Unit 1 Community Health Care Copyright 2008 Delmar

Objectives • Spell and define terms. • List the five basic functions of health

Objectives • Name the departments within a hospital. • Describe the functions of the

Introduction • Health care facilities have five basic functions: – Provide services for the

Overview of Health Care • Health care emphasizes patient-focused care • Many changes have

Overview of Health Care • There are several reasons for these changes – People

Overview of Health Care • Managed care means the insurance company will: – Not

Overview of Health Care • Managed care means the insurance company will: – Negotiate

Overview of Health Care • Managed care means the insurance company will: – Approve

Needs of the Community • Health care is needed throughout life • Short-term or

Preventive Care • Prenatal care – Care of mother during pregnancy • Well-baby checkups

Emergency Care • Short-term care given for sudden illness or injury • Surgery –

Rehabilitation • To help a patient regain abilities after an illness or injury •

Hospice Care • For patients who are dying and their families Copyright © 2008

Needs of the Community • People receiving health care called health care consumers –

Needs of the Community • Patient – Persons in acute care facilities, such as

Types of Health Care Facilities Short-Term Care Long-Term Care Hospitals Skilled care facilities Urgent

Long-term Acute Care Hospitals • Fully licensed hospitals in which a lengthy stay is

Long-term Acute Care Hospitals • Patients must have a medically-complex condition – Need acute

Magnet Hospitals • Magnet Program for Excellence in Nursing Services – Based on quality

Magnet Hospitals • Program is voluntary and recognizes hospitals for nursing excellence • Hospitals

Community Health Care Services • Hospitals – Most hospitals are licensed to care for

Community Health Care Services • Pediatric hospitals – Care for children from birth to

Community Health Care Services • Hospital organization – Provide the most efficient delivery of

Community Health Care Services • Hospital organization – Surgical department • Cares for patients

Community Health Care Services • Hospital organization – Obstetric department • Cares for newborns

Community Health Care Services • Hospital organization – Critical care department • Cares for

Community Health Care Services • Hospital organization – Medical department • Cares for patients

Community Health Care Services • Hospital organization – Larger hospitals – Many specialized units

Specialized Services • Dietary • Pharmacy • Diagnostic – Pathology (study of disease) –

Specialized Services • Rehabilitation services – Physical therapy – Occupational therapy – Speech therapy

Specialized Services • Environmental services – Housekeeping – Maintenance – Laundry Copyright © 2008

Specialized Services • • Business services Medical records department Volunteer services Pastoral services Copyright

Financing Health Care • Health care is paid for by: – Insurance – Out-of-pocket

Financing Health Care • Medicare is a federal government program – Pays a portion

Financing Health Care • Medicare payment is based on: – Diagnosis related groups (DRGs)

Financing Health Care • Rather, Medicare set the payment rates: – Based on data

Regulatory Agencies • Joint Commission for Accreditation of Healthcare Organizations (JCAHO) – Inspects and

Regulatory Agencies • Occupational Safety and Health Administration (OSHA) – Surveys health care facilities

Quality Assurance • All health care facilities have a program called quality assurance (QA)

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Objectives • Spell and define terms. • List the five basic functions of health care facilities. • Describe four changes that have taken place in health care in the last few years. • Describe the differences between acute care and long-term care. Copyright © 2008 Delmar Learning. All rights reserved.

Objectives • Name the departments within a hospital. • Describe the functions of the departments within a hospital. • Explain three ways by which health care costs are paid. • State the purpose of health care facility surveys. Copyright © 2008 Delmar Learning. All rights reserved.

Introduction • Health care facilities have five basic functions: – Provide services for the ill and injured – Prevent disease – Promote individual and community health – Educate health care workers – Promote research in medicine and nursing Copyright © 2008 Delmar Learning. All rights reserved.

Overview of Health Care • There are several reasons for these changes – People are living longer – Technology is becoming more advanced – Health care costs have increased – Many ethical questions that must be answered by health care providers and consumers Copyright © 2008 Delmar Learning. All rights reserved.

Overview of Health Care • Managed care means the insurance company will: – Not permit certain procedures or diagnostic tests until they have been approved by the insurer. Copyright © 2008 Delmar Learning. All rights reserved.

Overview of Health Care • Managed care means the insurance company will: – Negotiate with specific physicians, hospitals, pharmacies, and other care providers to render services at a lower cost to the company’s members. Copyright © 2008 Delmar Learning. All rights reserved.

Overview of Health Care • Managed care means the insurance company will: – Approve only a certain number of days of hospitalization for specific diagnoses. – Require that specific procedures be done on an outpatient basis rather than having the patient admitted to the hospital. Copyright © 2008 Delmar Learning. All rights reserved.

Needs of the Community • Health care is needed throughout life • Short-term or long-term care includes: – Preventive – Emergency – Surgery – Rehabilitation – Hospice care Copyright © 2008 Delmar Learning. All rights reserved.

Preventive Care • Prenatal care – Care of mother during pregnancy • Well-baby checkups and immunizations • Health education to teach individuals how to avoid disease and injury • Physical examinations throughout life Copyright © 2008 Delmar Learning. All rights reserved.

Rehabilitation • To help a patient regain abilities after an illness or injury • Long-term care – For persons who have chronic or incurable conditions Copyright © 2008 Delmar Learning. All rights reserved.

Needs of the Community • Patient – Persons in acute care facilities, such as hospitals • Client – Persons receiving care in their own homes • Resident – Persons in long-term skilled care facilities Copyright © 2008 Delmar Learning. All rights reserved.

Types of Health Care Facilities Short-Term Care Long-Term Care Hospitals Skilled care facilities Urgent care facilities Adult day care Surgicenters Assisted living facilities Rehabilitation centers Psychiatric hospitals Respite care Outpatient clinics Psychiatric hospitals Physician’s offices Home care Copyright © 2008 Delmar Learning. All rights reserved.

Long-term Acute Care Hospitals • Fully licensed hospitals in which a lengthy stay is anticipated • Provide a higher level of care than other chronic care settings Copyright © 2008 Delmar Learning. All rights reserved.

Magnet Hospitals • Program is voluntary and recognizes hospitals for nursing excellence • Hospitals who have been awarded magnet status are usually progressive – Desirable places to work Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospitals – Most hospitals are licensed to care for patients of all ages and with a variety of problems – Some hospitals take care of patients with special conditions or care for specific age groups Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Pediatric hospitals – Care for children from birth to 18 years • Psychiatric hospitals – Provide care for persons with mental illness • Rehabilitation hospitals – Provide restorative services to patients following disease, illness, or injury Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospital organization – Provide the most efficient delivery of service – Major departments established within each facility • Care for patients with specific conditions • 24 hours a day, 7 days a week Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospital organization – Surgical department • Cares for patients before, during, and after surgery – Pediatric department • Cares for sick and injured children Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospital organization – Obstetric department • Cares for newborns and their mothers – Emergency department • Cares for victims of trauma, natural disasters, or medical emergencies Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospital organization – Critical care department • Cares for seriously ill patients who require constant monitoring and care Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospital organization – Medical department • Cares for patients with medical conditions such as pneumonia or heart disease Copyright © 2008 Delmar Learning. All rights reserved.

Community Health Care Services • Hospital organization – Larger hospitals – Many specialized units staffed by nurses and therapists • Trained to care for persons with specific problems Copyright © 2008 Delmar Learning. All rights reserved.

Financing Health Care • Health care is paid for by: – Insurance – Out-of-pocket payments – Medicaid • State and federal government program • Pays for persons of any age who do not have financial resources for health care Copyright © 2008 Delmar Learning. All rights reserved.

Financing Health Care • Medicare is a federal government program – Pays a portion of health care costs for persons 65 years and older • For younger persons permanently disabled and qualify for benefit Copyright © 2008 Delmar Learning. All rights reserved.

Financing Health Care • Rather, Medicare set the payment rates: – Based on data from studies that determined the average length of stay – Required for various medical diagnoses, procedures, and treatments Copyright © 2008 Delmar Learning. All rights reserved.

Regulatory Agencies • Joint Commission for Accreditation of Healthcare Organizations (JCAHO) – Inspects and accredits health care agencies – Participation is voluntary – Hospitals are not eligible to receive Medicare payment unless they are JCAHO accredited Copyright © 2008 Delmar Learning. All rights reserved.

Regulatory Agencies • Occupational Safety and Health Administration (OSHA) – Surveys health care facilities – Protects health and safety of employees Copyright © 2008 Delmar Learning. All rights reserved.

Quality Assurance • All health care facilities have a program called quality assurance (QA) – Identifies problems and finds solutions for improvement Copyright © 2008 Delmar Learning. All rights reserved.