HEALTH CARE SYSTEMS

Health care systems include many agencies, facilities, and people involved in the delivery of health care.

Private facilities:

Require a fee for services. Some use grants and contributions to provide financial services.

TYPES OF FACILITIES1. Hospitals: may be private or proprietary (operated for profit),

non-profit or volunteer, religious or government; vary in size and services provided

2. Common types of hospitals

1. General Hospitals: treat a wide range of conditions and age groups (provide diagnostic, medical, surgical and emergency services.

2. Specialty Hospitals: provide care for only special conditions or age groups; examples: burn, cancer, pediatric, psychiatric, orthopedic or rehabilitation.

3. Government Hospitals: operated by federal, state or local government agencies; examples: VA (veterans administration)

4. University or college medical centers: provide hospital services along with research hospital services as well as research and education

Long-Term Care Facilities (LTC/LTCF): provide assistance and care for elderly patients (referred to as “residents”)

Types of LTCs:

Nursing Homes: provide basic physical and emotional care to individuals who can no longer care for themselves with activities of daily living (ADLs)

Extended care facilities or skilled care facilities: designed to provide skilled nursing care and rehabilitative care to prepare patients or residents for return to their homes.

Independent living and assisted living facilities:provide services such as meals, housekeeping, laundry transportation, social events, and basic medical care (assistance with medications)

Medical Offices: May be privately owned by one doctor to large corporations with several doctors. Services include diagnosis, treatment, examination, basic laboratory tests and minor surgeries.

Types of medical offices:

Pediatrics (infants and children)

Cardiology (diseases and disorders of the heart)

Obstetrics (care of pregnant female)

Dental Offices: Range from single dentist to clinics that hire a group of dentists. Provide dental care to all ages or specialized care to certain age groups or dental conditions.

Clinics or Satellite Centers: May be composed of a group of doctors or dentists who share the facility, others may by private and provide specialized care.

Types of Clinics:

Surgical Centers: perform minor surgeries (day surgeries)

Urgent or emergency care: first aid or emergency care

Rehabilitation clinics: offer physical, occupational, speech and other therapies

Types of Clinics Continued:

Specialty clinics: Diabetic or oncology

Outpatient clinics: provide care to outpatients

Health department clinics: pediatric health care, treatment of sexually transmitted diseases, immunizations, etc.

Medical center clinics: offer free or reduced charge treatment from medical students.

Optical Centers: can be individually owned or a part of a chain. Provide eye exams, prescribe glasses, etc.

Emergency Care Services: Provide care for accident victims or sudden illness.

Laboratories: may be part of the other facilities but can operate as separate health care services. Perform diagnostic tests, blood, urine, etc. Some labs perform dental services (dentures)

Home Health Care: agencies that provide care in the patient’s home.

Types of Home Care: Nursing, personal, therapy, homemaking.

Hospice: provide care for terminally ill

Mental Health Facilities: provide guidance and counseling, psychiatric clinics and hospitals, chemical abuse treatments, physical abuse treatment

Genetic Counseling Centers: Work with individuals or couples considering pregnancy. Provide prenatal screening, checking for abnormalities and birth defects, explaining test results, medical options, coping.

Rehabilitation Facilities: help patients with physical or mental disabilities obtain maximum self-care and function

Health Maintenance Organizations (HMO): provide for preventive care. HMOs are operated by large industries or corporations.

Industrial Health Care Centers: provide health care for employees.

School Health Services: found in schools and colleges. Provide emergency care, test for speech, vision, hearing problems & counseling.

GOVERNMENT AGENCIES

Tax supported agencies.

Examples:

1. World Health Organizations (WHO)- sponsored by the United Nations. Maintains information and statistics regarding diseases world-wide.

2. U.S. Department of Health and Human Services (USDHHS)-deals with health problems in the United States

3. National Institutes of Health-part of the USDHHS involved in research on disease.

4. Centers for Disease Control and Prevention (CDC)-part of the USDHHS, concerned with spread and control of disease.

5. Food and Drug Administration (FDA)- regulates food and drugs sold to public.

6. Agency for Health Care Policy and Research (AHCPR)- responsible for identify and implementing standards for health care

7. Occupational Safety and Health Administration (OSHA)-enforces standards that protect workers from job related injuries.

8. Health departments- provide health services directed by the USDHHS.

Voluntary and Nonprofit Agencies:

1. American Cancer Society

2. American Heart Association

3. American Diabetes Association

4. Many others

HEALTH INSURANCE PLANS

Terms to Know:

1. Deductible: amount the patient must pay for health care before the plan will pay.

2. Co-insurance: percentage shared by patient and insurance plan.

3. Co-payment: amount the patient pays for a service regardless of the total cost of the visit.

4. Health Maintenance Organization (HMO): a monthly fee or premium is paid for membership and the fee stays the same regardless of the amount of health care used.

5. Preferred Provider Organization (PPO): health plan provided by large companies to their employees. Restrict treatment to specific health care facilities.

6. Medicare: provides health care for almost all individuals over the age of 65.

7. Medicaid: usually provided for individuals with low income.

8. Workers’ Compensation: provides for treatment of workers injured on the job.

9. TRICARE: provides for care of military personnel.

10. Managed Care: Cost containment process that requires all health care provided must serve a purpose.

ORGANIZATIONAL STRUCTURE

All health care systems must have an organizational structure that includes a chain of command.