Chapter 2 Health Care Systems

• Largest and fastest growing industry in the US• Over 13 million workers• Expenditures-4 billion dollar per day business

and growing

Hospitals

• General Hospitals-treat a wide range of conditions

• Specialty hospitals-special conditions or age groups are treated

• Government hospitals-operated by gov. agencies

• University or college medical centers-provide services along with research and education

2.2 Government Agencies

• World Health Organization (WHO)• Compiles statistics and information on

disease, addresses serious health problems throughout the world

US Department of health and Human services (USDHHS)

• A National agency that deals with the health problems in the United States

National Institute of Health (NIH)

• Involved in disease research

Centers for Disease Control and Prevention (CDC)

• Concerned with causes, spread and control of diseases

Food and Drug Administration (FDA)

• A federal agency• Responsible for regulating food and drug

products sold to the public

Agency for Health Care Policy and Research (AHCPR)

• Research the quality of health care and identify standards of treatment to be provided

Occupational Safety and Health Administration OSHA)

• Provide for a safe work environment

Health Departments

• Under the direction of the USDHHS • Sanitation, inspections for environmental

health, clinics for health care

2.3 Voluntary or Nonprofit Agencies

• Funding-donations, grants, membership fees

• Function-provide funding for research, public education, provide equipment for patients in need

• Examples-Lion’s Club, American Cancer Society, American Heart Association

2.4 Health Insurance Plans• Why-pay for health care

• Deductible-amount that must be paid BEFORE the policy begins to pay

• Co-Insurance-a specific percentage of expenses is paid by the insurance company and the patient.

Ex: 70-30, 70% is paid by ins. Co. and 30% by patient• If the expenses total $2000, how much will you owe?

• Co-Payment-a specific amount the patient pays for a particular service.

Health Maintenance Organization (HMO)

• A managed care plan in which the payments stay the same each month. The advantage of this is that it covers routine examinations and preventive care. You must see HMO-affiliated providers to have coverage.

Preferred Provider Organization (PPO)

• You have to go to the preferred hospital and pay a co-payment and a deductible.

Medicare

• A federal government program that provides health care for almost all individuals over the age of 65, for any person with a disability who has received social security benefits for at least 2 years.

• 3 kinds of coverage a.) Hospital Insurance B.) Medical Insurance C.) Pharmaceutical (Medication) Expenses.

Medigap

• Policy which covers expenses not covered by Medicare.

Medicaid

• Medicaid is a medical assistance program that is jointly funded by the federal government and state government. Medicaid pays for health care of individuals with low incomes.

• State Children’s Health Insurance Program SCHIP)-healthcare for uninsured children

Worker’s Compensation

• Is a health insurance plan providing treatment for workers injured on the job.

Tricare

• U.S government health insurance plan for all military personnel.

• Provides care for all active duty members and their families, and survivors of the military personnel.

Managed Care

• All health care must have a purpose.• A second opinion is frequently required.• HMOs and PPOs are examples of Managed

Care

Health Insurance Portability and Accountability Act (HIPAA)

• Provided consumers with more access to health care

• Greater confidentiality in regards to medical records

• Standardized electronic health care records