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Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
Chapter 16
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Chapter 16

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  • 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?

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