Health Care Systems

What do health care systems include ?

many agencies, facilities, and personnel involved in the delivery of health care

How many different types of health careers are there?

more than 200

Hospitals

acute care facilities

Hospitals are classified into these 4 different groups based on their source of income:

private or proprietary, religious, nonprofit or voluntary, government

General hospitals

treat a wide range of conditions and age groups

Specialty hospitals

provide care for special conditions or age groups

Government hospitals

operated by federal, state, and local government agencies

University or college medical centers

provide hospital services as well as research and education

Long-term care facilities provide assistance and care to…

elderly patients

Most common types of LTC’s

residential care facilities, extended care facilities, independent living facilities

Residential care facilities

designed to provide basic physical and emotional care for individuals who can no longer care for themselves

Extended care facilities

designed to provide skilled nursing care and rehabilitative care to prepare patients

Independent living facilities

allow individuals who can care for themselves to rent or purchase an apartment in the facility

Medical Offices

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

Dental Offices

vary in size from offices that are privately owned by one or more dentists to dental clinics that employ a group of dentists

Clinics or Satellite Centers

composed of a group of medical or dental doctors and other personnel who share a facility

Optical Centers

can be individually owned by an ophthalmologist or optometrist, or they can be a part of a large chain of stores

Emergency Care Services

provide special care for victims of accidents or sudden (acute) illness

Laboratories

often a part of other facilities but can operate as separate health care services

Home Health Care

agencies are designed to provide care in a patient’s home

Hospice

agencies provide care for people who are terminally ill and who usually have life expectancies of 6 months or less

Mental Health Facilities

treat patients who have mental disorders and diseases

Genetic Counseling Centers

can be independent facilities or can be located in another facility such as a hospital, clinic, physicians office

Industrial Health Care Centers

or occupational health care clinics, are found in large companies or industries

School Health Services

found in schools and colleges

Who sponsors the World Health Organization (WHO)?

the United States

Function of the WHO

compiles statistics and information on disease, publishes health information, and investigates and addresses serious health problems throughout the world

Function of the U.S. Department of Health and Human Services USDHHS:

protect the health of all Americans, provides more grant money than any other federal agency

Function of National Institutes of Health (NIH)

involved in researching disease and conducting scientific studies

Function of Centers for Disease Control and Prevention (CDC)

concerned with the causes, spread , and control of diseases in populations

Function of Food and Drug Administration(FDA)?

regulates food and drug products sold to the public, protects the public by regulating things such as medical devices, cosmetics, and cell phones

Occupational Safety and Health Administration (OSHA) is sponsored by?

the federal government

Function of OSHA?

establishes and enforces standards that protect workers from non-related injuries and illnesses

Office of the National Coordinator for Health Information Technology (ONC) purpose?

leads national efforts to build a private and secure nationwide health information exchange

Goal of the ONC?

to improve health care by allowing health information to be exchanged quickly among providers

Agency for Healthcare Research and Quality (AHRQ) is funded by?

the federal agency

Purpose of the AHRQ?

improve the quality, safety, efficiency, and effectiveness of health care for Americans

Where can you find health departments?

in public and private sectors at national, state, and local levels

What services are provided by the health departments?

immunization for disease control, inspections for environmental health, sanitation, health education and more

Another name for a voluntary agency:

nonprofit agency

How do voluntary agencies receive their funding?

donations,,membership fees, fundraisers, and federal or state grants

Endowment

a gift to a non-profit organization to be used for specific purpose

3 levels voluntary agencies provide health services at:

national, state, and local levels

Joint Commission

a non-profit, US based organization

Why was the Joint Commission created?

to ensure that patients receive the safest, highest quality care in any health care setting

Premium

a fee the individual pays for insurance coverage, is paid to the insurance company

Deductibles

amount that must be paid by the patient for medical services before the policy begins to pay

Co-insurance

requires that specific percentages of expenses are shared by the patient and insurance company

Co-payment

a specific amount of money a patient pays for a particular service

Consumer

anyone who has used, is using, or will use health care services

Provider

doctors, laboratories, hospitals, etc.

Reimbursement

the action of repaying a person who has spent or lost money

What is it called if you have insurance coverage through your place of employment?

employer-sponsored health insurance or group insurance

3 main types of medical insurance programs

government(Medicare and Medicaid), group (HMO and PPO), individual/private insurance

Why was managed care developed?

response to rising health care costs

What is the principle behind managed care?

all health care provided to a patient must have a purpose

A second ___ or ___ of need is frequently require before care can be provided.

opinion, verification

Some of the preventative services available to the patient under this type of care:

routine physical examinations, well-baby care, immunizations, and wellness education to promote good nutrition, exercise, weight control, and healthy living practices

2 main providers of managed care:

HMOs and PPOs

Health Maintenance Organization (HMO)

another type of managed care and group insurance

Preferred Provider Organization (PPO)

another type of managed care health insurance plan usually provided by large industries or companies to their employees

Fee-for-service compensation

a health payment plan in which doctors or providers are paid for each service they render

Value-based compensation

or bundled payments, a health payment plan in which doctors are paid for their performance

Who qualifies for Medicare?

almost all individuals age 65 and older, for any person with a disability who recede Social Security benefits for at least 2 years, and for any person with end-stage renal (kidney) disease.

Medicare consists of 3 parts:

type A: hospital insurance, type B: medical insurance, type D: pharmaceutical (medication) expenses

Medigap policy

a health insurance plan that helps pay medical expenses not covered by Medicare

Who funds Medicaid?

the federal government and state governments

Who is covered by Medicaid?

individuals with low incomes, children who qualify for public assistance, and individuals who are physically disabled or blind

What type of care does Medicaid provide?

hospital services, physician’s care, long-term care services, and some therapies

When was the State Children’s Health Insurance Program (SCHIP) established?

1997

Why was the SCHIP established?

to provide healthcare to uninsured children of working families who earn too little to afford private insurance but too much to be eligible for Medicaid

What type of services does the SCHIP provide?

impatient and medical care, lab and x-ray tests and well-baby and well-childcare, including immunizations

Who is eligible for Worker’s Compensation?

workers injured on the job

Who administers Workers Compensation?

the state

Who makes the payments for Worker’s Compensation?

employers and the state

What does Worker’s Compensation reimburse the worker for?

wages lost because of an on-the-job injury

TRICARE was formerly known as___

civilian health and medical programs

Who does TRICARE provide care for?

all military personnel

Who provides care for military veterans?

the Veterans Administration

Health Insurance Portability and Accountability Act (HIPPA) was wrote by:

the federal government

What year was HIPPA written?

1996

When did HIPPA start taking affect?

April 2004

5 main components of HIPPA:

-Health care access, portability, and renewability

-Preventing health care fraud and abuse; administrative simplification and medical liability reform

-Tax-related health provisions

-Application and enforcement of group health plan requirements

-Revenue offsets

What is always included in the Organizational Structure?

lines of authority

What is the purpose of Organizational Structure?

health care workers are able to identify and understand their respective positions and the immediate supervisors in charge of their work