Chapter 2 Health Care Systems
• Largest and fastest growing industry in the US• Over 13 million workers• Expenditures-4 billion dollar per day business
and growing
Hospitals
• General Hospitals-treat a wide range of conditions
• Specialty hospitals-special conditions or age groups are treated
• Government hospitals-operated by gov. agencies
• University or college medical centers-provide services along with research and education
2.2 Government Agencies
• World Health Organization (WHO)• Compiles statistics and information on
disease, addresses serious health problems throughout the world
US Department of health and Human services (USDHHS)
• A National agency that deals with the health problems in the United States
National Institute of Health (NIH)
• Involved in disease research
Centers for Disease Control and Prevention (CDC)
• Concerned with causes, spread and control of diseases
Food and Drug Administration (FDA)
• A federal agency• Responsible for regulating food and drug
products sold to the public
Agency for Health Care Policy and Research (AHCPR)
• Research the quality of health care and identify standards of treatment to be provided
Occupational Safety and Health Administration OSHA)
• Provide for a safe work environment
Health Departments
• Under the direction of the USDHHS • Sanitation, inspections for environmental
health, clinics for health care
2.3 Voluntary or Nonprofit Agencies
• Funding-donations, grants, membership fees
• Function-provide funding for research, public education, provide equipment for patients in need
• Examples-Lion’s Club, American Cancer Society, American Heart Association
2.4 Health Insurance Plans• Why-pay for health care
• Deductible-amount that must be paid BEFORE the policy begins to pay
• Co-Insurance-a specific percentage of expenses is paid by the insurance company and the patient.
Ex: 70-30, 70% is paid by ins. Co. and 30% by patient• If the expenses total $2000, how much will you owe?
• Co-Payment-a specific amount the patient pays for a particular service.
Health Maintenance Organization (HMO)
• A managed care plan in which the payments stay the same each month. The advantage of this is that it covers routine examinations and preventive care. You must see HMO-affiliated providers to have coverage.
Preferred Provider Organization (PPO)
• You have to go to the preferred hospital and pay a co-payment and a deductible.
Medicare
• A federal government program that provides health care for almost all individuals over the age of 65, for any person with a disability who has received social security benefits for at least 2 years.
• 3 kinds of coverage a.) Hospital Insurance B.) Medical Insurance C.) Pharmaceutical (Medication) Expenses.
Medigap
• Policy which covers expenses not covered by Medicare.
Medicaid
• Medicaid is a medical assistance program that is jointly funded by the federal government and state government. Medicaid pays for health care of individuals with low incomes.
• State Children’s Health Insurance Program SCHIP)-healthcare for uninsured children
Worker’s Compensation
• Is a health insurance plan providing treatment for workers injured on the job.
Tricare
• U.S government health insurance plan for all military personnel.
• Provides care for all active duty members and their families, and survivors of the military personnel.
Managed Care
• All health care must have a purpose.• A second opinion is frequently required.• HMOs and PPOs are examples of Managed
Care
Health Insurance Portability and Accountability Act (HIPAA)
• Provided consumers with more access to health care
• Greater confidentiality in regards to medical records
• Standardized electronic health care records