slide 1 chapter 2 - - the health care system. slide 2 health care delivery, past and present
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Slide 1
Chapter 2 - - The Health Care
System
Slide 2
Health Care Delivery, Past and Present
Slide 3
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