1. HEALTH SYSTEMS ORGANIZATION 18 February 2008

2. HEALTHCARE ORGANIZATIONS In-patient Out-patient Home services Day care Equipment/Supplies Spa

3. INTERORGANIZATIONAL RELATIONSHIPS MARKET TRANSACTIONS –INPUT - SUPPLIERS –OUTPUT - INSURANCE COMPANIES, EMPLOYERS, PATIENTS INVOLUNTARY RELATIONSHIPS –GOVERNMENTAL- REGULATORY –PRIVATE - FINANCIAL STRATEGIC ALLIANCES

4. INTEGRATED ORGANIZATIONS HOSPITALS, PHYSICIANS, INSURERS, AND PURCHASERS FORM VERTICALLY AND HORIZONTALLY INTEGRATED ORGANIZATIONS IN OTHER CONTEXTS THESE ARE CALLED MONOPOLIES

5. HORIZONTAL INTEGRATION LINKING ORGANIZATIONS OF THE SAME TYPE TO INCREASE MARKET SHARE MEDICAL EXAMPLE –BUYING ALL THE NURSING HOMES MONOPOLY EXAMPLE –AT&T, Cox Cable

6. VERTICAL INTEGRATION LINKING ORGANIZATIONS SO THAT SUCCEDING TRANSACTIONS STAY WITHIN THE SYSTEM MEDICAL EXAMPLE –OCHSNER CLINIC MONOPOLY EXAMPLE –STANDARD OIL

7. HIGHLY INTEGRATED HEALTH SYSTEM VERTICAL INTEGRATION AND AN INSURANCE CONTRACT BIG MOVE TOWARD THIS IN THE 1980s AND 1990s TREND IS NOW AWAY FROM VERTICAL INTEGRATION

8. STRATEGIC ALLIANCE ANY FORMAL ARRANGEMENTS BETWEEN TWO OR MORE ORGANIZATIONS FOR PURPOSES OF MUTUAL GAIN THREE TYPES OF ALLIANCE –POOLED RESOURCES –SHARED PURPOSE –CONTRACTUAL/OWNERSHIP

9. INDEPENDENT PRACTICE ASSOCIATIONS LEGAL ENTITY COMPOSED OF PHYSICIANS WHO HAVE ORGANIZED FOR THE PURPOSE OF NEGOTIATING CONTRACTS TO PROVIDE SERVICES GROUP PRACTICE

10. SELF-REFERRAL ILLEGAL ! DO YOU WORK FOR THEM OR ARE YOU BEING BRIBED ? STRATEGIC ALLIANCES (page 234)

11. PAYORS FEDERAL GOVERNMENT STATE GOVERNMENT EMPLOYERS CHARITIES INDIVIDUALS

12. INSURANCE ARE THEY PAYORS? SINGLE PARTY PAYOR NATIONAL HEALTH

13. INSURANCE IS A CONTRACT PARTIES TO THE CONTRACT –THE PATIENT AND THE INSURANCE COMPANY HOW IS THE DOCTOR INVOLVED? HOW IS THE EMPLOYER INVOLVED?

14. INDEMNIFICATION INSURANCE WHAT MOST OF US THINK OF AS INSURANCE YOU HAVE A LOSS - THE INSURANCE COMPANY FIXES IT OR PAYS FOR IT

15. SELF INSURANCE GENERALLY INVOLVES THIRD PARTY ADMINISTRATORS LOOKS JUST LIKE INSURANCE USUALLY INCLUDES SOME TYPE OF CATASTROPHIC REINSURANCE

16. DIRECT CONTRACTING TAKES OUT THE INSURANCE COMPANY SAVES MONEY CREATES ISSUES FOR FOLLOW-UP

17. MANAGED CARE ORGANIZATIONS INTEGRATION OF FINANCING AND SERVICE DELIVERY INSURANCE COMPANIES WITH CAPTIVE PROVIDERS USE SOME SYSTEM OF GATEKEEPING

18. TYPES OF MCO HMO - HEALTH MAINTENANCE ORGANIZATIONS PPO - PREFERRED PROVIDER ORGANIZATIONS POS - POINT OF SERVICE PLANS

19. THE PURPOSE OF MANAGED CARE IS COST CONTAINMENT HAS IT WORKED? ACCESS TO CARE CONTROL OF PHYSICIANS PREVENTION

20. CONSENT

21. CONSENT TO CARE YOU HAVE TO HAVE PERMISSION FROM A CONSENTING ADULT TO DO ANYTHING TO THEM VIOLATING THIS IS BATTERY THE PATIENT MAY PICK AND CHOOSE WITH SOME EXCEPTIONS THE PATIENT MAY TERMINATE THE RELATIONSHIP BY REFUSING CONSENT

22. SUBSTITUTE CONSENT NOT EVERYONE CAN CONSENT KNOW WHO HAS THE AUTHORITY AND TALK ONLY TO THEM PARENTS HAVE LIMITED AUTHORITY OVER THEIR CHILDREN SPOUSES HAVE NO AUTHORITY OVER EACH OTHER

23. QUESTIONS OF ABILITY TO CONSENT YOU EITHER HAVE SOMEONE WITH THE LEGAL ABILITY TO CONSENT OR YOU DON’T QUESTIONABLE SITUATIONS HAVE TO BE ADDRESSED BY A JUDGE BIG CITY HOSPITALS OFTEN HAVE THE JUDGE’S PHONE NUMBER POSTED IN THE ER

24. INFORMED CONSENT MORE DETAILED THAN SIMPLE CONSENT MANY STATES HAVE STATUTES THIS IS ABOUT NOT LOOSING A LAW SUIT

25. EXCEPTIONS TO CONSENT EMERGENCY EXCEPTION –PRESERVATION OF LIFE AND LIMB –THE PATIENT IS MEDICALLY OR LEGALLY INCOMPETENT STATUTORY EXCEPTIONS –PUBLIC HEALTH LAW –MENTAL HEALTH LAW COURT ORDERED CARE