, and computers to provide health care from a distance
Interactive services are expected to grow rapidly in the future
Increases accessibility to specialty information
Decreases need for trip to medical center
Decreases need for Home Health visits
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Wellness
State of optimal health
Increase awareness of maintaining health and preventing disease
Emphasis on preventative measures rather than waiting for need for curative intervention
Different facilities will develop to meet needs of wellness emphasis
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Promoting Wellness
Physical wellness
Emotional wellness
Social wellness
Mental and intellectual wellness
Spiritual wellness
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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
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30. 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
May vary by cultural values or beliefs
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31. Types of Practitioners
Ayurvedic
Chinese medicine
Chiropractors
Homeopaths
Hypnotists
Naturopaths
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Types of Therapies
Refer to Table 1-2 in text
Most are noninvasive and holistic
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
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33. 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
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34. National Health Care Plan
Goal: ensure that all Americans can get health coverage
Various plan proposals
Costs
Potential problems
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35. Past, Present, and Future Trends
Advances in the past that impact care today
Current changes and challenges that are changing the face of health care
Projected discoveries that will change the future of health care
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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
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