Health Care Facilities
ObjectivesStudents will be able to:Differentiate between private, public, and non-profit facilities.Predict where and how factors such as cost, managed care, technology, and aging population, access to care, alternative therapies, and lifestyle behavior may affect various health delivery system models. Research the organizational structures and services of various types of health care facilities. Differentiate between various types of health care insurance plans Analyze the cause and effect on health care system change based on the influence of technology epidemiology, bio-ethics, socioeconomic and various forms of complimentary medicine
HospitalsVary according to:SizeSmallLarge
OwnershipProprietary / private / for profitNonprofitGovernmentReligious
Provide long-term care for elderly patients and for patients in rehabilitation.
Levels of long-term care:
A nursing home provides care for patients who can no longer care for themselves.
An independent living facility allows patients to use only the services they need, such as transportation or housekeeping.
Long-Term Care Facilities
Medical OfficesMay be operated by one or two doctors or a large groups of health care professionals.
Some medical offices treat a wide range of conditions. Others are specialized for specific ages or medical conditions.
Other Types of FacilitiesDental officesClinicsOptical centersEmergency Care CentersLaboratoriesHome Health Care HospiceMental HealthGenetic Counseling CentersRehabilitationHealth Maintenance Organizations (HMOs)Industrial Care CentersSchool Health Services
Government AgenciesWorld Health Organization (WHO)U.S. Department of Health and Human Services (USDHHS)National Institute of Health (NIH)Centers for Disease Control and Prevention (CDC)Food and Drug Administration (FDA)Agency for Health Care Policy And Research (AHCPR)Occupational Health and Safety AdministrationState and local health departments
Volunteer and Nonprofit AgenciesAmerican Cancer SocietyAmerican Heart AssociationAmerican Red CrossNational Association of Mental HealthNational Foundation of the March of Dimes
Health Insurance Plans
Health Care SystemsNearly every industrialized country has a national health care system.
Some countries have public or national health care systems, and other countries have private health care systems.
Public / NationalHealth Care SystemsMainly funded by taxes and social security insurance.
Advantage Every citizen is guaranteed health care regardless of economic status.
Disadvantages Health care is not always comprehensive, and taxes may be higher.
Norway, France, the United Kingdom, and Canada
Private Health Care SystemsMainly funded by private insurance agencies and out-of-pocket payments.
Advantages Coverage is often comprehensive, taxes may be lower, and economic growth is stimulated.
Disadvantage Not every citizen is guaranteed health care.
United States and Switzerland
Mixed SystemsVery few countries have a purely public or private systemMost countries create a mixed system by using various funding sources to cover health care expenses.
Example: Canada and the United States
Health InsuranceThe rising cost of health care is good for the economy, but the expenses are a burden for most individuals and families.
In the 1920s, the United States developed a system of health insurance to help cover the cost of medical expenses.
Health Insurance TermsPremium the amount paid to an insurance agency for a health insurance policy
Deductible - the amount that must be paid by the patient before the insurance agency will begin to make payments
Co-payment - an amount paid by the patient for a certain service
Out-of-pocket - a medical bill that must be paid by the patient
Individual and Group InsuranceIndividual insurance is when a person purchases a policy and agrees to pay the entire premium for health coverage.
Group insurance is generally purchased through an employer. The premium is split between the employer and the person being insured.
Managed CareTwo primary concepts of managed care:To promote good health To practice preventive medicine
Managed care plans offer medical services through a system of health care providers. The system of providers offers services at reduced rates.
Managed CareHealth Maintenance Organizations
Preferred Provider Organizations
Point of Service
Health Maintenance OrganizationsClients must pay a premium, deductible, and co-payments.
Clients must visit in-network doctors and select a primary care physician.
HMOs urge clients to practice healthy living and to receive preventive treatments.
Preferred Provider OrganizationClients must pay a premium, deductible, and co-payments.
Clients do not have to choose a primary care physician.
Clients may visit non-network physicians, but coverage is greater with in-network physicians.
PPOs often have other fees and co-payments.
Point of ServiceClients must pay a premium.
Clients must chose a primary care physician.
For in-network physicians, there is usually no deductible and co-payments are low.
Specialists may be non-network physicians, but coverage may be limited
Government ProgramsIn the 20th century, the United States government began to realize the need for public medical assistance.
In 1965, President Lyndon B. Johnson instituted two medical assistance programs to help those without health insurance. MedicaidMedicare
MedicaidIncome or needs based program
Designed by the federal government, but administered by state governments
Usually includes individuals with low incomes, children who qualify for public assistance, and individuals who are blind or physically disabled.
MedicareProgram for any citizen age 65 or older
Administered by the federal government
After an individual pays a deductible, Medicare will cover 80% of all medical expenses.
Medicare ServicesPart A: Hospital CareHospitalizationSkilled nursing facilitiesHome health careHospice careLong-term care facilities
Part B: Outpatient ServicesMedical expenses, including therapy, medical equipment, and testingPreventive Care
Workers CompensationProvides treatment for workers injured on the jobAdministered by the stateReimburses the worker for wages lost because of on-the-job injury
TRICAREFormerly called CHAMPUS (the Civilian Health and Medical Programs for the Uniform Services) Administered by the federal governmentProvides 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 ReformTax-Related Health Provisions Application and Enforcement of Group Health Plan Requirements Revenue Offsets
Trends in Todays Health Care Systems
Advances in technologyEpidemiologyBio-ethicsSocioeconomicsComplementary (nontraditional) medicine
Organizational StructureAn tool designed to help a facility operate smoothly by outlining responsibilities
It describes the line of authority that establishes levels of responsibility and supervision