Making Health Care Decisions

B. Lee GreenTexas A&M University

Objectives• Describe the role of information in making

decisions about health care• Identify high-quality sources of health

information, including reputable hotlines and internet sites

• Describe five advertising techniques used to promote health products and services

• Recognize quackery and health fraud and cite examples of each

• Learn how to employ several strategies when selecting a physician

Objectives• Identify a range of alternative and

complementary health care providers• Recognize the difference between primary,

secondary, and tertiary care and acknowledge your own and your physician’s responsibilities in regard to each form of health care

• Understand the advantages and disadvantages of traditional indemnity plans, HMO and preferred provider organizations

• Differentiate between prescription and over the counter drugs

• Understand the steps to take before taking a natural product as medicine

Buying Health Care: How Do Consumers Make Decisions?

• Decision Making and Accurate Health Information• Patient Package Insert: an information

sheet, required by the FDA, that warns the consumer of possible contraindications for use of a drug or medical product.

• Contraindications are circumstances that make use of a pharmaceutical or medical product inadvisable.

Making Health Care Decisions

Table 16.1

Making Health Care Decisions

Table 16.2

Buying Health Care: How Do Consumers Make Decisions?

• Advertising Health Care• Approaches to advertising:

• Scientific Studies• Bandwagon Approach• Testimonials• Emotional Appeals• Comparison with other Products• Price Appeal

Buying Health Care: How Do Consumers Make Decisions?

• Health Fraud• Quackery is a health claim made for a

product or service that cannot be justified by scientifically derived evidence.

• Placebo: a look-alike pill with no therapeutic value.

How to Choose Health Care Providers

• The Right Physician for You

Table 16.3.1

How to Choose Health Care Providers (cont'd.)

Table 16.3.2

How to Choose Health Care Providers• Complementary and Alternative

Health Providers• Naturopaths are the general

practitioners of alternative medicine

• Selecting a Health Care Provider• Referral from current physician• Referral from student health center• Ask a nurse if they would recommend a

physician.• Referral from a friend

How to Choose Health Care Providers• When to Go to the Hospital

• Primary Care: routine medical care provided by a physician in the office or at an emergency room in a hospital or clinic.

• Outpatient Care: care provided in a physician’s office, emergency room, or ambulatory clinic that does not involve hospitalization or overnight stays.

• Secondary Care: care involving surgery and nonroutine medical treatment, usually delivered in a hospital.

• Inpatient Care: health care provided in a hospital.

How to Choose Health Care Providers

• When You Go to the Hospital• Tertiary Care: special medical

procedures, such as open-heart surgery and transplants, performed at medical school hospitals or at large regional hospitals.

• Preadmission Certification: approval from a health plan of the need for inpatient hospital care prior to the actual admission.

How to Choose Health Care Providers

• When You Go to the Hospital

Figure 16.1

Paying For Health Care

• Uninsured: having no health insurance.

• Underinsured: having limited health insurance that compromises one’s access to health care services and places one at significant financial risk.

• Medicare is coverage for people over age 65.

• Medicaid is coverage for people of low income or who are disabled.

Paying For Health Care

• Indemnity (Fee-for-Service) Plans• Indemnity (Fee-for-Service) Plan:

insurance coverage in which a person pays for most of his or her medical bills and then files a claim to be reimbursed.

Paying For Health Care

• Managed Care Plans• Health Maintenance Organizations

(HMOs): prepaid plans that offer a defined set of benefits according to a predetermined monthly premium.

• Point-of-Service Plans (POS): HMOs having an indemnity-type option that lets members get care from physicians outside the plan’s network.

• Preferred Provider Organizations (PPO): a hybrid form of insurance that merges features of traditional fee-for-service insurance and prepaid plans.

Paying For Health Care

• Asking Questions about a Health Plan• What type of coverage do you need? • How do you feel about your choice of

physicians or hospitals?• What is the plan’s policy on special areas

of coverage?• When does coverage take effect?• Overall, does this plan meet your needs?

Drugs and Natural Products as Medicine

• Prescription Drugs are drugs ordered specifically for a person by his or her physician and filled by a registered pharmacist.

• Over-the-Counter (OTC) Drugs are drugs purchased without a prescription.

• Generic Drugs have the same active chemical ingredients as brand name drugs.

Drugs and Natural Products as Medicine• The Correct Way to Take Medications

• Five questions to ask when given a new medication:• What is the name of the drug and what is it

supposed to do?• How and when do I take it, and when do I stop

taking it?• What food, drinks, other drugs, or activities

should I avoid?• What are the side effects, and what should I

do if they occur?• Is there any written information available

about the drug?

Drugs and Natural Products as Medicine

• The Correct Way to Take

Medications

Figure 16.2

Concluding thoughts

• You are responsible for your health• Common sense• Health skills• Healthy behaviors