UNIT A

1
UNIT A

• Health Care Systems
• AH-II

2
Objectives

• Analyze health care facilities including
  government, profit and non-profit agencies.
• Explore health insurance, organizational
  structure, and trends in health care.

3
Assignment

• Read Unit-1 on page 8-23
• Complete review questions 1-8.

4
Health Care Facilities
5
General Hospitals

• General Hospitals Treat a wide range of
  conditions age groups usually provide
  diagnostic, medical, surgical emergency care
  services. Patients usually stays a few days to a
  week.

6
Specialty Hospitals

• Specialty Hospitals provide care for special
  illnesses or age groups example would be burn,
  oncology or psychiatric hospitals. Patients are
  generally hospitalized over a long time.

7
Government Hospitals

• Government Hospitals operate by federal, state
  local government agencies. Facilities. Facilities
  are located all over the world to provide care
  for government services personnel their
  dependants. Examples of Government hospitals are
  Veterans Administration hospitals state
  psychiatric hospitals.

8
University/College Medical Centers

• University/College Medical Centers provide
  hospital services along with research
  education can be funded by private and/or
  governmental services.

9
Long-Term Care Facilities

• Long-term care facilities are nursing homes or
  geriatric homes (convalescent care) mainly
  provide assistance care for elderly patients,
  usually called residents. Also provides care for
  disabled or handicapped and individuals with
  chronic long-term illness.

10
Extended Care Facilities

• Extended care facilities or skilled care
  facilities provides skilled nursing or/and
  rehabilitative care to prepare patients to return
  home, recover from major illness or surgery.
  Examples Treatments for cancer, dialysis or
  heart monitoring.

11
Independent Living Facilities

• Independent living facilities allows individuals
  who can take care of themselves to rent or
  purchase an apartment in the facility provides
  services such as meals, housekeeping, laundry,
  medical care social events.

12
Medical Offices

• Services vary from offices that are privately
  owned by one physician to large complexes that
  operate as corporations and employ many
  physicians and other health care professionals.
  Services offered range from physical exams,
  treatments, basic lab testing and minor surgery.

13
Medical Specialties Include

• Obstetrics
• Cardiology
• Pediatrics

14
Dental Offices

• Dental offices vary in size. Some offices are
  privately owned by one or more dentist. Dentist
  can work for major or retail department stores.
  Some dentist provide general care for all age
  groups or specialized care offered to a certain
  age group.

15
Clinics or Satellite Centers

• Clinics or satellite centers performs minor
  surgical procedures. Called frequently one-day
  surgical centers that send patients home
  immediately after they recover from their
  operation.

16
Urgent or Emergency Care Clinics

• Urgent or emergency care clinics provide first
  aid or emergency care to the ill or injured
  patients.

17
Rehabilitation Clinics

• Rehabilitation clinics offer physical,
  occupational, speech and other similar therapies.

18
Laboratories

• Laboratories are often a part of other facilities
  but can operate as a separate health care
  service. Medical laboratories can perform special
  diagnostic tests such as blood or urine test.
  Dental labs can prepare dentures and many other
  devices used to repair or replace teeth.

19
Home Health Care Agencies

• Home health care agencies are designed to provide
  care in a patients home. The services are
  frequently used by elderly disabled. Examples
  such as occupational, speech, homemaking,
  personal and/or respiratory care.

20
Hospice Agencies

• Hospice agencies provide care for terminally ill
  persons with life expectancies of six months or
  less. Care is provided in a persons home or in a
  hospice facility. Hospice allows the person to
  die with dignity in comfort. Psychological,
  social, spiritual financial counseling are
  provided for both the patient the family.

21
Government Agencies
22
World Health Organization (WHO)-

• Complies statistics and information on disease,
  publishes health information.

23
U.S. Department of Health Health Services (DHHS)

• National agency that deals with the health
  problems in the U.S.

24
National Institutes of Health (NIH)

• Involved in disease research.

25
Centers for Disease Control Prevention

• Concerned with causes, spread, control of
  diseases in populations.

26
Food Drug Administration

• Federal agency responsible for regulating food
  drug products sold to the public.

27
Health Maintenance Organization (HMOs)

• Another type of insurance plan that is focused on
  preventative care. A monthly fee or premium is
  paid for membership, and the fee stays the same
  regardless of the amount of healthcare used. The
  premium can be paid by an employer and/or an
  individual. The disadvantages of an HMO is that
  the insured is required to use only
  HMO-affiliated healthcare providers, labs
  hospitals. If patient chooses a non-affiliated
  provider, the patient pays for the care.

28
Mental Health Facilities

• Mental health facilities treat patients with
  mental disorders diseases.

29
Health Maintenance Organizations

• (HMOs) provide total healthcare directed toward
  preventive health care. Services include
  examinations, basic medical services, health
  education hospitalization or rehabilitation
  services.

30
Industrial Health Care

• Industrial health care centers or occupational
  health clinics are found in large companies or
  industries. Such centers provide health care for
  employees of the industry or business by
  performing basic examinations, teaching,
  accident, safety prevention emergency care.

31
School Health Services

• School health services are found in schools
  colleges. Examples of services provided include
• Emergency care or sudden illnesses
• Screening for speech, hearing vision problems.
• Health Education
• Counseling
• Maintaining a safe school

32
Occupational Safety Health Administration (OSHA)

• OSHA establishes enforces standards that
  protect workers from job-related injuries
  illnesses.

33
Health Departments

• Health Departments provide health services as
  directed by the U.S. Department of Health Human
  Services (USDHHS) Example of services such as
  immunizations, inspections of restaurants,
  communicable diseases, collection of statistics,
  health education, record related to health
  clinics for health care prevention.

34
Voluntary or Nonprofit Agencies

• Voluntary or Nonprofit Agencies are supported by
  donations, memberships fees, fundraisers
  federal or state grants. They provide health
  services at national, state local levels.

35
Examples of nonprofit agencies include

• American Heart Association
• American Diabetes Association
• National Association of Mental Health
• National Foundation of the March of Dimes
• American Red Cross

36
Health Insurance Plans

• Health insurance plans help pay for the costs of
  health care. Health insurance plans are offered
  by several thousand insurance agencies. A common
  example is Blue Cross/Blue Shield. When an
  insured individual has health care expenses
  covered by the insurance plan, the insurance
  company pays for the services. The amount of
  payment the type of services covered vary from
  plan to plan.

37
Common Insurance Terms

• Deductiblesamounts that must be paid by the
  patient for medical services before the policy
  begins to pay.
• Co-insurance requires that specific percentages
  of expenses be shared by the patient insurance
  companies for example, in as 80/20
  co-insurance, the company pays 80 of covered
  expenses patient pays remaining 20.
• Co-payment a specific amount of money a patient
  pays for a particular service for example, 10
  for each physician visit regardless of the total
  cost of the visit.
• Premium monthly cost for insurance

38
Health Maintenance Organization(HMO)

• (HMO) is another type of health insurance plan, a
  monthly fee or premium is paid for membership,
  and the fee stays the same regardless of the
  amount of healthcare used. The premium can be
  paid by an employer and/or an individual. Total
  care provided is directed toward preventive type
  healthcare. The disadvantage of an HMO is that
  the insured is required to use only
  HMO-affiliated healthcare providers, labs or
  hospitals for healthcare. If the patient chooses
  a nonaffiliated provider, the patient pays for
  the care.

39
Preferred Provider Organization(PPO)

• (PPO) is another type of health insurance plan.
  It is usually provided by large industries or
  companies to their employees. The industry or
  company forms a contract with certain health care
  agencies, such as a large hospital, specific
  dentists or doctors to provide care at a reduced
  rate. Employees are restricted to using only the
  specific hospital and or physicians.

40
Medicare

• Medicare is a federal government program that
  provides health care for almost all individuals
  over the age of 65 and for any person with a
  disability who has received Social Security
  benefits for at least two years.

41
Medicare Two Types

• Type A Covers hospital services and care
  provided by an extended care facility or home
  care agency with hospitalization.
• Type B Offers additional coverage for doctors
  services, outpatient treatment, therapy, other
  health care. Individual pays a premium for types
  B coverage also must pay an initial deductible
  for services. Medicare pays for only 80 of
  services the patient must either pay the balance
  or have another insurance policy to cover
  expenses.

42
Medicaid

• Medicaid is a medical assistance program operated
  by individual states. This program usually pays
  for the health care for the low income, children
  who qualify for public assistance individuals
  who are physically disabled or blind.

43
Workers Compensation

• Workers Compensation is a health insurance plan
  providing treatment for workers injured on the
  job. It is administered by the state. Payments
  are made by employers the state. This plan also
  pays the worker for wages lost because of on the
  job injuries.

44

• Tricare, formerly called CHAMPUS, the civilian
  health and medical programs for the uniform
  services, is a U.S. government health insurance
  plan for all military personnel. It provides care
  for all active duty members their families
  survivors of military personnel retired members
  of the Armed Forces.

45
Managed Care

• Managed Care is an approach that has developed in
  response to rising health care costs. All health
  care provided to a patient must have a purpose
  a verification of need is frequently required
  before care can be provided. Every effort is made
  to provide preventative care early diagnosis of
  disease in order to avoid the high cost o
  treating disease. The health care consumer who is
  enrolled in a managed care plan receives quality
  care at the most reasonable cost but is
  restricted in choice of healthcare providers.

46
Trends in the Health Care

• Cost Containment -To save money by buying
  hospital supplies in bulk.
• Cap on malpractice settlements.
• Outpatient services
• DRGs
• Wellness

47
Alternative Methods of Health Care

• Chi
• Acupuncture
• Herbs

48
DRGs Diagnostic Related Groups

• A group of diagnosis codes used with Medicare
  patients to keep cost down.
• The codes allow only certain procedures to be
  preformed on the patient. I.e. Chest X-ray code
  969
• Dx-pneumonia

49
National Health Care Plan

• ??????????????????????????
• What do you think?

50
THE END