HEALTH CARE SYSTEMS

CHAPTER 2

2:1 PRIVATE HEALTH CARE FACILITIES

• Growth—one of the largest and fastest growing industries in the United States• Employment opportunities—employs over 13

million workers in over 200 careers• Expenditures—it is a four-billion-dollar-

per-day business and growing

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PRIVATE HEALTH CARE FACILITIES(CONTINUED)

• Hospitals• Long-term care facilities (LTC or LTCF)• Independent living and assisted living • Medical offices• Dental offices• Clinics or satellite centers• Optical centers

PRIVATE HEALTH CARE FACILITIES(CONTINUED)

• Emergency care services• Laboratories• Home health care• Hospice agencies• Mental health facilities• Genetic counseling centers• Rehabilitation facilities

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PRIVATE HEALTH CARE FACILITIES(CONTINUED)

• Health maintenance organizations (HMOs)• Industrial health care centers or occupational

health clinics• School health services

2:2 GOVERNMENT AGENCIES

• Government services are tax supported• World Health Organization (WHO)• U.S. Department of Health and Human Services

(USDHHS)• National Institutes of Health (NIH)• Centers for Disease Control and Prevention (CDC)

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GOVERNMENT AGENCIES(CONTINUED)

• Food and Drug Administration (FDA)• Agency for Health Care Policy and Research

(AHCPR)• Occupational Safety and Health Administration

(OSHA)• Health Departments

2:3 VOLUNTARY OR NONPROFIT AGENCIES

• Supported by donations, membership fees, fundraisers and grants• Health services are provided at national, state,

and local levels• Examples include the American Cancer Society,

March of Dimes, American Red Cross and many more

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VOLUNTARY OR NONPROFIT AGENCIES(CONTINUED)

• Organizations focus on specific diseases• Educate the public• Provide special services• Purchase medical equipment • Staffed by many health care workers

and volunteers

2:4 HEALTH INSURANCE PLANS

• Health care costs are rising faster than other costs of living• Most people rely on health insurance plans to pay

for health care costs• Without insurance, the cost of an illness can

become a financial disaster

INSURANCE TERMINOLOGY

• Deductible• Co-insurance• Co-payment

TYPES OF PLANS

• Health insurance plans• Health maintenance organization (HMO)• Preferred provider organization (PPO)• Medicare• Medigap

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TYPES OF PLANS(CONTINUED)

• Medicaid• The State Children’s Health Insurance Program

(SCHIP)• Worker’s Compensation• U.S. government plans for all military

personnel and their families• Managed care plans

HIPAA

• Five components• Health care access• Preventing health care fraud• Tax-related health provisions• Application and enforcement of group health

plan requirements• Revenue offsets

2:5 ORGANIZATIONAL STRUCTURE

• Line of authority or chain of command• Indicates areas of responsibility• Goal: most efficient operation of facility• Complex or simple structure determined

by size and needs of organization• Sample organizational charts

(See Figure 2-4 and 2-5 in text)

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ORGANIZATIONAL STRUCTURE(CONTINUED)

• The line of authority must be clearly indicated in any organizational structure• Workers must identify and understand their

position in the structure• To follow proper channels of communication,

workers must take problems, reports, and questions to their immediate supervisor