Health Care SystemsHealth Science

Unit 2

KWL Chart

• Fill in the Know part of your chart

What do we know about the US Health Care system?

• It is the best?• Is the most or least expensive?• How does it compare to other countries?

US Ranking

• The U.S. healthcare system ranks last among 11 developed countries, according to a new study by the Commonwealth Fund.

• The Affordable Care Act may make the U.S. healthcare system better, but it's still got far to go

• The U.S. healthcare system notched another dubious honor in a new comparison of its quality to the systems of 10 other developed countries: its rank was dead last.

Affordable Care Act

• The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or "Obamacare", is a United States federal statute signed into law by President Barack Obama on March 23, 2010.

What does the ACA do?

• attempts to reform the healthcare system by providing more Americans with affordable quality health insurance

• Reforms by curbing the growth in healthcare spending in the U.S.. • Reforms include• new benefits, • rights and protections, • rules for insurance companies, • taxes, • tax breaks, • funding, • spending, • the creation of committees,• education, • new job creation and more.

Will the reform help?

• With enactment of health reform, the U.S. should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.

• America's healthcare spending is way out of line with other developed countries.

The good news…

• The good news in the Commonwealth Fund report is that some of the factors driving the U.S. rank into the cellar are beginning to change, due in part to the Affordable Care Act and provisions of the post-2008 stimulus plan, which encouraged the adoption of health information technology by doctors and hospitals.

Insurance termilogy

• Match the term with the definiton

Managed Care Facility

• Goal is to provide quality care at manageable price• Facilities included:• Preventative care• Physicals, immunizations, health ed programs

• Primary care providers• Family doctors

• Specialty care• Treat one type of problem• Ex. Orthopedics- specialty of correcting skeletal system

• Emergency care• Life threatening conditions

Ambulatory Care Facilities

• Ambulate- means to walk• Define ambulatory care- care that keeps patients at home as much as possible.• Facilities include- rehabilitation centers, outpatient surgery, out patient clinics, physicians offices, day care.• What does outpatient mean?

Specialty Care Facilities

• Includes podiatry, neurology,

orthopedics, etc. • Orthopedics- treating and

correcting skeletal system.

Other Types of Care Facilities

• Convalescent-Normally engage in geriatric care • Geriatric- medicine that deals with diseases of old age and

aging people

• Extended Care- designed to help those who need help with daily living • Ex. someone with Alzheimer's who needs care for the rest

of their life

DRG’s

• 1983 legislation was passed to regulate the price of medical care.

• Legislation Led to DRG’s or Diagnostic Related Groups• Grouping of medical conditions, the reasonable cost for each, and

its standard treatment by legislation.

• Help reduce unnecessary procedures and encourage self care to reduce medical costs

• How will this change the future of health care?

Chain Of Command

• tells you who to take questions, reports, and problems to.

• Successful way to find solutions to problems

Public Health Services(taken directly of US Public Health Service Website)

• U.S. Department of Health and Human Services• The mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and

advance the health and safety of our Nation. As America's uniformed service of public health professionals, the Commissioned Corps achieves its mission through:

• Rapid and effective response to public health needs• Leadership and excellence in public health practices• Advancement of public health science• The core values of the Commissioned Corps are: • Leadership • Provides vision and purpose in public health through inspiration, dedication, and loyalty. • Service • Demonstrates a commitment to public health through compassionate actions and stewardship of time,

resources, and talents. • Integrity • Exemplifies uncompromising ethical conduct and maintains the highest standards of responsibility

and accountability. • Excellence • Exhibits superior performance and continues improvement in knowledge and expertise.

Roles of Public Health Dept.

• researches diseases• prevent alcohol and drug abuse • safety of food and drugs• control diseases from plants, animals, and insects• make medical care affordable.

Government Agencies

• Funded by taxes• Responsible for:• giving direct healthcare • Safeguarding food and water supplies• Promoting health education

• Examples: • National Insitiute of Health/NIH- medical research, • Food and Drug Admin./ FDA- ensures safety of food and drugs,• Center of Disease Control- disease outbreak• OSHA- prevents medical mishaps in the workplace.

Cool facts

• FDA- (food)• FDA is responsible for regulating the safety of four-fifths of

the nation’s food supply;• FDA-regulated imported food products come from more

than 300,000 foreign facilities located in 200 countries;

Cool Facts

• CDC• During an hour's swimming at a municipal pool you will ingest

1/12 liter of urine.    An average person's yearly fast food intake will contain 12 body hairs.   In a year you will have swallowed 14 insects - while you slept!

Insurance

• What is Insurance?• Why do we need or want insurance?• Is insurance required?

form of risk managementOwn a home, because mortgage lenders need to know your home is protectedDrive vehicles, because few people could afford the repairs, health care costs and legal expenses associated with collisions and injuries without coverageMaintain your current standard of living if you become disabled or have a critical illnessCover health care costs like prescription drugs, dental care, vision care and other health-related itemsProvide for your family in the event of a death For the most part yes. Car insurance is required, other insurances are on a buy at your own risk poilcy.

Types of Governement Issued Insurance

• Medicare- Healthcare provided to people over the age of 65. • Has a premium that requires a periodic payment for

healthcare or prescription drugs

• Medicaid- The health insurance provided by the state and government for disabled, blind, and people on welfare.• Benefits and eligibility are different in each state

• Tricare- Health care program for active duty service members, retirees, and their families.

Mathematics of Insurance

• Co insurance- a negotiated set percentage of a medical bill you split with your insurance company. • Step 1- convert % to a decimal

Ex. 20%= .20• Step 2- multiply decimal by the amount of the full

medical bill.

Ex. .20 multiplied by $982= 147.30

Medical Math

• Learn to change percent to decimals• Learn to change decimals to percent • Learn to multiply decimals.

Comparing HMO to a PPO

• HMO• Has a network of

doctors• Required to use

network• WILL NOT cover out

of network expenses

• PPO• Has a network of

doctors• Preferred but not

required to use network

• WILL cover out of network expenses, you just pay a larger fee.

Insurance vocab you need to know

• Deductible- the amount of money you must pay before the insurance company will cover you.

• Premium- a set amount of money paid to insurance company • Copay- a designated payment made for each clinical visit

• Benefits- payments and assistance based on agreement

• Workers compensation- covered by this insurance if you are hurt or injured at work.• Employer must provide Workers Comp!

Non Profit Organizations

NPO’s do not get government funding. They are able to do work through donations, and unpaid volunteers.

Oganization In Health Care

• 4 major categories

• Therapeutic- provide care over time• Diagnostic- used to id particular condition• Informational- document and process info• Environmental- help create a relaxing healing and

supportive environment

Theraputic

Diagnostic

Environmental

Informational