Health Care FacilitiesHealth Care Facilities

ObjectivesObjectives

• Students will be able to:Students will be able to:• Differentiate between private, public, and non-profit Differentiate between private, public, and non-profit

facilities.facilities.• Predict where and how factors such as cost, managed care, Predict where and how factors such as cost, managed care,

technology, and aging population, access to care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect alternative therapies, and lifestyle behavior may affect various health delivery system models. various health delivery system models.

• Research the organizational structures and services of Research the organizational structures and services of various types of health care facilities. various types of health care facilities.

• Differentiate between various types of health care Differentiate between various types of health care insurance plans insurance plans

• Analyze the cause and effect on health care system change Analyze the cause and effect on health care system change based on the influence of technology epidemiology, bio-based on the influence of technology epidemiology, bio-ethics, socioeconomic and various forms of complimentary ethics, socioeconomic and various forms of complimentary medicinemedicine

HospitalsHospitalsVary according to:Vary according to:

SizeSize▫ SmallSmall▫ LargeLarge

OwnershipOwnership▫ Proprietary / private / for profitProprietary / private / for profit▫ NonprofitNonprofit▫ GovernmentGovernment▫ ReligiousReligious

ServicesServices▫ GeneralGeneral▫ SpecialtySpecialty

Provide long-term care for elderly Provide long-term care for elderly patients and for patients in rehabilitation.patients and for patients in rehabilitation.

Levels of long-term care:Levels of long-term care:▫ A A nursing homenursing home provides care for patients provides care for patients

who can no longer care for themselves.who can no longer care for themselves.

▫ An An independent living facilityindependent living facility allows patients to use only allows patients to use only the services they need, such the services they need, such as transportation or as transportation or housekeeping.housekeeping.

Long-Term Care FacilitiesLong-Term Care Facilities

Medical OfficesMedical Offices

May be operated by one or two May be operated by one or two doctors or a large groups of health doctors or a large groups of health care professionals.care professionals.

Some medical offices treat a wide Some medical offices treat a wide range of conditions. range of conditions.

Others are specialized Others are specialized

for specific ages or for specific ages or

medical conditions.medical conditions.

Other Types of FacilitiesOther Types of Facilities Dental officesDental offices ClinicsClinics Optical centersOptical centers Emergency Care Emergency Care

CentersCenters LaboratoriesLaboratories Home Health Care Home Health Care HospiceHospice

Mental HealthMental Health Genetic Counseling Genetic Counseling

CentersCenters RehabilitationRehabilitation Health Maintenance Health Maintenance

Organizations (HMO’s)Organizations (HMO’s) Industrial Care CentersIndustrial Care Centers School Health ServicesSchool Health Services

Government AgenciesGovernment Agencies World Health Organization (WHO)World Health Organization (WHO) U.S. Department of Health and Human U.S. Department of Health and Human

Services (USDHHS)Services (USDHHS) National Institute of Health (NIH)National Institute of Health (NIH) Centers for Disease Control and Prevention Centers for Disease Control and Prevention

(CDC)(CDC) Food and Drug Administration (FDA)Food and Drug Administration (FDA) Agency for Health Care Policy And Research Agency for Health Care Policy And Research

(AHCPR)(AHCPR) Occupational Health and Safety AdministrationOccupational Health and Safety Administration State and local health departmentsState and local health departments

Volunteer and Nonprofit Volunteer and Nonprofit AgenciesAgencies

American Cancer SocietyAmerican Cancer SocietyAmerican Heart AssociationAmerican Heart AssociationAmerican Red CrossAmerican Red CrossNational Association of Mental National Association of Mental

HealthHealthNational Foundation of the March National Foundation of the March

of Dimesof Dimes

Health Health

Insurance PlansInsurance Plans

Health Care SystemsHealth Care Systems

Nearly every industrialized Nearly every industrialized country has a national health care country has a national health care system. system.

Some countries have public or Some countries have public or national health care systems, and national health care systems, and other countries have private other countries have private health care systems.health care systems.

Public / NationalPublic / NationalHealth Care SystemsHealth Care Systems

• Mainly funded by taxes and social security Mainly funded by taxes and social security insurance.insurance.

• Advantage – Every citizen is guaranteed Advantage – Every citizen is guaranteed health care regardless of economic status.health care regardless of economic status.

• Disadvantages – Health care is not always Disadvantages – Health care is not always comprehensive, and taxes may be higher.comprehensive, and taxes may be higher.

• Norway, France, the United Kingdom, and Norway, France, the United Kingdom, and CanadaCanada

Private Health Care Private Health Care SystemsSystems

• Mainly funded by private insurance Mainly funded by private insurance agencies and out-of-pocket payments.agencies and out-of-pocket payments.

• Advantages – Coverage is often Advantages – Coverage is often comprehensive, taxes may be lower, comprehensive, taxes may be lower, and economic growth is stimulated.and economic growth is stimulated.

• Disadvantage – Not every citizen is Disadvantage – Not every citizen is guaranteed health care.guaranteed health care.

• United States and SwitzerlandUnited States and Switzerland

Mixed SystemsMixed Systems

• Very few countries have a purely Very few countries have a purely public or private systempublic or private system

• Most countries create a mixed Most countries create a mixed system by using various funding system by using various funding sources to cover health care sources to cover health care expenses.expenses.

• Example: Canada and the United Example: Canada and the United StatesStates

Health InsuranceHealth Insurance

The rising cost of health care is The rising cost of health care is good for the economy, but the good for the economy, but the expenses are a burden for most expenses are a burden for most individuals and families. individuals and families.

In the 1920’s, the United States In the 1920’s, the United States developed a system of health developed a system of health insurance to help cover the cost of insurance to help cover the cost of medical expenses.medical expenses.

Health Insurance TermsHealth Insurance Terms PremiumPremium – the amount paid to an insurance – the amount paid to an insurance

agency for a health insurance policy agency for a health insurance policy

DeductibleDeductible - the amount that must be paid - the amount that must be paid by the patient before the insurance agency by the patient before the insurance agency will begin to make paymentswill begin to make payments

Co-paymentCo-payment - an amount paid by the - an amount paid by the patient for a certain service patient for a certain service

Out-of-pocketOut-of-pocket - a medical bill that must be - a medical bill that must be paid by the patient paid by the patient

Individual and Group Individual and Group InsuranceInsurance

Individual insuranceIndividual insurance is when a person is when a person purchases a policy and agrees to pay purchases a policy and agrees to pay the entire premium for health coverage. the entire premium for health coverage.

Group insuranceGroup insurance is generally is generally purchased through an employer. The purchased through an employer. The premium is split between the employer premium is split between the employer and the person being insured. and the person being insured.

Managed CareManaged Care

Two primary concepts of Two primary concepts of managed managed carecare::▫ To promote good health To promote good health ▫ To practice preventive medicine To practice preventive medicine

Managed care plans offer medical Managed care plans offer medical services through a system of health services through a system of health care providers. The system of providers care providers. The system of providers offers services at reduced rates. offers services at reduced rates.

Managed CareManaged Care

Health Maintenance OrganizationsHealth Maintenance Organizations

Preferred Provider OrganizationsPreferred Provider Organizations

Point of ServicePoint of Service

Health Maintenance Health Maintenance OrganizationsOrganizations

Clients must pay a premium, Clients must pay a premium, deductible, and co-payments.deductible, and co-payments.

Clients must visit in-network doctors Clients must visit in-network doctors and select a primary care physician.and select a primary care physician.

HMOs urge clients to practice HMOs urge clients to practice healthy living and to receive healthy living and to receive preventive treatments.preventive treatments.

Preferred Provider Preferred Provider OrganizationOrganization

Clients must pay a premium, deductible, Clients must pay a premium, deductible, and co-payments.and co-payments.

Clients do not have to choose a primary Clients do not have to choose a primary care physician.care physician.

Clients may visit non-network physicians, Clients may visit non-network physicians, but coverage is greater with in-network but coverage is greater with in-network physicians.physicians.

PPOs often have other fees and co-PPOs often have other fees and co-payments.payments.

Point of ServicePoint of Service

Clients must pay a premium.Clients must pay a premium.

Clients must chose a primary care Clients must chose a primary care physician.physician.

For in-network physicians, there is For in-network physicians, there is usually no deductible and co-payments usually no deductible and co-payments are low.are low.

Specialists may be non-network Specialists may be non-network physicians, but coverage may be limitedphysicians, but coverage may be limited

Government ProgramsGovernment Programs In the 20th century, the United States In the 20th century, the United States

government began to realize the need government began to realize the need for public medical assistance. for public medical assistance.

In 1965, President Lyndon B. Johnson In 1965, President Lyndon B. Johnson instituted two medical assistance instituted two medical assistance programs to help those without health programs to help those without health insurance. insurance. ▫ MedicaidMedicaid▫ MedicareMedicare

MedicaidMedicaid

Income or needs based program Income or needs based program

Designed by the federal government, Designed by the federal government, but administered by state governmentsbut administered by state governments

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

MedicareMedicareProgram for any citizen age 65 or Program for any citizen age 65 or

olderolder

Administered by the federal Administered by the federal governmentgovernment

After an individual pays a After an individual pays a deductible, Medicare will cover 80% deductible, Medicare will cover 80% of all medical expenses. of all medical expenses.

Medicare ServicesMedicare Services

Part A: Hospital CarePart A: Hospital Care▫ HospitalizationHospitalization▫ Skilled nursing facilitiesSkilled nursing facilities▫ Home health careHome health care▫ Hospice careHospice care▫ Long-term care facilitiesLong-term care facilities

Part B: Outpatient ServicesPart B: Outpatient Services▫ Medical expenses, including therapy, Medical expenses, including therapy,

medical equipment, and testingmedical equipment, and testing▫ Preventive CarePreventive Care

Worker’s CompensationWorker’s Compensation

Provides treatment for workers Provides treatment for workers injured on the jobinjured on the job

Administered by the stateAdministered by the stateReimburses the worker for wages Reimburses the worker for wages

lost because of on-the-job injurylost because of on-the-job injury

TRICARE Formerly called CHAMPUS (the Civilian

Health and Medical Programs for the Uniform Services)

Administered by the federal government

Provides care for all active duty members and their families, survivors of military personnel, and retired members of the Armed Forces

Health Insurance Portability and Accountability Act

(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

Trends in Trends in Today’s Health Care Today’s Health Care

SystemsSystems

Advances in technologyAdvances in technologyEpidemiologyEpidemiologyBio-ethicsBio-ethicsSocioeconomicsSocioeconomicsComplementary (nontraditional) Complementary (nontraditional)

medicinemedicine

Organizational StructureOrganizational Structure

• An tool designed to help a facility An tool designed to help a facility operate smoothly by outlining operate smoothly by outlining responsibilitiesresponsibilities

• It describes the line of It describes the line of authority that authority that establishes levels establishes levels of responsibility of responsibility and supervisionand supervision

The End!The End!