Your SlideShare is downloading. ×
Chapter 16
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Introducing the official SlideShare app

Stunning, full-screen experience for iPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Chapter 16

152
views

Published on

Published in: Business, Economy & Finance

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
152
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. 16 PowerPoint® Lecture Outlines prepared by Dr. Lana Zinger, QCC  CUNY Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Consumerism: Selecting Health Care Products and Services
  • 2. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Responsible Consumerism: Choices and Challenges  Attracting consumer dollars • Tactics used • Some are subtle • Many choices available • Important to choose carefully
  • 3. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Responsible Consumerism: Choices and Challenges  Putting cure into perspective • Spontaneous remission – disappearance of symptoms without any apparent cause or treatment • Placebo effect – patients report relief of symptoms generally brought about by what they expect, desire, or were told would happen after “treatment”
  • 4. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Responsible Consumerism: Choices and Challenges  Taking responsibility for your health care • Self-help or self-care • Know your body • Pay attention to body signals • Take appropriate action to stop progression of illness or injury • Many common forms of self-care, including home health tests, learning minor first aid
  • 5. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Responsible Consumerism: Choices and Challenges  When to seek help • Recognize when a condition needs professional help • See a professional for conditions such as serious accident or injury, adverse drug reactions, unexplained sudden weight loss, any symptom that is unusual and recurs over time, pregnancy • Home health tests for many conditions should not be a substitute for professional diagnosis and care
  • 6. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Responsible Consumerism: Choices and Challenges  Assessing health professionals • Identify what type of help you need and where to find it • You should feel comfortable with your provider • Provider should explain diagnosis and treatment options thoroughly, and involve patient care decisions • Be sure to understand coverage options • Check certifications, affiliations, availability, respect for patient • Ask questions
  • 7. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Choices in Medical Care  Conventional western (allopathic) medicine • Primary care practitioners • Physician assistants • Osteopaths • Ophthalmologists • Optometrists  Do you always consider the person’s qualifications? Why or why not?
  • 8. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
  • 9. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Choices in Medical Care  Conventional western (allopathic) medicine (continued) • Dentists • Orthodontists • Oral surgeons • Nurses • Nurse practitioners (NP) • Physicians assistant
  • 10. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Health Care Organizations, Programs, and Facilities  Critical decisions • Choosing an insurance carrier or type of plan • Choosing from among the health care providers  Types of medical practices • Group practice • Solo practitioners
  • 11. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Health Care Organizations, Programs, and Facilities  Integrated health care organizations • Nonprofit hospitals • For-profit (proprietary) hospitals • Patient Dumping • Outpatient (ambulatory care) • Surgicenters • Be aware of JCAHO
  • 12. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Third-Party Payers  Insurance • People pay into a pool of money • Draw from this money when ill • 42 million Americans are uninsured • 75% are working or dependents of workers • Many students are uninsured
  • 13. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Third-Party Payers  Private health insurance • Major medical • Fee-for-service or indemnity • Deductibles, co-pays, coinsurance • Preexisting conditions • Waiting periods • Lifetime limit
  • 14. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.2
  • 15. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Third-Party Payers  Medicare and medicaid • Medicare – adults over 65 years of age • Medicaid – poor • DRGs
  • 16. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Third-Party Payers  Managed care  Capitation  Elements 1) A budget on an estimate of the annual cost 2) A network of physicians, hospitals, and others 3) An established set of administrative rules
  • 17. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Third-Party Payers  Health Maintenance Organizations (HMOs) • Wide range of covered health benefits • Least expensive form • Patient’s typically required to use the plan’s doctors and hospitals  What are some of the downsides to HMOs?
  • 18. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Third-Party Payers  Preferred Provider Organization (PPO) • Networks of independent doctors • Contract to provide discounts • Have choice of provider • Pay more  Point of Service (POS) • Fastest growing managed care • Can go outside of HMO • Pay extra
  • 19. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Issues Facing Today’s Health Care System  Cost • U.S spends more than any other nation • $1.9 trillion annually  Access • Supply • Proximity to care • Health status • Insurance coverage
  • 20. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.1 National Health Expenditures as a Percentage of the GDP
  • 21. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.2 Where Do We Spend Our Health Care Dollars?
  • 22. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Issues Facing Today’s Health Care System  Quality and malpractice • Deaths can occur because of mistakes • Mechanisms for safety • Outcome measurements  Do you believe the U.S. health care system is safe?