Health Care Systems

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Health Care Systems

• Private Health Care Facilities

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Private Health Care Facilities

• Health care systems include the many agencies,
  facilities, and personnel involved in the
  delivery of health care.
• According to the U.S. Government, health care is
  one of the largest and fastest-growing industries
  in the United States.
• Most private health care facilities require a fee
  for services.

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Types of Facilities

• Hospitals
• Long term care facilities
• Medical Offices
• Dental Offices
• Clinics
• Optical Centers
• Emergency Care Centers
• Laboratories
• Home Health Care
• Hospice
• Mental Health
• Genetic Counseling Centers
• Rehabilitation
• Health Maintenance Organizations (HMOs)
• Industry Health Care Centers
• School Health Services

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Hospitals

• One of the major types of health care facilities.
• Vary in size and types of services provided.
• Some are small and serve the basic need of a
  community others are large, complex centers
  offering a wide range of services including
  diagnosis, treatment, education and research.

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Hospitals (Contd)

• Classified as private or proprietary (operated
  for profit), religious, nonprofit, and
  government.
• Some are general hospitals treating a wide range
  of conditions others are specialty caring for
  only special conditions or age groups.

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Examples of Specialty Hospitals

• Burn Hospitals
• Pediatric Hospitals (or Childrens)
• Psychiatric Hospitals
• Oncology (cancer) Hospitals

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Other Types of Hospitals

• Government- operated by federal, state, and local
  government agencies.
• Ex. Veterans Administration hospitals, state
  psychiatric hospitals
• College or University Hospitals provides services
  along with research and education.

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Long-term care facilities

• Provide assistance and care for elderly patients,
  individuals with disabilities or handicaps, and
  individuals with chronic or long term illness.
• Some facilities are called nursing homes or
  geriatric homes.
• These are designed to provide basic physical and
  emotional care to individuals who can no longer
  care for themselves.

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Other Long term care facilities

• Extended care facilities or skilled care
  facilities these are designed to provide
  skilled nursing care and rehabilitative care to
  prepare patients for return to home environments
  or other long-term care facilities.
• Independent living and assisted living- allow
  individuals who can care for themselves, but
  services such as meals, housekeeping, laundry,
  transportation, and basic medical care, are
  provided.

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LTCs contd.

• Most assisted or independent living facilities
  are associated with nursing homes, extended care
  facilities, and/or skilled care facilities.
• The need for long-term care facilities has
  increased dramatically b/c of the large increase
  in the number of elderly people.
• Therefore, many health career opportunities are
  available in these facilities.

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Medical Offices

• Vary from offices that are privately owned by
  only 1 doctor to large complexes that operates
  corporations and employ many doctors and other
  health care professionals.

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Medical Offices

• Some Medical Doctors treat a wide variety of
  illnesses and age groups (ie Family Practitioner,
  General Practitioner, Primary Care Physician)
• Others specialize in and handle only certain age
  groups or conditions (ie Pediatrics (infant and
  children) Nephrologists (Kidney) Oncologist
  (cancer)).

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Medical Offices contd

• Some medical services obtained in these
  facilities
• Diagnosis-determining the nature of an illness
• Treatment
• Examination
• Basic Laboratory testing
• Minor surgery

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Dental Offices

• Vary in size from offices that are privately
  owned by 1 or more dentists to dental clinics
  that employ a number of dentists.
• Dental services can include general care provided
  to all age groups or specialized care offered
  only to certain age groups or dental conditions

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Clinics

• Aka satellite clinics or centers
• Composed of a group of medical or dental doctors
  who share a facility.
• Examples include Surgical Centers (minor surgical
  procedures), urgent care, rehabilitation.
• Health Departments offer- pediatric health care,
  treatment for sexually transmitted diseases and
  respiratory diseases (Tuberculosis)
  immunizations, and other special services.

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Optical Centers

• Individually owned by ophthalmologist (Medical
  Doctor) or optometrist (licensed, nonmedical
  practitioner).
• Or part of a large chain of stores.
• Provide vision examinations, prescribe eyeglasses
  or contact lenses, and check for presence of eye
  diseases.

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Emergency Care Services

• Provide special care for victims of accidents or
  sudden illness.
• Facilities Ambulance Services (both private and
  governmental) emergency care clinics, emergency
  rooms operated by hospitals and helicopter or
  airplane emergency medical services

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Laboratories

• Often these are part of other facilities but can
  operate as separate health care services.
• Laboratories perform special diagnostic tests
  such as blood and urine tests.
• Dental Laboratories can prepare dentures (false
  teeth) and other devices used to repair teeth.

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Home Health Care

• Agencies that provide care in the patients home.
• Frequently used by the elderly and disabled.
• Examples of services include, nursing care,
  personal care, therapy (physical, occupational,
  speech etc).

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Hospice

• Agency that provides care for the terminally ill
  (persons with life expectancies of 6 mos or
  less).
• Provided in patients home or hospice facility.
• Main goal is to make patient comfortable, so it
  increase their quality of life. Allowing a that
  pt to die with dignity and comfort.

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Mental Health

• Facilities that treat pts w/ mental disorders
  and diseases.
• Examples guidance and counseling centers,
  psychiatric clinics and hospitals, chemical abuse
  treatment centers (dealing w/ drug and alcohol
  abuse)

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Genetic Counseling Centers

• Independent facilities or shared facility
• Works with couples or individuals who are
  pregnant or trying to get pregnant.
• Perform prenatal screening tests, check for
  genetic abnormalities and birth defects, explain
  the results of the tests, identify medical
  options when birth defects are present.

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Rehabilitation

• Facilities located in hospitals, clinics, and/or
  private centers.
• Provide care for to help pt w/ physical or mental
  disabilities obtain maximum self-care and
  function.
• Services include physical, occupational,
  recreational, speech, and hearing therapy

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Health Maintenance Organizations (HMOs)

• Provide total health care directed toward
  preventative health care.
• Includes examinations, basic medical services,
  health education, and hospitalization.
• Some operated by large industries or
  corporations others private agencies.

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Industrial Health Care Centers

• Occupational health clinics found in large
  companies.
• Provide health care for employees of the industry
  or business.

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School Health Services

• Found in schools or colleges
• Provide emergency care for victims of accidents,
  sudden illness perform tests to check for health
  conditions such as speech, hearing problems they
  promote health education and maintain a safe and
  sanitary school enviornment.

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INFORMATION

• Government Agencies
• World Health Organization (WHO)- an international
  agency sponsored by the United Nations.
• Compiles statistics and information on disease
• Publishes health information
• Investigates and addresses serious health
  problems throughout the world

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Govt Agencies Contd.

• II. U.S. Department of Health and Human Services
  (USDHHS)- a national agency that deals with the
  health problems in the United States.
• a.) National Institutes of Health (NIH)-
  involved in research of disease.
• b.) Centers for Disease Control and Prevention
  (CDC)- concerned with causes, spread, and control
  of diseases in populations .

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USDHHS contd

• c.) Food and Drug Administration (FDA)- a federal
  agency responsible for regulating food and drug
  products sold to the public
• d.) Agency for Health Care Policy and Research
  (AHCPR)- a federal agency established in 1990 to
  research the quality of health care delivery and
  identify the standards of treatment that should
  be provided by health care facilities.
• e.) Occupational Safety and Health Administration
  (OSHA)- establishes and enforces standards that
  protect workers from job-related injuries and
  illnesses.

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USDHHS contd

• f.) Health Departments- (state and local county
  and city) provides health services directed by
  the USDHHS and also provides specific services
  needed by the state or local community.
• -Examples- immunizations, inspections for
  environmental health and sanitation, communicable
  disease control, collection of statistics, health
  education

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Voluntary or Nonprofit Agencies

• Supported by donations, membership fees,
  fundraisers, and federal or state grants.
• examples American Cancer Society, American Heart
  Association, March of Dimes, American Red Cross
• Many organizations focus on one specific disease
  or group of diseases.

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Health Insurance Plans

• Offered by several thousand insurance companies.
• The amount of payment and the types of services
  covered vary from plan to plan.
• Deductibles- are amounts that must be paid by the
  patient for medical services BEFORE the policy
  begins to pay.

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Health Insurance Plan cont

• Co-insurance- requires that a specific percentage
  of your expenses are shared by the pt and
  insurance company.
• Co-payment- a specific amount of money a pt pays
  for a particular service, paid at time of service
  regardless of the total cost of the visit.

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Health Ins contd

• HMO- another type of health ins plan- monthly fee
  is paid for membership, fee stays the same
  regardless of cost of services. Total care
  provided is directed towards preventative type
  health care.
• good bc most other ins plans do not cover
  preventative care
• Bad bc insured required to use only HMO
  affiliated providers.

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Health Insurance Plan contd

• Preferred Provider Organization (PPO)- another
  type of health ins plan usually provided by large
  industries or companies to their employees.
• Industry contracts w/ certain health care
  agencies, and employees are restricted to using
  these specific agencies, but provided at a lower
  cost.

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Health Insurance contd

• Medicare- a federal Gov't program, providing
  health care to individuals 65 years or older, or
  any person w/ a disability who has received
  social security benefits for at least 2 years.
• 2 types of coverage
• Type A- hospital insurance
• Type B- medical insurance
• Individual does pay a premium for type B and also
  an initial deductible for services

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Health Insurance contd

• Medicaid- operated by individual states- usually
  for people with low incomes, children who qualify
  for public assistance, and individuals who are
  physically disabled or blind.
• State Childrens health insurance plan- (SCHIP)-
  provides health care to uninsured children of
  working families who earn too little for private
  insurance but too much for Medicaid.

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Health Insurance Plan contd

• Workers Compensation- provides treatment for
  workers injured on the job. It also reimburses
  the worker for wages lost b/c of on-the-job
  injury.
• TRICARE (formerly called CHAMPUS)- provides care
  for active duty members and their families,
  survivors of military personnel, and retired
  members of the armed forces.

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Organizational Structure

• Organizational structure always encompasses a
  line of authority or chain of command. It should
  indicate areas of responsibility and lead to the
  most efficient operation of the facility.
• It is important for health care workers to
  identify and understand their respective
  positions in a given facilitys organizational
  structure.

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Organizational Structure contd

• Health care workers must always take questions,
  reports, and problems to their immediate
  supervisors, who are responsible for providing
  necessary assistance.
• It is also important for health care workers to
  understand the functions and goal of the
  organization.