chapter 16
TRANSCRIPT
16PowerPoint® Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Consumerism: Selecting Health Care Products and Services
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Responsible Consumerism: Choices and Challenges
Attracting consumer dollars
• Tactics used
• Some are subtle
• Many choices available
• Important to choose carefully
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Responsible Consumerism: Choices and Challenges
Putting cure into perspective
• Spontaneous remission – disappearance of symptoms without any apparent cause or treatment
• Placebo effect – patients report relief of symptoms generally brought about by what they expect, desire, or were told would happen after “treatment”
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Responsible Consumerism: Choices and Challenges
Taking responsibility for your health care
• Self-help or self-care
• Know your body
• Pay attention to body signals
• Take appropriate action to stop progression of illness or injury
• Many common forms of self-care, including home health tests, learning minor first aid
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Responsible Consumerism: Choices and Challenges
When to seek help
• Recognize when a condition needs professional help
• See a professional for conditions such as serious accident or injury, adverse drug reactions, unexplained sudden weight loss, any symptom that is unusual and recurs over time, pregnancy
• Home health tests for many conditions should not be a substitute for professional diagnosis and care
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Responsible Consumerism: Choices and Challenges
Assessing health professionals
• Identify what type of help you need and where to find it
• You should feel comfortable with your provider
• Provider should explain diagnosis and treatment options thoroughly, and involve patient care decisions
• Be sure to understand coverage options
• Check certifications, affiliations, availability, respect for patient
• Ask questions
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Choices in Medical Care
Conventional western (allopathic) medicine
• Primary care practitioners
• Physician assistants
• Osteopaths
• Ophthalmologists
• Optometrists
Do you always consider the person’s qualifications? Why or why not?
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Choices in Medical Care
Conventional western (allopathic) medicine (continued)
• Dentists
• Orthodontists
• Oral surgeons
• Nurses
• Nurse practitioners (NP)
• Physicians assistant
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Health Care Organizations, Programs, and Facilities
Critical decisions
• Choosing an insurance carrier or type of plan
• Choosing from among the health care providers
Types of medical practices
• Group practice
• Solo practitioners
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Health Care Organizations, Programs, and Facilities
Integrated health care organizations
• Nonprofit hospitals
• For-profit (proprietary) hospitals
• Patient Dumping
• Outpatient (ambulatory care)
• Surgicenters
• Be aware of JCAHO
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Third-Party Payers
Insurance
• People pay into a pool of money
• Draw from this money when ill
• 42 million Americans are uninsured
• 75% are working or dependents of workers
• Many students are uninsured
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Third-Party Payers
Private health insurance
• Major medical
• Fee-for-service or indemnity
• Deductibles, co-pays, coinsurance
• Preexisting conditions
• Waiting periods
• Lifetime limit
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.2
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Third-Party Payers
Medicare and medicaid
• Medicare – adults over 65 years of age
• Medicaid – poor
• DRGs
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Third-Party Payers
Managed care
Capitation
Elements
1) A budget on an estimate of the annual cost
2) A network of physicians, hospitals, and others
3) An established set of administrative rules
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Third-Party Payers
Health Maintenance Organizations (HMOs)
• Wide range of covered health benefits
• Least expensive form
• Patient’s typically required to use the plan’sdoctors and hospitals
What are some of the downsides to HMOs?
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Third-Party Payers
Preferred Provider Organization (PPO)
• Networks of independent doctors
• Contract to provide discounts
• Have choice of provider
• Pay more
Point of Service (POS)
• Fastest growing managed care
• Can go outside of HMO
• Pay extra
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Issues Facing Today’s Health Care System
Cost
• U.S spends more than any other nation
• $1.9 trillion annually
Access
• Supply
• Proximity to care
• Health status
• Insurance coverage
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.1
National Health Expenditures as a Percentage of the GDP
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.2
Where Do We Spend Our Health Care Dollars?
Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
Issues Facing Today’s Health Care System
Quality and malpractice
• Deaths can occur because of mistakes
• Mechanisms for safety
• Outcome measurements
Do you believe the U.S. health care system is safe?