Slide 1 Chapter 2 - - The Health Care System. Slide 2 Health Care Delivery, Past and Present.

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Chapter 2 - - The Health Care

System

Slide 2

Health Care Delivery, Past and Present

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PastA health care provider was trained as a generalist, rather than as a specialist

Charlatans used to offer ineffective “cures” in exchange for money

The home was the primary site for patient care

Changes in the Delivery of Health Care

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PresentHealth care professionals have to undergo intensive educational preparation

Large facilities provide on-site patient care

The family doctor is now called a “general practitioner” and is supported by a team of specialists

A holistic approach is now used: focuses on the care of the whole person - physically and emotionally

Changes in the Delivery of Health Care

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Health Care Organizations

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Types of Health Care Organizations

HospitalsProbably the best known type of health care organization

People who receive the services of a hospital are called patients

A patient who has to stay at the hospital for one or more nights receives inpatient care

A patient who goes home the same day receives outpatient care

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Types of Health Care Organizations

Sub-acute care unitsAlso called a skilled nursing unit or a skilled nursing facility

Provides care for a patient who has partially recovered but still requires skilled health care

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Types of Health Care Organizations

Long-term care facilities (nursing homes)For people who are unable to care for themselves at home, yet do not need to be hospitalized

Becomes the person’s home, either temporarily or permanently

People being cared for in long-term care facilities are called residents

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Types of Health Care Organizations

Assisted-living facilitiesFor people needing limited help

Examples of help: Medications Transportation Meals Housekeeping

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Types of Health Care Organizations

Home health care agenciesProvide skilled care in a person’s home

People receiving care in the home health care setting are typically called clients

Available for people of all ages with any number of medical needs

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Types of Health Care Organizations

Hospice organizationsPeople can receive services when they know that they have 3 to 6 months to live

Focus: To relieve pain To provide emotional and spiritual support

Services are provided for both the dying person and the family

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Structure of Health Care Organizations

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Structure of Health Care Organizations

Usually governed by a board of trustees

Has divisions in charge of certain aspects of the organization’s function

An administrator or chief executive officer (CEO) is the link between the board and the organization

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Government Regulation of the Health Care System

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Purpose of Government Regulations

Government regulations make sure that:

Providers of health care are properly trained and competent

Health care facilities meet standards of cleanliness and quality

Quality health care is available to everyone

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Paying for Health Care

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Paying for Health Care

Group insurance: insurance purchased at group rates by an employer or corporation

Pre-certification (pre-approval) process: health care provider has to prove that a person’s medical condition meets certain criteria before starting treatment

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Paying for Health Care

Managed care system: arrange contacts with various health care providers

Preferred Provider Organization (PPO): health care providers contract with an insurance company to accept a standard payment

Health Maintenance Organization (HMO): contract with health care providers to provide health care services for a prepaid fee

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Paying for Health Care

Medicare

People who are 65 years or older are eligible for Medicare

Started Diagnosis-related Groups (DRGs): payment is specified according to the diagnosis

Due to the DRG system, patients are discharged sooner and sicker

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Paying for Health Care

Medicaid

Designed to help people with low incomes to pay for health care

Federally funded and state-regulated plan

Medicaid reimbursements are given only to facilities approved by the state agency