Health -Care Providers Structure / Operation
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Transcript of Health -Care Providers Structure / Operation
Health-Care ProvidersStructure/Operation
Health-Care Facilities
• Primary Care– General Practice– General paediatrics– Dental Care– Visiting Nurses
• Secondary Care– Ambulatory Specialists
• Tertiary Care– Hospitals/Long Term Care Providers
General Practice
• Population wide care• Registration• Prevention/Treatment• Social Role of Physician• Density per 1000 population– CZ 0,7; Germany 0,65; Greece 0,28; – Norway 0,81; Sweden 0,62; UK 0,79; USA 0.3
Challenges
• Aging population• Changing competencies– Nursing care– Physiotherapy
• GP + Technology
Reimbursement
• Salaried GP• Fee for service• Capitation payment
Ambulatory Specialists
• Position– Hospitalits– Independent
• Reimbursement– Salaried– Fee for service– Payment per case
HospitalsBeds/1000 popul Employee/bed Nurse/bed
CZ 7,11 1,87 0,76
Germany 8,25 1,81 0,81
Netherlands 4,69 3,61 1,01
Norway 3,35 6,39 2,55
UK 3,34 6,45 NA
USA 3,08 6,25 2,27
Hospital structure
• Local ( Internal medicine +)• Regional ( average 10 specialties) • University Hospitals• Special Hospitals• Ownership– State/Municipality– Church– Private non for profit– Private for profit
Hospital department
• Outpatient– Acute – Clinics
• Inpatient– ICU – centralised/decentralised– Standard wards
Director
CMO
Head of Dept.
Ward Physician
Physicians
CNO
Head Nurse – Dept.
Ward Sister
Nurses/Porters
Head Therapists
Unit therapists
COO/CFO
Outpatient Care
• No formal limitation to patients• Low level of centralisation of Acute Care• Time management
Hospital reimbursement
• Budgeting• FFS• Case mix - DRG
Long Term CareBeds/1000 population
Beds/1000 seniors
Employees/1000 population
Employees/1000 seniors
CZ 6,5 43,3 3,6 2,4Germany 10,3 50,3 7,8 3,8Netherlands 10,4 68,5 11,7 7,7Norway 9,3 62,9 19,2 13UK 8,8 55,4 NA NAUSA 5,4 41,9 15,4 11,9
Medical Records vs. Medical Students
• Legal protection of contents – confidentiality• Only with the patient´s consent• Electronic/paper• Entries to be signed and confirmed by a
hospital employee• High level of protection– Patients ID (personal number)– Dg + treatment
Infection Prevention
• Vaccination• Clothing• Hand Hygiene– Hospital obliged to arrange– Hand + stethoscopes
• Special situations– Face masks– Pregnant students
Hospital Security and Patient Safety
• Individual badges• Doors• Awareness – strangers• Special precautions– Psychiatry– Paediatrics, neonatology– Infectious diseases