Transcript Unit 1 Health Care Systems

Unit 1 Health Care Systems
1:1 History of Health Care
 Beliefs and Developments
– Beliefs about health care from ancient to
current times
– Change in treatment of patients from ancient
to current times
– Major historical events from 4000 BC to
current century
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Future of Health Care
 When did most of the significant changes
in health care occur?
 Why were the greatest advances made in
this time period?
 What are some possibilities for the future
of health care?
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Summary
 Health care has seen many changes
over the centuries
 Future changes may be even
more dramatic
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1:2/1:3/1:4 Health Care
Systems
 Different Health Care Systems
– Private health care facilities
– Government agencies
– Voluntary or nonprofit agencies
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Trends in Health Care
 Growth – one of the largest and fastest
growing industries in the United States
 Employment opportunities – employs over
10 million workers in over 200 careers
 Expenditures – it is a two billion dollar per
day business and growing
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Types of Services
 Inpatient services
(e.g., hospitals, long-term care)
 Outpatient services
(e.g., clinics, provider offices)
 Specialty services
(e.g., laboratories, mental health)
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Health Care Facilities
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Hospitals
Long-term care facilities (LTC or LTCF)
Medical offices
Dental offices
Clinics
Optical centers
Emergency care services
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Health Care Facilities (continued)
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Laboratories
Home health care
Hospice agencies
Mental health facilities
Genetic counseling centers
Rehabilitation facilities
Health maintenance organizations (HMOs)
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Health Care Facilities (continued)
 Industrial health care centers or
occupational health clinics
 School health services
 Government agencies
 U.S. Department of Health and Human
Services (USDHHS)
 State and local departments
 Voluntary and nonprofit agencies
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Summary
 Many different types of health care
facilities
 Employ many types of health care workers
 Important to be aware of facilities and
type of services
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1:5 Health Insurance Plans
 Health care costs are rising faster than
other costs of living
 Most people rely on health insurance
plans to pay for health care costs
 Without insurance, the cost of an illness
can become a financial disaster
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Insurance Terminology
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Deductible
Co-insurance
Co-payment
Preferred provider
Monthly fee or premium
Managed care
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Types of Plans
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Health insurance plans
Health maintenance organizations (HMO)
Preferred provider organizations (PPO)
Medicare
Medicaid
Worker’s Compensation
U.S. government plans
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Summary
 Health insurance plans do not solve all the
problems of health care costs
 Do help many people pay for all or
part of cost
 Important for individuals to understand
what plan covers
 Also need understanding of co-insurance
and other restrictions plan may have
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1:6 Organizational Structure
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Line of authority or chain of command
Indicates areas of responsibility
Goal: most efficient operation of facility
Complex or simple structure determined
by size and needs of organization
 Sample organizational charts –
See Figure 1-4 and 1-5 in text
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Summary
 The line of authority must be clearly
indicated in any organizational structure
 Workers must identify and understand
their position in the organization structure
 To follow proper channels of
communication, workers must take
problems, reports, and questions to their
immediate supervisor
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1:7 Trends in Health Care
 Changes in Health Care
– Many events lead to changes in health care
– Changes in health care are inevitable and
occur rapidly
– Health care workers must be flexible
to face and keep pace with
the rapid changes
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Some Current Issues
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Cost containment
Home health care
Geriatric care
Telemedicine
Wellness
Alternative and complementary
health care
 National health care plans
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Cost Containment
 Purpose: control the rising cost of health
care and achieve maximum benefit for
every dollar spent
 Necessity: costs increasing with
technological advances, improved survival
rates, aging population, and lawsuits
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Cost Containment Methods
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Diagnostic related groups (DRGs)
Combination of services
Outpatient services
Mass or bulk purchasing
Early intervention and preventive services
Energy conservation
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Cost Containment Issues
 Important not to decrease quality of care
 Workers can decrease costs (e.g., look for
areas to control costs and avoid waste,
keep expenditures down)
 Consumers can decrease costs (e.g., take
responsibility for their own care, follow
preventative measures to decrease need
for services, use services appropriately)
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Home Health Care
 Industry grew rapidly when DRGs initiated
 Services provided in patient’s home
 Visits must be pre-authorized by insurance
agency (unless private pay)
 Often necessary to teach family members
to perform care since visits are limited
 Emphasis on cost containment also
applies to Home Health
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Geriatric Care
 Care for the elderly
 Percentage of elderly population
growing rapidly
 Need for more facilities
 Omnibus Budget Reconciliation Act
(OBRA) of 1987
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OBRA
 Federal law regarding long-term care and
home health care
 States must establish training and
competency evaluation programs for
nursing/geriatric assistants and maintain
registry of qualified individuals
 Requires compliance with patient’s/
resident’s rights
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Telemedicine
 Use of audio, video, and computers to
provide health care from a distance
 Interactive services are expected to grow
rapidly in the future
 Increases accessibility to
specialty information
 Decreases need for trip to medical center
 Decreases need for Home Health visits
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Wellness
 State of optimal health
 Increase awareness of maintaining health
and preventing disease
 Emphasis on preventative measures
rather than waiting for need for
curative intervention
 Different facilities will develop to meet
needs of wellness emphasis
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Promoting Wellness
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Physical wellness
Emotional wellness
Social wellness
Mental and intellectual wellness
Spiritual wellness
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Holistic Health
 Treat the whole body, mind, and spirit
 Each person is unique with different needs
 Use many methods of diagnosis
and treatment
 Emphasis on protection and restoration
 Promote body’s natural healing processes
 Patient responsible for choosing care and
worker respects the choice
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Alternative and Complementary
Methods of Treatment
 Increasingly used to replace or
supplement traditional medical treatment
 Holistic approach: belief that the effect on
one part effects the whole person
 Based on belief that the person has a life
force or energy that can be used in the
healing process
 May vary by cultural values or beliefs
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Types of Practitioners
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Ayurvedic
Chinese medicine
Chiropractors
Homeopaths
Hypnotists
Naturopaths
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Types of Therapies
 Refer to Table 1-2 in text
 Most are noninvasive and holistic
 Often less expensive than
traditional treatments
 Nonjudgmental attitude is essential –
patients have right to choose treatment
 Increased use requires increased
awareness by health care workers
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Office of Alternative Medicine
(OAM)
 Established in 1992 at the National
Institutes of Health (federal government)
 Purpose: research therapies and establish
standards of quality care
 Many states have passed laws
 Know your state’s law regarding the legal
requirements of alternative therapies
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National Health Care Plan
 Goal: ensure that all Americans can get
health coverage
 Various plan proposals
 Costs
 Potential problems
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Past, Present, and
Future Trends
 Advances in the past that impact
care today
 Current changes and challenges that are
changing the face of health care
 Projected discoveries that will change the
future of health care
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Summary
 Health care has changed and will continue
to change
 Workers must be constantly aware of
changes that occur
 Workers must make every attempt to learn
about trends
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