Health care industry employees over 14 million people in over 200

different health careers.

It is a 2-billion-dollar-a-day business.

TYPES OF HEALTH CARE FACILITIES

Hospitals: classified as to source of funding

1. Private—operated for profit2. Religious3. Non-profit or voluntary4. Government:tax monies and or pt. fees

Government Hospitals

• Operated by federal, state and local govt agencies

• World wide facilities for govt service personnel and their dependents

• Veteran’s hospitals• State psychiatric hospitals• State rehab centers

*General Hospitals: treat a wide range of conditions

*Specialty Hospitals: treat special conditions such as oncology, burn, pediatrics, psychiatry, maternal, rehab.

Long-Term Care Facilities (LTC)

Cares mostly for elderly. Also cares for any age people with disabilities or

handicaps ; people with chronic or long term illness.

Nursing homes

• Provide basic physical and emotional care• Usually for persons who can’t care for

themselves• Help with ADL’s-activities of daily living.

Independent Living and Assisted Living Facilities

Person rents or purchases apartment.Services provided include meals,

housekeeping, laundry, transportation, social events and basic medical care.

Medical Offices offer examinations, basic lab testing, minor surgery. Some are generalists; some are specialists.

Clinics may be operated by individual doctors or groups. They may provide general care or specialized care such as pediatrics, STD’s, diabetes care, oncology, respiratory care.

Dental offices vary in size from offices that are privately owned by one or more dentists to dental clinics that employ a number of dentists. Services range from general to specialized care.

Optical centers can be individually owned by ophthalmologists (M.D.) or optometrists (B.S./ M.S.). They provide vision exams, prescribe eyewear and check for diseases.

Emergency care services

EMS cares for victims of accidents or illness. Ambulances, rescue squads (frequently operated by fire department), emergency clinics, helicopter and air ambulances provide services.

Air Medical Support

LaboratoriesLaboratories may be attached to a clinic or free standing. They perform a variety of diagnostic tests such as blood, urine and sputum.

Dental laboratories can prepare dentures and artificial support appliances for teeth.

Home Health CareServices provided by home health care include nursing, personal care, therapies including physical, respiratory, & speech. Services may be provided by hospitals, health depts., government agencies, & nonprofit volunteer agencies

Hospice is care for terminally ill patients that have a life expectancy of 6 months or less.

Services may be provided at home…

or in a long term care facility.

Perinatal Hospice

When a life-threatening condition is diagnosed prior to birth, Perinatal hospice services are provided to families. The family has support from physicians, nurses, social workers, ministers, and nutritionists trained to help plan for the time from birth to the death of the newborn.

Mental health

Mental health facilities provide services for mental disorders and diseases. Facilities include guidance and counseling centers, psychiatric clinics and hospitals, chemical abuse (including drug and alcohol), physical abuse treatment centers (dealing with child abuse and spousal abuse).

Genetic Counseling

Genetic counseling centers can be an independent facility or located in another facility. Employees work with couples or individuals who are pregnant or considering pregnancy. They perform prenatal screening tests, check for genetic abnormalities and birth defects, explain the results of the tests, identify medical options and help the person deal with the psychological issues caused by genetic disorder.

Rehabilitation

The goal of rehabilitation is to get the patient to their optimal level of functioning . Services may include physical, occupational, recreational, speech and hearing therapy.

HMOs --Health Maintenance organizations provide total care directed at preventative health care.

Services include examinations, basic medical services, health education and hospitalization or rehab as needed. HMOs are operated by large corporations or private agencies.

Industrial Health Care Centers

Industrial health care centers are provided by large corporations to provide on-site health care for their employees where they can receive services including basic exams, learn accident prevention and safety and emergency care.

School Clinics

School clinics provide services that include emergency care, checks for health conditions such as speech, vision, and hearing problems, health education and some counseling services. They assist with medications.

Government Agencies

World Health Organization (WHO) sponsored by the United Nations gathers data about disease, publishes health information , and investigates and addresses serious health problems throughout the world.

United Nations

U.S. Dept. of Health and Human Services (USDHHS)deals with health problems in US.

One part of the USDHHS is the National Institutes of Health. NIH is a collection of 27 different institutes dedicated to research. Some of the institutes include National Cancer Institute, National Institute on Aging, National Institute of Biomedical Imaging and Bioengineering, National Institute of Dental and Craniofacial Research.

Center for Disease Control and Prevention (CDC)

The CDC is concerned with causes, spread and control of diseases in populations. They emphasis environmental health, occupational health and safety, health promotion, prevention and education. It accomplishes its goals through partnership with state and local agencies.

Food and Drug Administration

The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

Agency for Health Care Policy and Research

Agency 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.

Occupational Health and Safety Administration

Establishes and enforces standards that protect workers from job-related injury and illnesses.

State and local (including city) health departments provide specific services needed by the state or local community. These may include immunizations for disease control; inspections for environmental health and sanitation, communicable disease control and health education.

World Health Organization (WHO) sponsored by the United Nations gathers data from around the world, advises, teaches, investigates

U.S. Dept. of Health and Human Services –health problems in US National Institutes of Health—disease research

Center for Disease Control and Prevention (CDC) monitor causes, spreading and control of diseases

Food and Drug Administration (FDA) regulates food and drug products

Agency for Health Care Policy and Research (AHCPR) research quality of health care delivery and identify standards of treatment that should be provided.

Occupational Safety and Health Administration (OSHA) establishes and enforces standards that protect workers from job related injuries and illnesses.

Voluntary or Non-Profit Agencies

• Supported by donations, membership fees, fundraisers, and federal or state grants.

• Am. Cancer Society• Am. Heart Assoc.• Am. Diabetes Assoc.• Am. Respiratory Disease Assoc.• National Assoc. of Mental Health • March of Dimes• Am. Red Cross• and many more

Health Insurance Plans

• 16 % of GNP goes to health care.• Most people rely on insurance to afford health care.• Premium is paid monthly/quarterly to insurance co.• When care is received, insurance co. pays for some/all of the

costs and the patient is responsible for the remainder.• Payment depends on the plan. Some have limits and

deductibles. Deductibles are amounts that have to be paid before insurance begins to pay. (Some companies pay the deductible for their worker)

• Co-insurance requires that a % of the expense are paid by the patient and insurance co. (80/20)

HMO

• Monthly fee or premium—amount is the same each month regardless of how much you use it.

• Directed at preventative care.• Ready access to health exams, early tx and

detection of dz. (disease)—goal is to be healthier

• Disadvantage—required to use only HMO-affiliated providers

PPO Preferred Provider Org.

• Usually provided by large corp. to employees• Corp. makes an alliance with health care

facilities to provide care to employee at a reduced cost.

• Employees utilize the specific hospitals or doctors (in network) at a reduced rate.

• May go out of network at a higher rate.

Medicare

• Federal gov. provides health care for people over age 65 and for any person with a disability who has received Social Security benefits for at least two years.

• Type A covers hospital stays• Type B covers doctor’s visits, therapies …requires

that a premium be paid for type B coverage and also must pay an initial deductible for services.

• Only pays for 80% of cost. Person or their private insurance must pay for the rest.

Medicaid

• Medical assistance program operated by states

• Usually pays for care of individual with low income, children who qualify for public assistance, and physically disabled or blind.

State Children’s Health Insurance Program

(SCHIP)

• Est. 1997 to provide health care to uninsured children of working families who earn too little to afford private insurance but too much to be eligible for Medicaid.

• Provides inpt and outpt services

Workers’ Compensation

• Paid by employers and the state for person’s injured while on the job.

• Reimburses worker for wages lost because of the on-the-job injury

TRICARE

• US gov. pays for military personnel, their families, their survivors, and retired members of US armed forces

• Veteran’s Administration provides for military veterans.

Managed Care

• Approach has developed in response to rising health care costs.

• Way to make certain that money is spent efficiently rather than wastefully.

• **Principle behind MC is that all health care provided to a pt must have a purpose.

• A second opinion is frequently needed • Try to provide preventative care; early dx to avoid high cost of

treating dz.• HMO is main group to do this• Goal is to get quality care at the lowest price.

Authority is often used interchangeably with the term "power". However, their meanings differ: while "power" is defined as "the ability to influence somebody to do something that (s)he could not have done", "authority" refers to a claim of legitimacy, the justification and right to exercise that power.

Organizational Structure

Regardless whether a structure/organization/business is large or small, there must be a line of authority or chain of command. The organizational structure should indicate areas of responsibility and lead to the most efficient operation of the facility.

It is important that health care workers (HCW) understand their respective positions in a given facility’s organizational structure. This way everyone knows the lines of authority and understands who is their immediate boss.

Problems must be handled in proper sequence up and down the chart/ladder.

GOAL of organization in health care facilities: delivery of safe, quality health care in a financially prudent manner.

Organizational Structure

“Chaos in the midst of chaos isn't funny, but chaos in the midst of order is.” Steve Martin“Chaos is a name for any order that produces confusion in our minds.” George SantayanaChaos is inherent in all compounded things. Strive on with diligence.Buddha

TRENDS IN HEALTH CARE

Cost Containment: trying to control the rising cost of health care and achieving the maximum benefit for every dollar spent.

Reasons for high health costs:*technological advances—machines are expensive*people survive illness that were once fatal and require expensive, life-long care*people are living longer, as population ages there are more chronic illness to treat*increase in health related lawsuits—practioners must pay more for malpractice insurance, order diagnostic tests that might not be necessary

…as a result, cost of health care continues to rise and may rise out of the reach of some people.…all people should have access to equal access to care.

All aspects of health care are directed toward cost containment.

Diagnostic Related Groups (DRGs)

Congress is trying to control cost for Medicare and Medicaid. They lump certain diagnosis together and pay a flat amount for the care of a pt with one of those diagnoses.

Congress is trying to get facilities to provide care within the expense limit allowed.

If a facility treats the pt and goes under budget, it gets to keep the extra.However, if it turns out that it costs most, the facility has to accept the loss.

Advantage: facility works in a more efficient manner

Disadvantage: care might possibly be short changed

Other ways to contain costs

1.Agencies joining together or sharing specific services2.Outpatient services less expensive than in pt.3.Buying in bulk4.Early intervention and prevention5.Energy conservation

Omnibus Budget Reconciliation Act (OBRA) 1987

1. Federal guideline that requires states to establish training for nursing and geriatric assistants.

2. Requires compliance with patients’/residents’ rights and forces states to ensure standards of care.

Telemedicine

• Uses video, audio, and computers to provide medical and other health care services.

• New technology allows interactive services between health care providers even though they are in different locations.

Wellness

• State of balance in optimum health with a balanced relationship between physical, mental and social health and maintain and prevent disease thereby lowering healthcare costs

• Recognize importance of following: 1. exercise 2. good nutrition 3. weight control 4. healthy living habits

Alternative Methods of Health Care

• Acupuncture, positive thought, relaxation techniques, yoga, meditation, therapeutic touch, reflexology, hypnosis