Chapter #4: The Health Care Delivery System

What are the major healthcare insurance and benefit systems discussed in Chapter 4?

• Fee-for-service

• Health maintenance organizations (HMOs)

• Managed-care systems

• Preferred provider organizations (PPOs)

• Federal health insurance programs.

What does fee-for-service mean?

A healthcare payment system in which payment is associated with the healthcare services provided.

What is a health maintenance organization (HMO)?

A type of healthcare plan included among the healthcare insurance systems

-Limits coverage to medical care from doctors and hospitals that contract directly with the organization.

What is a managed-care system?

A healthcare delivery/payment system designed to manage healthcare services and their associated costs.

What is a preferred provider organization (PPO)?

A type of healthcare plan included among the managed healthcare systems.

What federal healthcare programs are identified in Chapter 4?

• Affordable Care Act (ACA)

• Medicare

• Medicaid.

What does ACA stand for?

Affordable Care Act.

What are Medicare and Medicaid?

Federal healthcare insurance/benefit programs identified in the chapter.

What are the two broad types of healthcare facilities discussed in Chapter 4?

1. Hospitals

2. Outpatient centers.

   
   

What are four classifications of hospitals listed in the chapter?

1. Private

2. Public

3. Not-for-profit

4. Proprietary.

What is a private hospital?

A hospital classified as private within the healthcare facility system.

What is a public hospital?

A hospital classified as public within the healthcare facility system.

What is a not-for-profit hospital?

A hospital classified as not-for-profit.

What is a proprietary hospital?

A hospital classified as proprietary.

What are examples of outpatient healthcare centers?

Urgent care centers and surgery centers.

What is the main distinction between a hospital and an outpatient center?

They are different types of healthcare facilities; outpatient centers include facilities such as urgent care and surgery centers.

Why is the healthcare team important?

Different healthcare professionals have different roles and specialties that contribute to patient care.

What is a radiologist?

A physician specializing in radiology.

What is a hospitalist?

A physician specialty identified in the chapter that is associated with hospital-based care.

What is an intensivist?

A specialized medical doctor who provides critical care to severely ill or injured patients.

What is a pathologist?

A medical doctor who diagnoses diseases by examining body tissues, cells, and fluids.

What is an oncologist?

A medical doctor who specializes in the diagnosis, treatment, and prevention of cancer.

What is a pulmonologist?

A medical doctor who specializes in diagnosing and treating conditions of the respiratory system.

What is an ophthalmologist?

A medical or osteopathic doctor who specializes in the medical and surgical care of the eyes and vision.

What surgical specialties are listed?

• Abdominal

• Plastic

• Neurologic

• Orthopedic

• Thoracic surgery.

What is the basic organizational structure of a hospital?

Executive Board → Administration → Departments.

What four general categories are hospital departments divided into?

"Good Doctors Treat Seriously"

1. General

2. Diagnostic

3. Therapeutic

4. Support.

What is the purpose of general/direct patient services?

They provide direct services to patients, such as…

-Admissions

-Emergency services

-Nursing

-Social services

-Chaplain/counseling services.

What is the purpose of diagnostic departments?

They provide diagnostic services, including imaging and other diagnostic examinations.

What is the purpose of therapeutic departments?

They provide services involved in treating patients.

What is the purpose of support services?

They provide services that support the operation of the healthcare facility.

Which hospital department category includes radiography?

Diagnostic.

Which hospital department category includes surgery?

Therapeutic.

Which hospital department category includes physical therapy?

Therapeutic.

Which hospital department category includes respiratory therapy?

Therapeutic.

Which hospital department category includes oncology?

Therapeutic.

Which hospital department category includes dietary services?

Therapeutic.

Which hospital department category includes accounting?

Support services.

Which hospital department category includes human resources?

Support services.

Which hospital department category includes housekeeping?

Support services.

Which hospital department category includes medical records?

Support services.

Which hospital department category includes security?

Support services.

A patient is sent for an MRI examination. What category of hospital service is involved?

Diagnostic, because MRI is listed as a diagnostic department/service.

A patient receives physical therapy following an injury. Which hospital department category is involved?

Therapeutic, because physical therapy is listed as a therapeutic service.

A hospital employee needs assistance with personnel-related matters. Which department would most likely be involved?

Human resources, which is a support service.

What is a pediatrician?

A medical doctor who manages the physical, emotional, and social health of infants, children, adolescents, and young adults from birth up to age 18 or 21.

What is an otorhinolaryngologist?

A medical doctor who specializes in treating conditions of the ear, nose, and throat (ENT).

Which hospital department category includes CT?

Diagnostic.

Which hospital department category includes MRI?

Diagnostic.

Which hospital department category includes nuclear medicine?

Diagnostic.

Which hospital department category includes sonography?

Diagnostic.