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Lesson 3
1. Lecture 3
Health Care Systems
Quality Assurance in Hospital Management
Institute for Nile States Strategic Studies and
Researches
2. After this lecture, you should be
able to understand:
◦ Major Trends in Health Care
◦ Types of Health Care Facilities & Agencies
◦ Health Insurance
Lecture Objectives
4. Trends in Health Care
• Technology
• Preventive Medicine and Wellness
• Aging Population
• Underinsured and Uninsured
• Ambulatory Care and Outpatient Surgery
• Home Health Care
4
6. Health Care Facilities
1. Hospitals
2. Long-Term Care
3. Practitioners’ Offices
4. Clinics
5. Laboratories
6. Emergency Medical Services
7. Home Health Care
8. Rehabilitation
9. Hospice 6
7. Health Care Agencies
• Government Agencies (Local – Nation
-Worldwide)
• Volunteer and Nonprofit Health
Agencies
7
8. Government Agencies
• Local Health Departments
– Provide immunizations, inspections, and
environmental protection.
– Collect statistics about communicable
diseases.
– May provide health education and other
health-related services to the community.
8
9. Government Agencies (cont.)
• World Health Organization
(WHO)
– International agency sponsored
by the United Nations.
– Primary goal is to help all people
attain the highest possible level
of health.
– Compiles statistics on disease.
– Provides training for medical
personnel.
9
10. Volunteer and Nonprofit
Health Agencies
• Can be on the state, local, or national level.
• Supported by private contributions and
fund-raising.
• Usually focus on a single disease.
10
12. Health Insurance
• Paying for Health Care
• Managed Care
• Health Maintenance Organizations
• Workers’ Compensation
• Military Health Care
12
13. Paying for Health Care
• Insurance company decides what medical
services will be covered.
• Group insurance coverage is offered to
employees by many employers.
Chapter 2 13
14. Managed Care
Advantages
• Most include preventive care,
such as annual physicals,
mammograms, and well-baby
care.
• Monthly premiums and out-of-
pocket expenses are usually
lower than with traditional
insurance.
• Reduced paperwork.
Disadvantages
• Limited choice of doctors and
hospitals, except for emergency
treatment.
• Must be referred to specialist by
primary care physician.
• Usually more restrictive than
ordinary insurance.
• Not all health expenses count
toward deductible.
14
15. Health Maintenance Organizations
• Focus on prevention and wellness.
• Businesses or individuals pay
premiums to the HMO instead of an
insurance company.
• HMOs focus on wellness care not
usually covered by insurance.
• Popular in the 1980s and 1990s.
15
16. Workers’ Compensation
• Insurance that covers accidents,
injuries, or diseases that occur in the
workplace.
• Federal law requires businesses to
purchase and maintain a minimum
amount of workers’ compensation
insurance.
16
17. 17
Military Health Care
• Provided to current military
personnel, retired military
personnel, and veterans through
CHAMPUS/TRICARE program.
• Public Health Service and National
Oceanic and Atmospheric
Administration are also covered
by this benefit.
Editor's Notes
There are Major Trends affecting the Health Care like:
Technology: where
Computer technology allows noninvasive diagnosis of soft tissue diseases and injuries.
Ultrasound used to examine body cavities.
Field of radiology no longer limited to X rays.
Miniaturization allows cameras and instruments to be inserted into the body for surgical procedures.
Digital images can be transmitted to a consulting specialist.
Client’s records can be made available anytime and anywhere.
Preventive Medicine and Wellness: where Hospital wellness centers offer services such as:
Cardiac rehabilitation.
Pulmonary rehabilitation.
Occupational medicine.
Sports medicine.
Clinical weight management.
Physical therapy.
Aging Population: As the population ages, demands on the health care services will increase.
Underinsured and Uninsured: As new technology and products emerge, costs increase, County hospitals, supported by taxes, care for uninsured low income people. Costs associated with the uninsured are passed on to those who are insured or can afford to pay.
Ambulatory Care and Outpatient Surgery: Technology, research, and new medications make same-day surgery possible and so Costs can be reduced when patients do not remain overnight.
Home Health Care: where Patients are released from the hospital early and receive home visits by a skilled professional. And this comes to Patient with benefits by exposure to fewer pathogens, lowered stress and anxiety, and decreased cost.
Health Care Facilities can be categorized into
Hospitals
Long-Term Care:
Residents may be frail, elderly, handicapped, or disabled.
Residents seen by the physician monthly.
Assisted-living centers offer separate living quarters, and provide meals and housekeeping.
Some residents are able to perform many of their own activities of daily living (ADL).
Practitioners’ Offices: for example Dentists and dental hygienists are included in this group.
Clinics: Practitioners have separate clients, but share billing, reception, and record-keeping staff. And it may move from location to location.
5. Laboratories: Can be part of a clinic or hospital. And Some are supported by public money.
6. Emergency Medical Services: Police officers, firefighters, and ambulance staff may perform EMS (Emergency Medical Services). And In rural areas, volunteers, park rangers, or ski patrol may provide EMS (Emergency Medical Services).
7. Home Health Care: May be long term or short term.
8. Rehabilitation: Designed to help clients regain physical or mental abilities or to help them live with disabilities. And May be part of a hospital, clinic, or privately owned.
9. Hospice: Services are provided to the terminally ill. And Includes treatment from doctors, nurses, therapists, dieticians, social workers, clergy, and volunteers.
We’ve two types of Health Care Agencies:
Government Agencies (Local – Nation -Worldwide)
Volunteer and Nonprofit Health Agencies
First, Government Agencies,
Local Health Department which:
Provide immunizations, inspections, and environmental protection.
Collect statistics about communicable diseases.
May provide health education and other health-related services to the community.
Also, the World Health Organization (WHO):
International agency sponsored by the United Nations.
Primary goal is to help all people attain the highest possible level of health.
Compiles statistics on disease.
Provides training for medical personnel.
Second, Volunteer and Nonprofit Health Agencies:
Can be on the state, local, or national level.
Supported by private contributions and fund-raising.
Usually focus on a single disease.
Paying for Health Care
Medicare and Medicaid Programs which are result of federal legislation.
Managed Care
Workers’ Compensation
Military Health Care
Paying for Health Care: where
Insurance company decides what medical services will be covered.
Group insurance coverage is offered to employees by many employers.
Managed Care: Health care plans specifically designed to control costs.
Advantages:
Most include preventive care, such as annual physicals, mammograms, and well-baby care.
Monthly premiums and out-of-pocket expenses are usually lower than with traditional insurance.
Reduced paperwork.
Disadvantages:
Limited choice of doctors and hospitals, except for emergency treatment.
Must be referred to specialist by primary care physician.
Usually more restrictive than ordinary insurance.
Not all health expenses count toward deductible.
Health Maintenance Organizations:
Focus on prevention and wellness.
Businesses or individuals pay premiums to the HMO instead of an insurance company.
HMOs focus on wellness care not usually covered by insurance.
Popular in the 1980s and 1990s.
Workers’ Compensation:
Insurance that covers accidents, injuries, or diseases that occur in the workplace.
Federal law requires businesses to purchase and maintain a minimum amount of workers’ compensation insurance.
Military Health Care:
Provided to current military personnel, retired military personnel, and veterans through CHAMPUS/TRICARE program.
Public Health Service and National Oceanic and Atmospheric Administration are also covered by this benefit.
