Chapter 2 Health Care Systems 2009 Delmar Cengage

Chapter 2 Health Care Systems © 2009 Delmar, Cengage Learning

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 (continues) © 2009 Delmar, Cengage Learning

Private Health Care Facilities (continued) • • Hospitals Long-term care facilities (LTC or LTCF) Independent living and assisted living Medical offices Dental offices Clinics or satellite centers Optical centers © 2009 Delmar, Cengage Learning

Private Health Care Facilities (continued) • • Emergency care services Laboratories Home health care Hospice agencies Mental health facilities Genetic counseling centers Rehabilitation facilities (continues) © 2009 Delmar, Cengage Learning

Private Health Care Facilities (continued) • Health maintenance organizations (HMOs) • Industrial health care centers or occupational health clinics • School health services © 2009 Delmar, Cengage Learning

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) (continues) © 2009 Delmar, Cengage Learning

Government Agencies (continued) • Food and Drug Administration (FDA) • Agency for Health Care Policy and Research (AHCPR) • Occupational Safety and Health Administration (OSHA) • Health Departments © 2009 Delmar, Cengage Learning

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 (continues) © 2009 Delmar, Cengage Learning

Voluntary or Nonprofit Agencies (continued) • • • Organizations focus on specific diseases Educate the public Provide special services Purchase medical equipment Staffed by many health care workers and volunteers © 2009 Delmar, Cengage Learning

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 © 2009 Delmar, Cengage Learning

Insurance Terminology • Deductible • Co-insurance • Co-payment © 2009 Delmar, Cengage Learning

Types of Plans • • • Health insurance plans Health maintenance organization (HMO) Preferred provider organization (PPO) Medicare Medigap (continues) © 2009 Delmar, Cengage Learning

Types of Plans (continued) • 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 © 2009 Delmar, Cengage Learning

HIPAA • Five components – – Health care access Preventing health care fraud Tax-related health provisions Application and enforcement of group health plan requirements – Revenue offsets © 2009 Delmar, Cengage Learning

2: 5 Organizational Structure • • 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) (continues) © 2009 Delmar, Cengage Learning

Organizational Structure (continued) • 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 © 2009 Delmar, Cengage Learning