Transcript Health-Care Providers Structure/Operation

Health-Care Providers
Structure/Operation
Health-Care Facilities
• Primary Care
– General Practice
– General paediatrics
– Dental Care
– Visiting Nurses
• Secondary Care
– Ambulatory Specialists
• Tertiary Care
– Hospitals/Long Term Care Providers
General Practice
•
•
•
•
•
Population wide care
Registration
Prevention/Treatment
Social Role of Physician
Density per 1000 population
– CZ 0,7; Germany 0,65; Greece 0,28;
– Norway 0,81; Sweden 0,62; UK 0,79; USA 0.3
Challenges
• Aging population
• Changing competencies
– Nursing care
– Physiotherapy
• GP + Technology
Reimbursement
• Salaried GP
• Fee for service
• Capitation payment
Ambulatory Specialists
• Position
– Hospitalits
– Independent
• Reimbursement
– Salaried
– Fee for service
– Payment per case
Hospitals
Beds/1000 popul
Employee/bed
Nurse/bed
CZ
7,11
1,87
0,76
Germany
8,25
1,81
0,81
Netherlands
4,69
3,61
1,01
Norway
3,35
6,39
2,55
UK
3,34
6,45
NA
USA
3,08
6,25
2,27
Hospital structure
•
•
•
•
•
Local ( Internal medicine +)
Regional ( average 10 specialties)
University Hospitals
Special Hospitals
Ownership
–
–
–
–
State/Municipality
Church
Private non for profit
Private for profit
Hospital department
• Outpatient
– Acute
– Clinics
• Inpatient
– ICU – centralised/decentralised
– Standard wards
Director
CMO
CNO
Head of Dept.
Head Nurse –
Dept.
Ward Physician
Ward Sister
Physicians
Nurses/Porters
COO/CFO
Head
Therapists
Unit therapists
Outpatient Care
• No formal limitation to patients
• Low level of centralisation of Acute Care
• Time management
Hospital reimbursement
• Budgeting
• FFS
• Case mix - DRG
Long Term Care
Beds/1000
population
Beds/1000
seniors
Employees/
1000
population
Employees
/1000 seniors
Netherlands
6,5
10,3
10,4
43,3
50,3
68,5
3,6
7,8
11,7
2,4
3,8
7,7
Norway
UK
USA
9,3
8,8
5,4
62,9
55,4
41,9
19,2
NA
15,4
13
NA
11,9
CZ
Germany
Medical Records vs. Medical Students
•
•
•
•
Legal protection of contents – confidentiality
Only with the patient´s consent
Electronic/paper
Entries to be signed and confirmed by a
hospital employee
• High level of protection
– Patients ID (personal number)
– Dg + treatment
Infection Prevention
• Vaccination
• Clothing
• Hand Hygiene
– Hospital obliged to arrange
– Hand + stethoscopes
• Special situations
– Face masks
– Pregnant students
Hospital Security and Patient Safety
•
•
•
•
Individual badges
Doors
Awareness – strangers
Special precautions
– Psychiatry
– Paediatrics, neonatology
– Infectious diseases