This will walk you all through the provider section in U.S Healthcare system.This contains basic information about what is Provider umbrella.

1. An Overview

2.  Health Insurance: It will be a contract that requires your health insurer to pay
some or all of your health care costs in exchange for a premium.
 Insurer/Payer: The insurance company whose plan pays to help cover the
cost of your care.
 Primary Insurer: The insurance plan processes the claim first when a member
has more than one group insurance plan covering the services.
 Healthcare Provider: It can be any person (doctor or nurse)/institution
(hospital, clinic or laboratory) that provides medical care.
 Member/Subscriber: A person who is enrolled in a health plan (also called an
enrollee or subscriber)
 Group: It can be an Employer, Group Insurance
 Plan: An individual or group plan that provides, or pays the cost of medical
care.

3.  An institution (such as a hospital or clinic) or
person (such as a physician, nurse, allied
health professional or community health
worker)
 Provides preventive, curative, promotional,
rehabilitative or palliative care services in a
systematic way to individuals, families or
communities.

4.  The World Health Organization estimates
there are
◦ 9.2 million physicians
◦ 19.4 million nurses and midwives
◦ 1.9 million dentists and other dentistry personnel,
◦ 2.6 million pharmacists and other pharmaceutical
personnel
◦ 1.3 million community health workers worldwide,
making the health care industry one of the largest
segments of the workforce.

6. Components of US Healthcare System

7. Types of Healthcare Providers
• Primary Care
• Nursing Care
• Drug Therapy
• Specialty Care

8.  A primary care provider (PCP) is a person you may see first for checkups and
health problems. PCPs can help manage your overall health. If you have a
health care plan, find out what type of practitioner can serve as your PCP.
 The term "generalist" often refers to medical doctors (MDs) and doctors of
osteopathic medicine (DOs) who specialize in internal medicine, family
practice, or pediatrics.
 Obstetrician/Gynecologists (OB/GYNs) are doctors who specialize in obstetrics
and gynecology, including women's health care, wellness, and prenatal care.
Many women use an OB/GYN as their primary care provider.
 Nurse practitioners (NPs) are nurses with graduate training. They can serve as
a primary care provider in family medicine (FNP), pediatrics (PNP), adult care
(ANP), or geriatrics (GNP). Others are trained to address women's health care
(common concerns and routine screenings) and family planning. NPs can
prescribe medicines.
 A physician assistant (PA) can provide a wide range of services in collaboration
with a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO).

9.  Licensed practical nurses (LPNs) are state-licensed caregivers who
have been trained to care for the sick.
 Registered nurses (RNs) have graduated from a nursing program,
have passed a state board examination, and are licensed by the
state.
 Advanced practice nurses have education and experience beyond
the basic training and licensing required of all RNs.
 Advanced practice nurses include nurse practitioners (NPs) and the
following:
 Clinical nurse specialists (CNSs) have training in a field such as
cardiac, psychiatric, or community health.
 Certified nurse midwives (CNMs) have training in women's health
care needs, including prenatal care, labor and delivery, and the
care of a woman who has given birth.
 Certified registered nurse anesthetists (CRNAs) have training in the
field of anesthesia. Anesthesia is the process of putting a person
into a painless sleep, and keeping the person's body working so
surgeries or special tests can be done.

10.  Licensed pharmacists have graduate training from
a college of pharmacy.
 Your pharmacist prepares and processes drug
prescriptions that were written by your primary or
specialty care provider. Pharmacists provide
information to people about medicines. They also
consult with health care providers about dosages,
interactions, and side effects of medicines.
 Your pharmacist may also follow your progress to
check that you are using your medicine safely and
effectively.
 Pharmacists also can evaluate your health and
prescribe medicines.

11.  Your primary care provider may refer you to
professionals in various specialties when
necessary, such as:
◦ Allergy and asthma
◦ Anesthesiology -- general anesthesia or spinal block for
surgeries and some forms of pain control
◦ Cardiology -- heart disorders
◦ Dermatology -- skin disorders
◦ Endocrinology -- hormonal and metabolic disorders,
including diabetes
◦ Gastroenterology -- digestive system disorders
◦ General surgery -- common surgeries involving any part of
the body. Etc.

12.  Group of health care providers that have contracted
with a health insurance carrier.
◦ Example: HMO - Health Maintenance Organization
◦ PPO - Preferred Provider Organization
◦ EPO - Exclusive Provider Organization
 Health insurance companies want you to use the
providers in their network for two main reasons:
◦ These providers have met the health plan’s quality standards.
◦ They've agreed to accept a negotiated discount rate for their
services, in trade for the patient volume they'll receive by
being part of the plan's network.

13. Spending and
Estimations

14.  According to the World Health Organization (WHO),
total health care spending in the U.S. was 18% of its
GDP in 2011, the highest in the world. The Health
and Human Services Department expects that the
health share of GDP will continue its historical
upward trend, reaching 19% of GDP by end of 2017.
 Of each dollar spent on health care in the United
States, 31% goes to hospital care, 21% goes to
physician/clinical services, 10% to pharmaceuticals,
4% to dental, 6% to nursing homes and 3% to home
health care, 3% for other retail products, 3% for
government public health activities, 7% to
administrative costs, 7% to investment, and 6% to
other professional services (physical therapists,
optometrists, etc.)

15.  Facilities : As of 2018, there were 5,534 registered
hospitals in the United States. There were 4,840
community hospitals, which are defined as
nonfederal, short-term general, or specialty
hospitals. The non-profit hospitals share of total
hospital capacity has remained relatively stable
(about 70%) for decades. There are also privately
owned for-profit hospitals as well as government
hospitals in some locations, mainly owned by
county and city governments.

16. End Of Slide