1. Health Care Systems Unit C Health Team Relations

2. Introduction Many different health care systems deliver health care Many different health care systems deliver health care Health care is one of the largest and fastest growing industries in the United States Health care is one of the largest and fastest growing industries in the United States Employs over 10 million workers in over 200 careers Employs over 10 million workers in over 200 careers Two billion dollar per day business Two billion dollar per day business

3. Hospitals Vary in size and type of service provided Vary in size and type of service provided General hospitals treat wide range of conditions General hospitals treat wide range of conditions Typically our small town hospitals Typically our small town hospitals Care for certain conditions or age groups Care for certain conditions or age groups Examples: burn, oncology or cancer, pediatric or children, psychiatric, rehabilitation, and orthopedic Examples: burn, oncology or cancer, pediatric or children, psychiatric, rehabilitation, and orthopedic Example – Duke Children’s Hospital Example – Duke Children’s Hospital Specialty Hospitals

4. Government Hospitals Operated by federal, state, and local government agencies Operated by federal, state, and local government agencies World-wide facilities for government service personnel and their dependents World-wide facilities for government service personnel and their dependents Veteran’s Administration hospitals Veteran’s Administration hospitals State psychiatric hospitals State psychiatric hospitals State rehabilitation centers State rehabilitation centers Example: Fort Bragg Army Hospital, Naval Hospital at Camp Lejeune Example: Fort Bragg Army Hospital, Naval Hospital at Camp Lejeune

5. University or College Medical Centers Provide services, research and education Provide services, research and education Can be funded by private or government sources Can be funded by private or government sources

6. Long Term Care Facilities (LTC or LTCF) Provide care for elderly, individuals with chronic or long-term illness Provide care for elderly, individuals with chronic or long-term illness Individuals receiving care are usually called residents instead of patients (or clients) Individuals receiving care are usually called residents instead of patients (or clients)

7. Long-term care facilities Nursing homes or geriatric homes Provide basic physical and emotional care Provide basic physical and emotional care Usually for individuals who cannot care for themselves Usually for individuals who cannot care for themselves Help individuals with activities of daily living (ADL’s), provide a safe and secure environment, and promote opportunities for social interactions Help individuals with activities of daily living (ADL’s), provide a safe and secure environment, and promote opportunities for social interactions

8. Extended care or skilled care facilities Provide skilled nursing and rehabilitative care – could be temporary for clients between hospital stay and returning to home. Provide skilled nursing and rehabilitative care – could be temporary for clients between hospital stay and returning to home. Prepare resident for return to home environment or other long-term facility Prepare resident for return to home environment or other long-term facility Some have sub-acute units: provide rehabilitation services for major illness or surgery, treatment for cancer, or treatments such as dialysis or heart monitoring Some have sub-acute units: provide rehabilitation services for major illness or surgery, treatment for cancer, or treatments such as dialysis or heart monitoring

9. Extended care or skilled care facilities Independent or assisted living facilities: individuals purchase or rent unit and can receive services such as meals, housekeeping, laundry, transportation, social events, and basic medical care Independent or assisted living facilities: individuals purchase or rent unit and can receive services such as meals, housekeeping, laundry, transportation, social events, and basic medical care

10. Medical Offices Services Diagnosis- determine illness Diagnosis- determine illness Treatment – helping to get well Treatment – helping to get well Examinations Examinations Basic laboratory tests Basic laboratory tests Minor Surgery Minor Surgery Specialties (Examples include: Pediatrics, Cardiology, and Obstetrics) Specialties (Examples include: Pediatrics, Cardiology, and Obstetrics)

11. Dental Offices Private offices to dental clinics employing several dentists Private offices to dental clinics employing several dentists Dental clinics now found in major retail/department stores Dental clinics now found in major retail/department stores Can provide general or specialized dental care Can provide general or specialized dental care

12. Clinics Satellite Clinics or Satellite Centers Found in many types of health care Found in many types of health care Can refer to group of medical/dental doctors who share a facility and other personnel Can refer to group of medical/dental doctors who share a facility and other personnel

13. Clinics Other clinics operated by corporation or private groups and provide special care: Other clinics operated by corporation or private groups and provide special care: Surgical clinics or surgicenters Surgical clinics or surgicenters Emergency care clinics Emergency care clinics Rehabilitation clinics Rehabilitation clinics Specialty Clinics: Diabetes or oncology (cancer) clinics Specialty Clinics: Diabetes or oncology (cancer) clinics Hospitals often operate clinics such as outpatient clinics Hospitals often operate clinics such as outpatient clinics

14. Clinics Health Departments offer clinics such as… Health Departments offer clinics such as… –Pediatric care –Sexually transmitted diseases –Respiratory diseases –Immunizations –Women’s health Medical Centers also sponsor clinics Medical Centers also sponsor clinics

15. Optical Centers Can be individually owned by an ophthalmologist (eye doctor) or optometrist (eye specialist) or be part of a large chain of stores Can be individually owned by an ophthalmologist (eye doctor) or optometrist (eye specialist) or be part of a large chain of stores Provide vision examinations Provide vision examinations Prescribe eye glasses or contact lenses Prescribe eye glasses or contact lenses Check for the presence of eye diseases Check for the presence of eye diseases

16. Emergency Care Services Provide special care for accidents or sudden illness Provide special care for accidents or sudden illness Ambulance services: private and governmental Ambulance services: private and governmental Rescue squads: frequently operated by fire departments Rescue squads: frequently operated by fire departments Emergency care clinics Emergency care clinics ERs operated by hospitals ERs operated by hospitals Helicopter or airplanes Helicopter or airplanes

17. Laboratories Can be part of other facility or operated as separate health care service Can be part of other facility or operated as separate health care service Medical laboratories: perform diagnostic tests Medical laboratories: perform diagnostic tests Dental laboratories: prepare dentures and other devices Dental laboratories: prepare dentures and other devices

18. Home Health Care Provide care in patient’s home Provide care in patient’s home Examples of care… Examples of care… Nursing care Nursing care Personal care: bathing dressing, and so forth Personal care: bathing dressing, and so forth Therapy: physical, occupational, speech, respiratory Therapy: physical, occupational, speech, respiratory Homemaking: food preparation, cleaning, washing, and so forth Homemaking: food preparation, cleaning, washing, and so forth

19. Hospice Provide care for terminally ill persons with life expectancy of six months or less Provide care for terminally ill persons with life expectancy of six months or less Care provided in person’s home or hospice facility Care provided in person’s home or hospice facility Allows person to die with dignity and in comfort Allows person to die with dignity and in comfort Provides psychological, social, spiritual, and financial counseling for both patient and family Provides psychological, social, spiritual, and financial counseling for both patient and family

20. Mental Health Facilities Deal with mental diseases and disorders Deal with mental diseases and disorders Examples… Examples… Guidance and counseling centers Guidance and counseling centers Psychiatric clinics and hospitals Psychiatric clinics and hospitals Chemical abuse treatment centers for alcohol/drug abuse Chemical abuse treatment centers for alcohol/drug abuse Physical abuse treatment centers (child or spouse abuse) Physical abuse treatment centers (child or spouse abuse)

21. Genetic Counseling Centers Perform prenatal (before birth) screening tests Perform prenatal (before birth) screening tests Checking for genetic abnormalities and birth defects Checking for genetic abnormalities and birth defects Explaining the results of the tests Explaining the results of the tests Identifying medical options when a birth defect is present Identifying medical options when a birth defect is present Helping individuals cope with the psychological issues caused by a genetic disorder Helping individuals cope with the psychological issues caused by a genetic disorder

22. Rehabilitation Centers Provide care directed at helping patient with physical or mental disabilities obtain maximum self-care and function Provide care directed at helping patient with physical or mental disabilities obtain maximum self-care and function Can include hospitals, clinics, and/or private centers Can include hospitals, clinics, and/or private centers Services can include physical, occupational, recreational, speech, and hearing therapies Services can include physical, occupational, recreational, speech, and hearing therapies

23. Health Maintenance Organizations HMO Preventive health care Preventive health care Examinations Examinations Basic medical services Basic medical services Health Education Health Education Hospitalization Hospitalization Rehabilitation services Rehabilitation services

24. Industrial Health Care Centers Located in large industries or companies Located in large industries or companies Provide care for employees of the industry Provide care for employees of the industry Services: basic exams, teach accident prevention/safety, provide emergency care Services: basic exams, teach accident prevention/safety, provide emergency care

25. School Health Service Found in schools and colleges and provide the following services… Found in schools and colleges and provide the following services… Emergency care for accidents and sudden illness Emergency care for accidents and sudden illness Tests to check for health conditions: speech, vision, hearing, and so forth Tests to check for health conditions: speech, vision, hearing, and so forth Promote health education Promote health education Maintain safe and sanitary school environment Maintain safe and sanitary school environment Counseling Counseling

26. Government Agencies World Health Organization (WHO) International agency sponsored by United Nations International agency sponsored by United Nations Compiles statistics and information on disease Compiles statistics and information on disease Publishes health information Publishes health information Investigates and deals with serious health problems throughout the world Investigates and deals with serious health problems throughout the world

27. United States Department of Health and Human Services 1.National Institutes of Health (NIH): research on disease 2.Centers for Disease Control and Prevention (CDC): causes, spread and control of diseases in populations 3.Food and Drug Administration (FDA): regulates food and drug products sold to the public

28. United States Department of Health and Human Services 4.Agency for Health Care Policy and Research (AHCPR): established in 1990 to research the quality of health care delivery and identify the standards of treatment that should be provided by health care facilities 5.Occupational Safety and Health Administration (OSHA): establishes and enforces standards that protect workers from job-related injuries and illnesses

29. Health Departments Provide specific services needed by state or local community Provide specific services needed by state or local community Immunization for disease control Immunization for disease control Inspections for environmental health and sanitation Inspections for environmental health and sanitation Health education Health education Collection of statistics and health records Collection of statistics and health records

30. Nonprofit / Volunteer Agencies Supported by donations, membership fees, fundraisers, and federal or state grants Supported by donations, membership fees, fundraisers, and federal or state grants Provide health services at national, state, and local levels Provide health services at national, state, and local levels Focus on specific diseases or professions Focus on specific diseases or professions

31. Nonprofit / Volunteer Agencies Examples… Examples… American Cancer Society American Cancer Society American Heart Association American Heart Association American Respiratory Disease Association American Respiratory Disease Association American Diabetes Association American Diabetes Association National Association of Mental Health National Association of Mental Health National Foundation of March of Dimes National Foundation of March of Dimes American Red Cross American Red Cross HOSA- non profit healthcare organization for Health Occupations Students HOSA- non profit healthcare organization for Health Occupations Students

32. Health Insurance Plans Established to help pay for the cost of health care. Established to help pay for the cost of health care. Thousands of individual insurance agencies Thousands of individual insurance agencies –BlueCross/Blue Shield Some insurance plans provide coverage through places of employment.

33. Terminology related to insurance Premium- A fee the individual pays for insurance coverage, paid to the insurance company. Premium- A fee the individual pays for insurance coverage, paid to the insurance company. Deductible- Amount that must be paid by the patient for medical services before the policy begins to pay. Deductible- Amount 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. Co-insurance- requires that specific percentages of expenses are shared by the patient and insurance company.

34. 80-20 co-insurance – company pays 80% and the patient pays the remaining 20% 70-30 co insurance – company pays 70% and the patient pays the remaining 30%

35. Co-Payment Co-Payment –A specific amount of money a patient pays for a particular service. –Ex $10 for each physician visit –Ex $50 for specialist visit –Ex $250 for emergency room visit

36. Health Insurance Plans Health Maintenance Organizations (HMO) Health Maintenance Organizations (HMO) Preferred Provider Organization (PPO) Preferred Provider Organization (PPO) Medicare Medicare –Type A –Type B Medicaid Medicaid Workers’ Compensation Workers’ Compensation TRICARE TRICARE Managed Care Managed Care

37. HMO Provides a managed care plan for health care sevices Provides a managed care plan for health care sevices Pay monthly fee for premium Pay monthly fee for premium Care directed toward preventive type health care and plan covers these screening visits Care directed toward preventive type health care and plan covers these screening visits Disadvantage – must use HMO affiliated providers for health care. If provider is not on the list, client must pay for the visit. Disadvantage – must use HMO affiliated providers for health care. If provider is not on the list, client must pay for the visit.

38. Preferred provider organization (PPO) Another type of managed care plan usually provided by large companies for their employees. Another type of managed care plan usually provided by large companies for their employees. PPO forms contract with health care agencies to provide health care at reduced rates. PPO forms contract with health care agencies to provide health care at reduced rates. Employees are restricted to use these providers. Will have to pay to use provider outside the plan. Employees are restricted to use these providers. Will have to pay to use provider outside the plan.

39. Medicare Provided by Federal Government Provided by Federal Government Individuals over 65 years of age, or persons with disabilities Individuals over 65 years of age, or persons with disabilities Type A - hospital Type A - hospital Type B - medical Type B - medical Type D – pharmaceutical Type D – pharmaceutical

40. Medicaid Medical assistance program funded by state and federal government, but operated by individual states Medical assistance program funded by state and federal government, but operated by individual states Low income, children who qualify for public assistance and individuals who are disabled or blind Low income, children who qualify for public assistance and individuals who are disabled or blind

41. Workers Compensation Health insurance plan providing treatment for workers injured on the job Health insurance plan providing treatment for workers injured on the job Administered by the state Administered by the state Paid by employer Paid by employer Reimbursement for lost wages Reimbursement for lost wages

42. TRICARE US Government plan for all military personnel. US Government plan for all military personnel. Provides care for all active duty members and their families, survivors of military personnel and retired members of the Armed Forces. Provides care for all active duty members and their families, survivors of military personnel and retired members of the Armed Forces. The Veterans Administration provides for the military veterans. The Veterans Administration provides for the military veterans.

43. Managed Care Approach that has developed in response to the rising cost of health care. Approach that has developed in response to the rising cost of health care. Principle behind this is that all health care provided must have a purpose. Principle behind this is that all health care provided must have a purpose. Often require a second opinion Often require a second opinion Focus on preventive and early diagnosis of disease Focus on preventive and early diagnosis of disease HMO’s and PPO’s are common types. HMO’s and PPO’s are common types.

44. Summary Many different types of health care facilities Many different types of health care facilities Employ many types of health care workers Employ many types of health care workers Important to be aware of facilities and type of services Important to be aware of facilities and type of services Important to be aware of different insurance plans Important to be aware of different insurance plans