Student : Borgella J.Jean VictorProfessor: Dr Pierre Larousse Subject: Introduction to the Healthcare

Hospitals, clinic and community health agencies can be very different from other work environments. Healthcare systems are complex and there are many things you need to know about types of hospital systems, patient care, insurance, healthcare providers and legal issues. This tutorial will help you learn basic healthcare concepts so you can be successful on the job and understand the system.

Why do you need to understand the healthcare system?You need to know about the healthcare system so you can be effective on the job. The image below shows the different groups you will be working with. As you work with the healthcare team, you will need to know about hospital systems, types of care, and the roles of each member of the healthcare team. As you work with patients, you will need to understand different types of insurance, how to help uninsured patients and how to protect patient rights and privacy. You also need to know what community resources are available and how to access those services for patients.

Healthcare Systems

In this part of the tutorial we will look at several aspects of the healthcare system including: Hospital systems Types of patient care Public health programs

Hospital SystemsA hospital system is a group of hospitals or facilities that work together to deliver services to their communities. Different types of hospital systems have different types of ownership and financial goals. Types of hospital systems include: Public HospitalsPublic hospitals are funded and owned by local, state or federal governments and receives money from the government. Some public hospitals are associated with medical schools. Non-profit HospitalsNon-profit hospitals are often community hospitals and may be linked with a religious denomination. The main goal of a non-profit hospital is to provide service to the community.Private HospitalsPrivate hospitals are owned by investors. Their goal is to earn a profit. Private hospitals tend to offer more profitable services such as rehabilitation, elective or plastic surgery or cardiology. They try to avoid unprofitable services such as emergency medicine, which can lose money due to uninsured patients.

Healthcare Systems

Types of Patient Care

There are several different types of care for patients, depending on their need. Types of patient care are listed below. Click on the type of care to see a description. Amber Meiwes is happy to tell you what's wrong with primary care in America: It's hard to get any, and when you do, it's a health risk. Can't Find a Doctor? You're Not AloneDuring a long struggle with recurring stomach pain, Meiwes got used to waiting three weeks to get in to see a doctorand then being hustled back out in mere minutes. "They had way more patients than they really can see," says Meiwes, 29, of Piedmont, Okla. "They would say, Take an antacid and go home." When she fell ill on weekends, her only options were an after-hours clinic or the emergency room. It took three years of office visits and ER visits before she got a diagnosis: inactive gallbladder. "I got to the point where I wouldn't even go to the doctor anymore."It's not supposed to work that way. A primary-care doctor is supposed to be the go-to doc for almost every ailment from ingrown toenails to suspicious breast lumpsthe trusted guide to the system who knows the patient, her medical history, her family. Any time the patient must navigate the bumpy and often frightening path through specialty care, it's these internists and family and general practice doctors who make sure that nothing critical falls through the cracks. Indeed, study after study has shown that patients fare better in areas of the country not overpopulated by medical specialists and where primary-care physicians handle the bulk of care. Yet increasingly, the system is fraying. Consider: Twenty-nine percent of people with Medicare said they had trouble finding a doctor who would take that insurance in 2007, up from 24 percent the year before. That's 11.6 million people. Two thirds of Americans say they have a hard time getting medical care on nights, weekends, and holidays, according to 2007 survey by the Commonwealth Fund. Just 30 percent of Americans say they can get in to see their doctor on the same dayputting the United States second to last among industrialized countries, ahead of Canada, according to the Commonwealth Fund survey. In California, almost half of emergency department patients surveyed in 2006 by the California HealthCare Foundation said they thought their problem could have been handled by a primary-care physician. Two thirds of those people said they couldn't get an appointment with their doctor. In Texas, 24 counties now have no primary-care doctors at all. In Alaska, not one of the 749 private-practice physicians was taking new Medicare patients for primary care in November 2007.The shortages don't reflect a lack of doctors; the number of physicians per capita rose 77 percent between 1970 and 2000. But given the choice, most new doctors simply reject primary care. A specialist performing a procedurea colonoscopy, sayis commonly paid three times as much for 30 minutes as a primary-care physician who spends that time talking with patients about how to manage their heart failure or diabetes. An internist or a family-practice physician might start off making $100,000 to $150,000 a year, but specialists make about twice as much on average, says David Dale, a Seattle internist who is president of the American College of Physicians. And a typical medical student graduates with $130,000 in debt.As a result, the number of grads choosing residencies in family practice, internal medicine, and pediatrics fell 7 percent from 1995 to 2006, according to congressional testimony from the Government Accountability Office in February. And while half of residents in internal medicine chose to go into primary care in 1998, now just 20 percent do. In the past few years, many have instead chosen to join the growing ranks of "hospitalists," a new genre of internist who manages the care of patients while they are in the hospital. Hospitalists may make $200,000 a year to start, with fewer hours than a private practitioner and none of the start-up costs or managerial headaches.Those who remain find themselves struggling to make money even though they can't meet demand. "The waiting list to get a physical with me is 14 months," says Kate Atkinson, a family-practice physician in Amherst, Mass., who does home visits, answers patients' E-mails within a few hours, and prides herself on being the kind of doctor she'd like to go to. Atkinson sees 25 to 30 patients a day, yet she's barely staying afloat, largely because of the cost of staff she needs to keep up with insurance paperwork and Massachusetts's combination of low insurance reimbursements and a high cost of living. "It's very frustrating," she says. Her salary is supposed to be $110,000. But one month last year, she wasn't able to pay herself at all.

Health Insurance

In this section we will look at: How insurance works Health insurance payers and plans Uninsured patients

Before we go on, it will help to know a few health

Healthcare Team

Who is on the healthcare team?Healthcare is a team effort. Each healthcare provider is like a member of the team with a special role. Some team members are doctors or technicians who help diagnose disease. Others are experts who treat disease or care for patients' physical and emotional needs.In this part of the tutorial you will learn about different types of healthcare providers, their jobs and role on the healthcare team. You will also learn who the team members are for patients with different chronic diseases. Healthcare team members we will look at include: Doctors Physician Assistants Nurses Pharmacists Dentists Technologists and technicians Therapists and rehabilitation specialists Emotional, social and spiritual support providers Administrative and support staff Community health workers and patient navigatorsinsurance definitions:

Ethics and the LawAnyone who works with patients or medical records needs to know some important ethical and legal issues. In this section of the tutorial you will learn about patient rights and responsibilities. You will also learn about HIPAA, an important law that protects patient privacy.You also know that one of your responsibilities is to keep patient information private and secure. Protecting patient information is very important. If you are ever unsure about how to handle patient information, ask your supervisor.Patient RightsWhat is the "Patient's Bill of Rights and Responsibilities"?In 1997 a presidential commission created the Patient's Bill of Rights and Responsibilities. The Patient Bill of Rights helps ensure quality healthcare. It also protects patients and healthcare workers. They also give a way for patients to address problems with the healthcare system.What are a patient's rights?According to the Consumer Bill of Rights and Responsibilities, patients have a right to: Accurate and easy to understand informationabout their health and healthcare providers. If patients speak another language, have a physical or mental disability or don't understand something, assistance must be provided so they can make informed healthcare decisions. Choose providersand plans that provide access to high-quality healthcare.Emergency serviceswhenever and wherever needed, without prior authorization or financial penalty. Know their treatment options and make decisions about their care. If patients cannot make their own decisions, parents, guardians, family members, or other designated individuals can represent them. Respect and nondiscriminatory carefrom healthcare providers and health plan administrators. Private and protected health information. This means that patients have the right to talk privately with a doctor and that only people involved with their healthcare can see their medical records. Patients also have the right to review and copy their medical records and ask that their records be changed if they are not correct or complete. Complain about healthcareor anything they feel dissatisfied with such as wait times, operating hours, the conduct of healthcare personnel or the quality of healthcare facilities. Patients also have a right to a fair, fast, and objective review of any complaint against their health plan, doctors, hospitals or other healthcare personnel.It is generally believed that as many as 40 million Americans may be without health insurance of any kind. The charge to the committee assumes access to a health plan or health insurance by all persons with RA or SLE, but such access may be the most important determinant of care and outcome for all but the most affluent.Recommendation: Community-based samples that include nonmembers of health plans should be included in longitudinal studies of differential disease course and functional status of RA and SLE patients.