Chapter 16

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Chapter 16

  1. 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. 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. 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. 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. 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. 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. 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. 8. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings.
  9. 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. 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. 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. 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. 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. 14. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.2
  15. 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. 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. 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. 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. 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. 20. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.1 National Health Expenditures as a Percentage of the GDP
  21. 21. Copyright © 2009 Pearson Education, Inc., publishing as Benjamin Cummings. Figure 16.2 Where Do We Spend Our Health Care Dollars?
  22. 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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