Transcript Health care industry employees over 14 million people in over 200

Health care industry employees over
14 million people in over 200
different health careers.
It is a 2-billion-dollar-a-day business.
TYPES OF HEALTH CARE FACILITIES
Hospitals: classified as to source of funding
1. Private—operated for profit
2. Religious
3. Non-profit or voluntary
4. Government:tax monies and or pt. fees
Government Hospitals
• Operated by federal, state and local govt
agencies
• World wide facilities for govt service
personnel and their dependents
• Veteran’s hospitals
• State psychiatric hospitals
• State rehab centers
*General Hospitals: treat a wide range of
conditions
*Specialty Hospitals: treat special
conditions such as oncology, burn, pediatrics, psychiatry,
maternal, rehab.
Long-Term Care
Facilities (LTC)
Cares mostly for elderly. Also cares for
any age people with disabilities or
handicaps ; people with chronic or long
term illness.
Nursing homes
• Provide basic physical and emotional care
• Usually for persons who can’t care for
themselves
• Help with ADL’s-activities of daily living.
Independent Living and
Assisted Living Facilities
Person rents or purchases apartment.
Services provided include meals,
housekeeping, laundry, transportation, social
events and basic medical care.
Medical Offices offer
examinations, basic lab testing,
minor surgery. Some are
generalists; some
are specialists.
Clinics may be operated
by individual doctors or
groups. They may
provide general care or
specialized care such as
pediatrics, STD’s,
diabetes care, oncology,
respiratory care.
Dental offices vary in size from
offices that are privately
owned by one or more
dentists to dental clinics that
employ a number of dentists.
Services range from general
to specialized care.
Optical centers can be
individually owned by
ophthalmologists (M.D.)
or optometrists (B.S./
M.S.). They provide
vision exams, prescribe
eyewear and check for
diseases.
Emergency care services
EMS cares for victims of
accidents or illness.
Ambulances, rescue
squads (frequently
operated by fire
department), emergency
clinics, helicopter and air
ambulances provide
services.
Air Medical
Support
Laboratories
Laboratories may be attached to a clinic or free standing. They perform a
variety of diagnostic tests such as blood, urine and sputum.
Dental laboratories can prepare dentures and
artificial support appliances for teeth.
Home Health Care
Services provided by home
health care include nursing,
personal care, therapies
including physical, respiratory, &
speech. Services may be
provided by hospitals, health
depts., government agencies, &
nonprofit volunteer agencies
Hospice is care for terminally ill patients that
have a life expectancy of 6 months or less.
Services may be
provided at
home…
or in a long
term care
facility.
Perinatal Hospice
When a life-threatening condition is diagnosed prior to birth, Perinatal
hospice services are provided to families. The family has support from
physicians, nurses, social workers, ministers, and nutritionists trained to help
plan for the time from birth to the death of the newborn.
Mental health
Mental health facilities provide services for mental disorders and
diseases. Facilities include guidance and counseling centers,
psychiatric clinics and hospitals, chemical abuse (including drug and
alcohol), physical abuse treatment centers (dealing with child abuse
and spousal abuse).
Genetic Counseling
Genetic counseling centers can be an independent facility or located in another
facility. Employees work with couples or individuals who are pregnant or
considering pregnancy. They perform prenatal screening tests, check for genetic
abnormalities and birth defects, explain the results of the tests, identify medical
options and help the person deal with the psychological issues caused by
genetic disorder.
Rehabilitation
The goal of rehabilitation is to get the patient to their optimal level of
functioning . Services may include physical, occupational, recreational,
speech and hearing therapy.
HMOs --Health
Maintenance
organizations provide
total care directed at
preventative health
care.
Services include
examinations, basic
medical services, health
education and
hospitalization or rehab
as needed. HMOs are
operated by large
corporations or private
agencies.
Industrial Health Care Centers
Industrial health care centers are provided by large corporations to
provide on-site health care for their employees where they can receive
services including basic exams, learn accident prevention and safety
and emergency care.
School Clinics
School clinics provide services that include emergency
care, checks for health conditions such as speech,
vision, and hearing problems, health education and
some counseling services. They assist with
medications.
Government Agencies
United Nations
World Health Organization (WHO) sponsored by the
United Nations gathers data about disease, publishes
health information , and investigates and addresses
serious health problems throughout the world.
U.S. Dept. of Health and
Human Services
(USDHHS)
deals with health
problems in US.
One part of the USDHHS is the National Institutes of
Health. NIH is a collection of 27 different institutes
dedicated to research. Some of the institutes include
National Cancer Institute, National Institute on Aging,
National Institute of Biomedical Imaging and
Bioengineering, National Institute of Dental and
Craniofacial Research.
Center for Disease Control and
Prevention (CDC)
The CDC is concerned with causes, spread and control of diseases in
populations. They emphasis environmental health, occupational health and
safety, health promotion, prevention and education. It accomplishes its goals
through partnership with state and local agencies.
Food and Drug Administration
The FDA is responsible for protecting the public health by
assuring the safety, efficacy, and security of human and
veterinary drugs, biological products, medical devices,
our nation’s food supply, cosmetics, and products that
emit radiation.
Agency for Health Care Policy and Research
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.
Occupational Health and Safety
Administration
Establishes and enforces standards that
protect workers from job-related injury
and illnesses.
State and local (including city) health
departments provide specific
services needed by the state or local
community. These may include
immunizations for disease control;
inspections for environmental
health and sanitation,
communicable disease control and
health education.
World Health Organization (WHO) sponsored by the United Nations
gathers data from around the world, advises, teaches, investigates
U.S. Dept. of Health and Human Services –health problems in US
National Institutes of Health—disease research
Center for Disease Control and Prevention (CDC) monitor causes,
spreading and control of diseases
Food and Drug Administration (FDA) regulates food and drug products
Agency for Health Care Policy and Research (AHCPR) research
quality of health care delivery and identify standards of treatment that
should be provided.
Occupational Safety and Health Administration (OSHA) establishes
and enforces standards that protect workers from job related injuries
and illnesses.
Voluntary or Non-Profit Agencies
• Supported by donations, membership fees,
fundraisers, and federal or state grants.
• Am. Cancer Society
• Am. Heart Assoc.
• Am. Diabetes Assoc.
• Am. Respiratory Disease Assoc.
• National Assoc. of Mental Health
• March of Dimes
• Am. Red Cross
• and many more
Health Insurance Plans
•
•
•
•
16 % of GNP goes to health care.
Most people rely on insurance to afford health care.
Premium is paid monthly/quarterly to insurance co.
When care is received, insurance co. pays for some/all of the
costs and the patient is responsible for the remainder.
• Payment depends on the plan. Some have limits and
deductibles. Deductibles are amounts that have to be paid
before insurance begins to pay. (Some companies pay the
deductible for their worker)
• Co-insurance requires that a % of the expense are paid by the
patient and insurance co. (80/20)
HMO
• Monthly fee or premium—amount is the same
each month regardless of how much you use
it.
• Directed at preventative care.
• Ready access to health exams, early tx and
detection of dz. (disease)—goal is to be
healthier
• Disadvantage—required to use only HMOaffiliated providers
PPO Preferred Provider Org.
• Usually provided by large corp. to employees
• Corp. makes an alliance with health care
facilities to provide care to employee at a
reduced cost.
• Employees utilize the specific hospitals or
doctors (in network) at a reduced rate.
• May go out of network at a higher rate.
Medicare
• Federal gov. provides health care for people
over age 65 and for any person with a
disability who has received Social Security
benefits for at least two years.
• Type A covers hospital stays
• Type B covers doctor’s visits, therapies
…requires that a premium be paid for type B
coverage and also must pay an initial
deductible for services.
• Only pays for 80% of cost. Person or their
private insurance must pay for the rest.
Medicaid
• Medical assistance program operated by
states
• Usually pays for care of individual with low
income, children who qualify for public
assistance, and physically disabled or blind.
State Children’s Health
Insurance Program
(SCHIP)
• Est. 1997 to provide health care to uninsured
children of working families who earn too
little to afford private insurance but too much
to be eligible for Medicaid.
• Provides inpt and outpt services
Workers’ Compensation
• Paid by employers and the state for person’s
injured while on the job.
• Reimburses worker for wages lost because of
the on-the-job injury
TRICARE
• US gov. pays for military personnel, their
families, their survivors, and retired members
of US armed forces
• Veteran’s Administration provides for military
veterans.
Managed Care
• Approach has developed in response to rising health care
costs.
• Way to make certain that money is spent efficiently rather
than wastefully.
• **Principle behind MC is that all health care provided to a pt
must have a purpose.
• A second opinion is frequently needed
• Try to provide preventative care; early dx to avoid high cost of
treating dz.
• HMO is main group to do this
• Goal is to get quality care at the lowest price.
Organizational Structure
Regardless whether a structure/organization/business is large or small,
there must be a line of authority or chain of command. The
organizational structure should indicate areas of responsibility and lead
to the most efficient operation of the facility.
Authority is often used interchangeably with the term "power".
However, their meanings differ: while "power" is defined as "the
ability to influence somebody to do something that (s)he could not
have done", "authority" refers to a claim of legitimacy, the
justification and right to exercise that power.
It is important that health care workers (HCW) understand their
respective positions in a given facility’s organizational structure. This
way everyone knows the lines of authority and understands who is
their immediate boss.
Problems must be handled in proper sequence up and down the
chart/ladder.
GOAL of organization in health care facilities: delivery of safe, quality
health care in a financially prudent manner.
Organizational Structure
“Chaos in the midst of chaos isn't funny,
but chaos in the midst of order is.”
Steve Martin
“Chaos is a name for any order that
produces confusion in our minds.”
George Santayana
Chaos is inherent in all compounded
things. Strive on with diligence.
Buddha
TRENDS IN HEALTH CARE
Cost Containment: trying to control the rising cost of health care
and achieving the maximum benefit for every dollar spent.
Reasons for high health costs:
*technological advances—machines are expensive
*people survive illness that were once fatal and require expensive, lifelong care
*people are living longer, as population ages there are more chronic
illness to treat
*increase in health related lawsuits—practioners must pay more for
malpractice insurance, order diagnostic tests that might not be necessary
…as a result, cost of health care continues to rise and may rise out of the
reach of some people.
…all people should have access to equal access to care.
All aspects of health care are directed toward cost containment.
Diagnostic Related Groups (DRGs)
Congress is trying to control cost for Medicare and Medicaid. They
lump certain diagnosis together and pay a flat amount for the care of a pt
with one of those diagnoses.
Congress is trying to get facilities to provide care within the expense
limit allowed.
If a facility treats the pt and goes under budget, it gets to keep the extra.
However, if it turns out that it costs most, the facility has to accept the
loss.
Advantage: facility works in a more efficient manner
Disadvantage: care might possibly be short changed
Other ways to contain costs
1.Agencies joining together or sharing specific
services
2.Outpatient services less expensive than in pt.
3.Buying in bulk
4.Early intervention and prevention
5.Energy conservation
Omnibus Budget Reconciliation Act
(OBRA) 1987
1. Federal guideline that requires states to establish
training for nursing and geriatric assistants.
2. Requires compliance with patients’/residents’ rights
and forces states to ensure standards of care.
Telemedicine
• Uses video, audio, and computers to provide
medical and other health care services.
• New technology allows interactive services
between health care providers even though
they are in different locations.
Wellness
• State of balance in optimum health with a balanced
relationship between physical, mental and social
health and maintain and prevent disease thereby
lowering healthcare costs
• Recognize importance of following:
1. exercise
2. good nutrition
3. weight control
4. healthy living habits
Alternative Methods of Health Care
• Acupuncture, positive thought, relaxation
techniques, yoga, meditation, therapeutic
touch, reflexology, hypnosis