Health Care Systems

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Chapter 2

• Health Care Systems

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21 Private Health Care Facilities

• Growthone of the largest and fastest growing
  industries in the United States
• Employment opportunitiesemploys over 13 million
  workers in over 200 careers
• Expendituresit is a four-billion-dollar-per-day
  business and growing

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Private Health Care Facilities(continued)

• Hospitals
• Long-term care facilities (LTC or LTCF)
• Independent living and assisted living
• Medical offices
• Dental offices
• Clinics or satellite centers
• Optical centers

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Private Health Care Facilities(continued)

• Emergency care services
• Laboratories
• Home health care
• Hospice agencies
• Mental health facilities
• Genetic counseling centers
• Rehabilitation facilities

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Private Health Care Facilities(continued)

• Health maintenance organizations (HMOs)
• Industrial health care centers or occupational
  health clinics
• School health services

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22 Government Agencies

• Government services are tax supported
• World Health Organization (WHO)
• U.S. Department of Health and Human Services
  (USDHHS)
• National Institutes of Health (NIH)
• Centers for Disease Control and Prevention (CDC)

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Government Agencies(continued)

• Food and Drug Administration (FDA)
• Agency for Health Care Policy and Research
  (AHCPR)
• Occupational Safety and Health Administration
  (OSHA)
• Health Departments

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23 Voluntary or Nonprofit Agencies

• Supported by donations, membership fees,
  fundraisers and grants
• Health services are provided at national, state,
  and local levels
• Examples include the American Cancer Society,
  March of Dimes, American Red Cross and many more

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Voluntary or Nonprofit Agencies(continued)

• Organizations focus on specific diseases
• Educate the public
• Provide special services
• Purchase medical equipment
• Staffed by many health care workers
• and volunteers

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24 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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Insurance Terminology

• Deductible
• Co-insurance
• Co-payment

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Types of Plans

• Health insurance plans
• Health maintenance organization (HMO)
• Preferred provider organization (PPO)
• Medicare
• Medigap

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Types of Plans(continued)

• Medicaid
• The State Childrens Health Insurance Program
  (SCHIP)
• Workers Compensation
• U.S. government plans for all military personnel
  and their families
• Managed care plans

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HIPAA

• Five components
• Health care access
• Preventing health care fraud
• Tax-related health provisions
• Application and enforcement of group health plan
  requirements
• Revenue offsets

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25 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 2-4
  and 2-5 in text)

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Organizational Structure(continued)

• The line of authority must be clearly indicated
  in any organizational structure
• Workers must identify and understand their
  position in the structure
• To follow proper channels of communication,
  workers must take problems, reports, and
  questions to their immediate supervisor