HEALTH CARESYSTEMS

Unit 2

Health Care SystemsIntroduction The Health Care industry

employs over 10 million workers in over 200 different health careers.

Health Care SystemsIntroduction Health care has become a

2-billion-dollar-a-day business.

$2,000,000,000.00Many different types of

facilities make up this network of health care systems.

Health Care SystemsI. Types of Facilities A. Hospitals: vary in size as

well as services provided. 1. Small: serve

communities2. Large: serve larger

areas & provide different services

Health Care SystemsI. Types of Facilities A. Hospitals: fall under

different income classifications:

- Private or Proprietary (for profit)

- Religious (funds by religious affiliation)

- Nonprofit (funds used for institution only)

- Government (funded by government)

Health Care SystemsI. Types of Facilities A. Hospitals: types of

hospitals: General – treat all age

groups & conditions; provides diagnostic, medical, surgical, and emergency care services; usually private (Health Central Hospital) (Orlando General Hospital)

Health Care SystemsI. Types of Facilities A. Hospitals: types of

hospitals: Specialty – provide care for

special conditions or age groups; private; donations

(Shriner’s Burn Center – Cincinnati) (MD Anderson Cancer Centers)(Arnold Palmer Hospital For Children)(Winnie Palmer Hospital For Women)

Health Care SystemsI. Types of Facilities A. Hospitals: types of

hospitals: Government –

operated/funded by federal, state and local governments

(Veteran’s Administration “VA Hospital”) (State Psychiatric Hospital -

Chattahoochee)

Health Care SystemsI. Types of Facilities A. Hospitals: types of

hospitals: University/College Medical

Centers – provide hospital services; research & education facility as well; can be funded privately, donations, or government sources (research)

Health Care SystemsI. Types of Facilities A. Hospitals: types of

hospitals: University/College Medical

Centers – Examples:University of Miami (Miami)University of South Florida (Tampa)Johns Hopkins University (Baltimore,

Maryland)Cleveland Clinic (Ohio – School of

Medicine)

Health Care SystemsI. Types of Facilities B. Long-Term Care: provide

assistance/care for elderly patients called “residents.” They can also provide care for persons with disabilities and/or chronic long-term illness.

Health Care SystemsI. Types of Facilities B. Long-Term Care: Types: - Nursing/Geriatric Homes:

provide basic care for those who can no longer care for themselves; assist with ADL’s (activities of daily living); provide safe/secure environment; social interaction

Health Care SystemsI. Types of Facilities B. Long-Term Care: Types: - Extended/Skilled Care:

provide skilled nursing care and rehabilitative services to prepare residents to return home or to other LTC facility

Health Care SystemsI. Types of Facilities B. Long-Term Care: Types: - Extended/Skilled Care:

Subacute Units:provide Services to residents who need rehabilitation to recover from major illness (surgery, cancer, dialysis, heart disease, stroke)

Health Care SystemsI. Types of Facilities B. Long-Term Care: Types: - Independent/Assisted Living:

individuals who can care for themselves (ADL’s) can rent or purchase apartment in facility(meals, housekeeping, laundry, transportation, social events, basic medical care are provided)

Health Care SystemsI. Types of Facilities B. Long-Term Care: Types: - Independent/Assisted Living:

most are associated with nursing homes; this allows resident to move from one facility to the other as conditions warrant

Health Care SystemsI. Types of Facilities B. Long-Term Care: - Many career opportunities

are available in long term care for health care workers.

- Regulated by AHCA and OBRA

- AHCA=Agency for Health Care Administration

- OBRA = Omnibus Reconciliation Act of 1987

Health Care SystemsI. Types of Facilities C. Medical Offices: can vary

to only have a single doctor or a group of doctors; can be a general practice or specialty practice

Health Care SystemsI. Types of Facilities C. Medical Offices: Types:- General Practice: treats all

ages and all conditions- “Family Doctor”- “General Practitioner”

Health Care SystemsI. Types of Facilities C. Medical Offices: Types:- Specialty Practice: specializes

in one particular age group or type of treatment given

- Pediatrics- Cardiology- Obstetrics- Orthopedics

Health Care SystemsI. Types of Facilities C. Medical Offices: Offer

several different opportunities for employment. Administration, nursing, bookkeeping, billing, medical coding. offices can be found in different locations to include; office buildings, stand-alone offices and even malls.

Health Care SystemsI. Types of Facilities D. Dental Offices: can vary in

size; one dentist, group of dentist (DDM=Doctor of Dental Medicine)(DDS=Doctor of Dental Services)

Dentists’ offices can also be found in many different places to include professional office buildings, stand-alone offices and even malls.

Health Care SystemsI. Types of Facilities E. Clinics: Health care

facilities which can provide different types of care. Can be dental or medical or (veterinary).

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Surgical: perform minor

surgeries, also called outpatient or “one-day” clinics; patient is sent home same day after surgery

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Urgent Care: provide first aid

or emergency care to ill or injured patients; not equipped to treat critically ill patients

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Rehabilitation: offer physical

occupational, speech therapies for patients after injury or illness

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Specialty: offer care for

patients with specific diseases (diabetes, cancer), disorders (stroke) or injuries (head injury)

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Outpatient: offer procedures

to patients who are then not admitted to the hospital – go home. Different than surgical clinics in that procedures are not only surgeries (endoscopy, colonoscopy)

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Health Department: may

offer treatment for pediatric patients;sexually transmitted diseases; respiratory diseases; immunizations and other services (pharmacy)

Health Care SystemsI. Types of Facilities E. Clinics: Types:- Medical Center: Usually

located in colleges and universities; often offer FREE medical care and treatment to provide learning experiences for medical students.

Health Care SystemsI. Types of Facilities F. Optical Centers: can be

individually owned by ophthalmologist (M.D. or D.O.) or optometrist (O.D.); or part of large chain of stores (Lens Crafters, Pearle Vision, etc.)

Health Care SystemsI. Types of Facilities G. Emergency Care Services:

provide care for victims of accidents or sudden illness by highly trained medical professionals

Health Care SystemsI. Types of Facilities G. Emergency Care Services:

Types: - Private ambulance services- Rescue squads (Fire Dept.)- Emergency/Urgent Care

Clinics- Emergency Rooms- Aircraft

(helicopters/airplanes)

Health Care SystemsI. Types of Facilities H. Laboratories: can be part

of larger facility, such as hospital, clinic or college/university, or can be stand-alone

- Pathologist- Laboratory technicians- Phlebotomist

Health Care SystemsI. Types of Facilities I. Home Health Care: provide

care in patient’s home- Nursing care- Personal care- Therapy- Homemaking

Health Care SystemsI. Types of Facilities J. Hospice: care for patients

who have less than 6 months to live as a result of a medical condition

Care can occur in the patient’s home or in Hospice care centers

The family of the patient is ALSO cared for.

Health Care SystemsI. Types of Facilities K. Mental Health: Types:- Counseling centers- Psychiatric clinics- Chemical abuse- Physical abuse

Health Care SystemsI. Types of Facilities L. Genetic Counseling: - Prenatal (before birth) tests- Checking for abnormalities &

birth defects- Identify all medical options- Assist parents in coping with

genetic disorders of child

Health Care SystemsI. Types of Facilities M. Rehabilitation: can be

located in hospitals, clinics or be stand-alone entity; the goal of rehabilitation is to have the patient reach their maximum potential, given their specific medical condition.

Health Care SystemsI. Types of Facilities N. Health Maintenance

Organizations (HMO’s): provide total health care directed toward preventative health care; some HMO’s are run by large corporations with many employees (lowers costs)

Health Care SystemsI. Types of Facilities O. Industrial Health Care

Centers: found in large companies; provide healthcare for employees of the company; focus on accident prevention and safety

Health Care SystemsI. Types of Facilities P. School Health Services:

found in many schools and colleges; many different levels of services provided

Health Care SystemsII. Government AgenciesGovernment Agencies: are

financially supported by taxes. National and international organizations exist around the world which monitor health and health care-related issues.

Health Care SystemsII. Government AgenciesA. World Health Organization

(WHO): international agency sponsored by the United Nations

- Statistics & info about diseases

- Publishes health info- Investigates/addresses

serious health threats around the world

Health Care SystemsII. Government AgenciesB. U.S. Dept. of Health and

Human Services (USDHHS): national agency

- Deals with health problems within the United States

Health Care SystemsII. Government AgenciesC. National Institutes of Health

(NIH): national agency- Division of USDHHS involved

in research of diseases

Health Care SystemsII. Government AgenciesD. Centers for Disease Control

and Prevention (CDC): national agency

- Division of USDHHS concerned with causes, spread, and control of diseases in populations

Health Care SystemsII. Government AgenciesE. Food and Drug

Administration (FDA): national agency

- Responsible for regulating food and drug products sold to the public

Health Care SystemsII. Government AgenciesF. Agency For Health Care

Policy and Research (AHCPR): national agency established in 1990

- Responsible for researching the quality of health care delivered and identify standards of treatment for health care facilities

Health Care SystemsII. Government AgenciesG. Occupational Safety and

Health Administration (OSHA): national agency

- Establishes & enforces standards that protect workers from job related injuries and illnesses

Health Care SystemsII. Government AgenciesH. Health Departments:

national agency; falls under USDHHS

- Community based- Gather statistics, trends- Prevention education- Immunizations

Health Care SystemsIII. Health Insurance PlansIn order to pay for costs

associated with health care most people rely on health insurance plans.

There are THOUSANDS of insurance plans, but most work under same basic idea: You pay premium to insurance company and insurance covers costs.

Health Care SystemsIII. Health Insurance PlansThe amount of payment and

type of services covered by the insurance company you have may vary. Not all insurances are the same and no two insurance plans are alike. Some cover more, some cover less than others.

Health Care SystemsIII. Health Insurance PlansTerms to know:Deductible: amount paid by

patient for medical services before policy begins to pay

Example: $500 out-of-pocket before insurance pays anything

Health Care SystemsIII. Health Insurance PlansTerms to know:Co-insurance: expenses for

medical care are shared between the patient and the insurance company

Example: 80/20 plan: insurance

pays 80%, you pay remaining 20%

Health Care SystemsIII. Health Insurance PlansTerms to know:Co-payment: also known as

“co-pay” this is the amount of $ you pay for a particular service regardless of total cost of service

Example: $25 per visit; whether for a physical or more serious illness

Health Care SystemsIII. Health Insurance PlansA. Medicare: government

programs that provides health care for individuals over the age of 65 and for any person who has been disabled for at least two years

Health Care SystemsIII. Health Insurance PlansA. Medicare: Types:- Part A: covers hospital

services and care provided by an extended care facility, or home health care agency after hospitalization

Health Care SystemsIII. Health Insurance PlansA. Medicare: Types:- Part B: covers doctor’s visits,

outpatient treatments, therapy and other health care

- A deductible is paid for Medicare Part B

- Part B only pays 80%

Health Care SystemsIII. Health Insurance PlansB. Medicaid: medical

assistance program operated by individual states. Persons covered by this program vary from state to state.

- Low income- Children who qualify - Physically disabled or blind

Health Care SystemsIII. Health Insurance PlansB. Medicaid: provides inpatient

and outpatient hospital services, physician’s medical and surgical care, lab, x-ray, well-baby and well-child care, including immunizations

Health Care SystemsIII. Health Insurance PlansC. Worker’s Compensation:

provides treatment for workers injured on the job. Funded by employers and each individual state

Health Care SystemsIII. Health Insurance PlansD. TRICARE: U.S. Government

health insurance program. Provides care for all active duty personnel and their families, survivors of military personnel, and retired members of the military

Health Care SystemsIV. Organizational StructureAll health care facilities must

have an organizational structure. This is the line of authority, or chain of command within a facility. This organizational structure of a facility should indicate areas of responsibility.

Health Care SystemsIV. Organizational StructureThe higher you are on the

organizational structure of an institution or facility, the more responsibility you will have.

School Principal

Health Care Systems

Superintendent

Asst. Superintendent

Asst. PrincipalAsst. Principal Asst. Principal

Teacher

Teacher

Teacher

Teacher

Teacher

Teacher

StudentStudentStudentStudentStudentStudentStudentStudentStudentStudentStudentStudent

IV. Organizational Structure

Nurse Manager

Health Care Systems

Hospital Administrator

Chief Nursing Officer

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IV. Organizational Structure

Nurse Manager

Health Care Systems

Hospital Administrator

Chief Nursing Officer

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IV. Organizational Structure

Health Care Systems

End of Lecture