Transcript Accessing Reliable Health Care - Warren Hills Regional School

Accessing Reliable Health Care
Why is it important to access Reliable
health Care?
When you are sick or injured you may need immediate
help!
Knowing where to get medical help!
How to pay for it can save time, hassle, stress, &
money.
What to Know about Health-Care Practitioners
and Providers
Health-Care Provider-trained professional who provides people with medical
care.
Physician- an independent health-care provider who is licensed to practice
medicine.
Physician’s Job Description- obtain medical histories, perform physical
examinations, give diagnoses & licensed to prescribe medications (some
physicians are licensed to perform surgery).
Two Types of Physicians
Medical Doctor (M.D.)- is a physician who is
trained in a medical school and has a medical
doctoral degree (can choose to work in primary
care or specialist area)
Doctor of Osteopathy (D.O.)- is a physician who is
trained in a school of osteopathy and has a doctor
of osteopathy degree (can choose to work in
primary care or specialist area).
Medical Terminology
Osteopathy- uses common
medical procedures, but
also places emphasis on
the relationships between
body systems. (These
doctors “osteopaths” are
trained that the body
systems are all connected
and if one system is
disturbed it can affect other
systems.
Medical Terminology
Primary Care- is
general health care.
The first health care
provider that a patient
contacts is the
primary physician to
provide basic care.
Also, primary care
physicians can refer
patients to specialists.
Medical Terminology
Specialist- is a professional who has
specialized training in a particular area.
(Two-thirds of physicians are specialists)
Health-Care Practitioners-an independent
health-care provider who is licensed to provide
general or specialized care for a specific area of
the body.
Podiatrist- a doctor of Podiatric Medicine (DPM) who specializes in
the care and treatment of feet.
Optometrist- is an eye care professional who is specially trained in a
school of Optometry. This doctor can examine eyes and prescribe
corrective lenses or exercise for a patient with eye problems.
Dentist- is a doctor of Dental Surgery (DDS) or doctor of Medical
Dentistry (DMD) who specialized in the care and treatment of the
teeth and mouth.
Allied PRofessional- is a trained health-care
provider who practices under the supervision of
a physician or health-care practitioner.
i.e. Audiologists, dental hygienists, pharmacists,
physical therapists and radiologists.
Choosing Health-Care Providers
Check telephone book (Health-Care Providers)
listed in yellow pages of telephone directory.
Check local chapters such as the American Medical
Association (AMA), and the America Dental
Association (ADA), which keep lists of their
members.
Inquire Hospitals- have lists of physicians
recommended/or offer other recommendations.
Primary-care Physician
To choose primary-care physician
who will provide basic medical
care and help prevent illness.
Family Practitioners, Pediatricians,
Internists
Should be familiar with patient’s
medical history/health-care needs.
May refer patient to a specialist if
further diagnosis or treatment
needed.
Health Insurance!!!!
Health Insurance- financial
protection that provides benefits
for sickness or injury.
1st Patient buys insurance.
2nd Health Provider- agrees to
pay or reimburse the cost of care
3rd Insurance Provider- predicts
that they will collect more money
in premiums than it will pay out in
claims.
Health Insurance Terminology
Premium- amount paid for the insurance coverage
Claim- is a bill from the health-care provider.
Insurance Policy- is a legal document that outlines the
terms of the insurance coverage.
Deductible- is the amount that must be paid by the
individual before the insurance pays the claims.
Co-payment-is the portion of the medical fee the
individual must pay whether or not there is a deductible.
* Private Insurance Policies must be paid by the
individual, or the employer , or even both parties (some
pay entire cost of medical, others pay a portion).
Managed Care- control the types of health care
individuals receive and the amount paid for care.
TWO TYPES OF MANAGED CARE
1. Health Maintenance Organizations
(HMOs)2. Preferred Provider
Organizations (PPOs)
Health Maintenance Organization- a
business that organizes health care
services for its members.
Try to provide lowest cost
Except for an emergency or with approval
Only covers services from the HMO
HMOs encourage preventive health care
Preferred Provider Organization- a business that
has a contract with a group of health-care
providers who agree to provide services at a
reduced rate.
Individuals must select preferred providers/ or
pay higher cost for health services
Government Insurance
Medicare-insurance for people 65 years and
older. Also, for individuals who received social
security disability benefits for two or more
years.
Medicaid- insurance for people with low
incomes.
Two Kinds of Expenses
Covered Expense- is a medical expense that
is paid for under the terms of a health
insurance plan.
Excluded Expense- is a medical expense that
a health insurance plan will not pay.
Recommendations for Evaluating
Health Insurance
Study health insurance carefully by looking at terms and conditions such as what
is covered and not covered!!!
Shop around for health insurance and ask questions!!!
Choose a plan that is the most comprehensive coverage ad is affordable!
Pre-existing Conditions- is a health problem that a person had before being
covered by the insurance.
Some insurance providers will not sell you insurance if you have any disabilities
or pre-existing conditions (considered high risk)!
Make Yourself Insurable!!!
Get routine check-up/immunizations
Learn to do breast or testicular self-exams
Get plenty of rest. sleep, and physical activity
Eat appropriate amounts of healthy foods, limit amount if sugar, sodium intake,
avoid drugs, alcohol, and tobacco
Control stress, drive safely and wear a seatbelt
More than 40 million people in the U.S. do not have
health insurance. Therefore, in case of an emergency, it
can become very expensive to seek treatment in a
hospital emergency room or trauma center.
Living without Health Insurance
Life transitions: new job, self-employment,
unemployment, marriage, divorce, or graduation
from college (could affect your health insurance)
Being Uninsured May Not Be a Matter of Choice
Expensive Health Insurance Premiums
Be eligible for Health Insurance
Unemployment
Rising Health-Care costs(difficult for employers to
offer)
Chronic Health conditions/not eligible (high-risk
category)
Group Health Insurance
Self-employed: trade groups, labor unions,
associations, chambers of commerce, or other
groups that offer health insurance programs.
Some states offer health insurance pools for people
with certain chronic diseases, agriculture workers,
asbestos removal workers and scuba divers.
27.3% of ages 18-24 years old are uninsured
Children’s Health Insurance Program (CHIP)
created in 1997
Short-Term Health Insurance Policies
People temporarily out of work and looking for a job
Maximum 6 months and is renewable for one time
Plan to leave a job may convert group plan to
individual plan.
Consolidated Omnibus Budget Reconciliation
Act (COBRA)- gives worker’s the right to continue
their employer’s health benefits for limited period of
time because of job loss, reduction in hours
worked, death, divorce, or other life events.
Health-Care Facilities
Location of Facility
Hours
Services Provided
Fees they charge
What To Know About Health-Care Facilities
Hospital- is a healthcare facility where people can
receive medical care, diagnosis, and treatment in
an inpatient or outpatient center.
Inpatient Center- is treatment that requires a
person to stay overnight at a facility.
Outpatient Center- is treatment that does not
require a person to stay over night at a facility.
Ambulatory Surgery Center- facility where
surgery is performed on an outpatient basis. (health
insurance recommend outpatient surgery/care
because it is one-third less cost than inpatient care.
Urgent-Care Centers
Do not need an appointment for these
centers
Fees are less than hospital emergency
rooms
Physician’s Office
Physician’s Office- facility that provides
routine health care. i.e. diagnosis, simple
testing, treatments, examinations or minor
surgeries. (nurse, practitioners and
physician’s assistants)
Types of Hospitals
Private Hospital- owned by private
individuals
Voluntary Hospitals- owned by
community/organization (does not operate
by profit)
Government- operated by federal, state, or
local government through the benefit of a
special populations. i.e. Veterans
Administration
Health Centers
Health Center- facility that provides routine
health care to a special population. i.e. low
income families.
Mental Health Clinic- facility that provides
services for people who have mental
disorders. (majority of mental health clinics
are open 24 hours).
Laboratories
Laboratories- these are medical laboratories
that perform diagnostic test, such as blood
or urine tests. (also can be part of hospitals)
i.e. Dental Laboratories-make crowns, or
bridges used to repair teeth.
Extended-Care Facility
Extended-Care Facility- facility that
provides nursing, personal and residential
care
People who need assistance with daily
living
Examples are nursing homes and
convalescent homes
Home-Health Care Organizations offer
nursing care, medical treatment, and
therapy in the home.
Home-Health Care
Home-Health Care- agencies that provide
care in a patient’s home. Services: nursing,
rehabilitation therapy, bathing,
housekeeping, and food preparation.
Who offers Home-Health Care?
Health Departments, Hospitals,
Private Agencies and Volunteer
Groups
Hospice
Hospice- is a care for the terminally ill and their
families. (In-Home Care)
Provides 24 hour service, contact, and
support continues for at least one year
after a family member dies.