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4.2 Health Care Today

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Kristen Jahns

on 26 June 2014

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Transcript of 4.2 Health Care Today

Senior citizens learning about Medicare

Health care workers wear at least three different hats—as a patient, a taxpayer,
and a health care professional, but they must always put their patients first.
Many changes have occurred in the past and the future holds yet more promise, but issues relating to medical ethics will need to be addressed.

Key Points

The current trend in health care is managed care, where primary care doctors serve as gatekeepers to help reduce costs
while maintaining quality and continuity in care; outpatient care, wellness, and preventive care are emphasized.

Key Points

FIGURE 4.14 Geriatric patients participating in activities designed to enhance their health and wellness


Health care reform terms


No
preexisting conditions
Individual
mandate
to get insurance
Preventative
care covered
No life time
limitations
Employers
to provide insurance

Need to
control costs
Need to increase access to health care


HOW???

Patient Protection & Affordable Care Act
2010


TRICARE
coverage for military, retirees, & their families


Workers’ Compensation
coverage for job related injuries

Medicaid
State insurance for those who are

blind, disabled, or of low income


Doctors can choose IF they will accept
medicaid patients

Medicaid pays providers
less
than other
insurance companies pay
HMOs
Require a
co-pay
for services
Must
use “their” doctors & hospitals
HMO pays nothing for “outside” providers
"gate keepers"
PPOs
Require
co-pay
for medical services
Can
use “outside” doctors/hospitals
for a higher price
DEDUCTABLE

$$ patient pays
before
insurance starts

CO-INSURANCE
Percent
that patient pays
(20% patient, 80% insurance company)

Third-party payers
Insurance plans

CO-PAYMENT
"co-pay"
$$ patient pays for each service


Mid-1800s

first

Health insurance

1920s

first
Hospital coverage

1940s
Employer
benefit packages

Government programs:

Social Security, Medicare, Medicaid

Health Insurance
To CONTROL COSTS:

Provide care in
least expensive settings
Avoid
unnecessary
tests & treatments

Diagnostic-related
groupings
(DRG's)
Coordinate
services among providers

Managed Care
WHY are costs rising?

Salaries/benefits

Medical
research
, devices, drugs
Technology
, equipment, patient supplies
Construction
& maintenance
Training
of health care professionals
Health Care as a BUSINESS
U.S.
spends $ 2 trillion
/year on health care

Costs rising
~ 8% a year

Unpaid medical bills->
bankruptcy


Health care costs ~
20% of total goods

& services produced each year
Health Care as a BUSINESS
Paid through taxes:

Medicare

Government program for people
65 & older

Medicaid

Government program for
low-income
and

disabled
people
Health Care as a BUSINESS
Reducing health care costs:

Preventing
errors
Preventing
duplication
Providing
efficient
care

Preventing spread of
infection
Caring for one’s
self


Businesses provide goods & services

Health care providers may be:
Corporation
or
sole proprietor
Public
or
private
For profit
or
not-for-profit

Health Care as a Business
(3) Informational services
document and process information
medical records

(4) Environmental services

create a clean, safe environment
for patients, visitors, employees

Health Care Services
An organizational charts shows:

"
chain of command
"
departments
relationships
between departments
areas of
responsibility
Health care Organization
Supported by
:
donations, membership fees
fund-raisers and endowments
volunteer workers

Provide funding for
:
medical research
public education
Not-for-Profit Organizations
STATE and LOCAL Agencies

U.S. Dept. Health and Human Services

Medicare, Medicaid


VA

Veterans
Administration

NIH
National
Institute of Health

FDA

Food & Drug
Administration

OSHA
Occupational
Safety
& Health Admin.
CDC
Centers for
Disease Control
FEDERAL Government Agencies
American
Cancer Society
American
Red Cross
American
Diabetes
Association
American
Heart & Lung
Associations
March of Dimes
Parkinsons
Association

And many many more….



Not - For - Profit Organizations
FIGURE 4.8 Completing health care paperwork
Source: Carmen Martin/Pearson Education


The student will:

know
government
&
not-for-profit

agencies providing health care

know services health care provides



Lesson 1B Objectives
(2)
CONVALESCENT
care provides:

long term
care -- chronic conditions
assisted
living facilities
rehabilitation
services
extended
care: nursing homes
independent
living facilities
Health Care Providers LONG TERM Care
Lesson 2 Learning Outcomes
Efforts are underway to reform the health care system with a focus on new types of health insurance programs;
examples are health care exchanges and accountable care organizations.
The Patient Protection and Affordable Care Act, signed into law in 2010, is controversial and under debate.

Key Points

Medicare
(over 65)

Part A
covers inpatient care
hospitals, home health care

Part B
covers medical services
outpatient care; doctor visits
requires monthly premium fee

Part D
covers medications
CONTROLLING COSTS

MANAGED CARE
replacing fee-for-service

Gatekeepers monitor & control access

Encourage
PREVENTION


Managed Care
(1) THERAPEUTIC services

provide care over time
rehabilitation

(2) DIAGNOSTIC
testing services
identify
diseases & disorders
monitor
chronic conditions

Health Care SERVICES
Health care organizations are SYSTEMS

Each part of system

works towards

common goals

Input
information, materials, human effort
Output
patient services
Goals
for providing services, controlling costs

HEALTH CARE ORGANIZATION
State & Federal agencies
provide

Standards
for health care
Education
for health care
Monitor
compliance
with laws


Examples
: Joint Commission, OSHA,
Nuclear Regulatory Agency


Health Care REGULATION
Describe 4
government
health agencies

Describe 2
not-for-profit
health care programs

Describe 2 health care
regulatory

agencies


Describe 4 types of
services
provided

Lesson 1B Student Outcomes
Health Care Providers COMMUNITY care
(5)
COMMUNITY Services


work
place health care
school
health services
home
health care
hospice

telemedicine, audiovisual media


(3)
AMBULATORY care services:

outpatient
, intermediate care
testing
facilities
diagnosis, treatment, wellness care
staff: MDs, RNs, PAs, or NPs


TYPES
Physician and dental offices
Walk in clinics
Health Care Providers OUTPATIENT CARE
Lesson 1A Learning Outcomes
Student will be able to:

define the key
terms
.

describe 5 types of health care
provider

facilities
Lesson Goals
The student will understand the:

structure & function
of health care system


factors which influence health care
costs

current
trends
and
issues
in health care today
The Health Care Industry

(4)
REHABILITATION, special services


outpatient
care for special therapies
physical, occupational, speech therapy
mental health care

Health Care Providers COMMUNITY Care

ACUTE
illness: sudden, severe, short term

(1) HOSPITALS:
emergency & short term
acute care
inpatient & outpatient
services
diagnostic
, medical, surgical care
generalized or specialty care

Health Care Providers ACUTE CARE
HEALTH CARE TODAY
4.2
State
psychiatric
hospitals
State
medical centers
State
public health
services

County
hospitals

Public
health departments
Senior center clinics
Lesson 2: Objectives
Student will be able to describe:



business vs service
aspects of health care
impact of
costs & lack of insurance


insurance
& managed care programs

Lesson 2: Learning Outcomes
Describe the "
business
" of health care.

List 3 reasons for the
rising cost
of health care.

Explain how
lack of insurance
affects patients & providers

Describe concepts of
managed care vs. fee-for-service
.



Give 3 examples of how providers can provide
quality health care for less cost
.

Describe 3 types of
health insurance
programs.

Describe the new health care reform laws

Health Care as a Business
Health Insurance
Health Insurance
Health Insurance
Health Insurance
Health Insurance
Health Insurance
HEALTH CARE REFORM
Health Care REFORM
BIG PICTURE Where do you fit in?
Key Points

as a consumer of health care
as a healthcare provider
as a taxpayer
as an employee

Many types of health care
providers


Four types of health care
services
:
Therapeutic
Diagnostic
Information
Environmental/support services
Key Points
Many
healthcare agencies

Private, public, government



Many
regulatory agencies


FDA, OSHA, CDC, Joint commission


Key Points
Key Points
Rising health care costs

Aging population


People can’t afford health care

Some don't have health coverage

Some don’t have access to health care


Trends:



managed care

outpatient care

emphasis on prevention
reduce duplication, waste


US DEPARTMENT OF HEALTH
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