Transcript DHO_Chapter02.ppt

Chapter 2
Health Care Systems
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2:1 Private Health Care Facilities
• Growth—one of the largest and fastest
growing industries in the United States
• Employment opportunities—employs over
13 million workers in over 200 careers
• Expenditures—it is a four-billion-dollarper-day business and growing
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Private Health Care Facilities
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Hospitals
Long-term care facilities (LTC or LTCF)
Independent living and assisted living
Medical offices
Dental offices
Clinics or satellite centers
Optical centers
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Private Health Care Facilities
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Emergency care services
Laboratories
Home health care
Hospice agencies
Mental health facilities
Genetic counseling centers
Rehabilitation facilities
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Private Health Care Facilities
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• Health maintenance organizations (HMOs)
• Industrial health care centers or occupational
health clinics
• School health services
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2:2 Government Agencies
• Government services are tax supported
• World Health Organization (WHO)
• U.S. Department of Health and Human
Services (USDHHS)
• National Institutes of Health (NIH)
• Centers for Disease Control and Prevention
(CDC)
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Government Agencies
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• Food and Drug Administration (FDA)
• Agency for Health Care Policy and Research
(AHCPR)
• Occupational Safety and Health
Administration (OSHA)
• Health Departments
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2:3 Voluntary or Nonprofit Agencies
• Supported by donations, membership fees,
fundraisers and grants
• Health services are provided at national,
state, and local levels
• Examples include the American Cancer
Society, March of Dimes, American Red
Cross and many more
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Voluntary or Nonprofit Agencies
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Organizations focus on specific diseases
Educate the public
Provide special services
Purchase medical equipment
Staffed by many health care workers
and volunteers
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2:4 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
• Deductible – a specified amount of money
that the insured must pay before an insurance
company will pay a claim.
• Co-insurance – a type of insurance in which
the insured pays a share of the payment made
against a claim.
• Co-payment – a payment made by the
beneficiary (patient) in addition to that made
by an insurer.
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Types of Plans
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Health insurance plans
Health maintenance organization (HMO)
Preferred provider organization (PPO)
Medicare
Medigap
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Types of Plans
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• Medicaid
• The State Children’s Health Insurance
Program (SCHIP)
• Worker’s Compensation
• U.S. government plans for all military
personnel and their families
• Managed care plans
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HIPAA
• HIPAA – Health Insurance Portability &
Accountability Act
• Five components
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Health care access
Preventing health care fraud
Tax-related health provisions
Application and enforcement of group health
plan requirements
– Revenue offsets
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2:5 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 2-4 and 2-5 in text)
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Organizational Structure
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• The line of authority must be clearly
indicated in any organizational structure
• Workers must identify and understand their
position in the structure
• To follow proper channels of
communication, workers must take problems,
reports, and questions to their immediate
supervisor
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QUESTIONS???
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