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Health Care Facilities
Hospitals
Vary according to:
 Size
▫ Small
▫ Large
 Ownership
▫ Proprietary / private / for profit
▫ Nonprofit
▫ Government
▫ Religious
 Services
▫ General (Diagnostic, medical, surgical, and emergency
care)
▫ Specialty (Patients needing long-term stays; chronic
diseases, psychiatric problems, pulmonary rehab)
Long-Term Care Facilities
 Provide long-term care for elderly patients
and for patients in rehabilitation.
 Levels of long-term care:
▫ A nursing home provides care for patients who
can no longer care for themselves.
▫ An independent living facility (assisted
living)
allows patients to use only
the services they need, such
as transportation or
housekeeping.
Medical Offices
May be operated by one or two doctors or a
large groups of health care professionals.
Some medical offices treat a wide range of
conditions.
Others are specialized
for specific ages or
medical conditions.
Other Types of Facilities
 Physician and dental facilities – illness dx, simple surgery,
counseling, diagnostic services, x-rays, admin of drugs
 Rehab Centers – outpatient care for physical, occupational,
recreational, speech, or hydrotherapy
 Industrial Healthcare facilities – located in large companies
and industrial facilities to provide care to staff
 School Health Services – provide emergency care of
accidents, illnesses in a school setting. Provide care of
chronic conditions that need monitoring
 HMOs – mananged care organization that stresses wellness
as preventative care. Provides immunizations, check-ups,
education, basic medical services
Other Types of Facilities
 Home Health Agencies – provide care in home that don’t
need hospitalization; includes nursing, PT, personal care,
and homemaking
 World Health Organization (WHO) – funded by the United
Nations; concerned with world health problems and
publishes public health information
 Hospices – end of life care to patients expected to live 6
months or less.
Government Agencies
 Veterans Administration hospitals – provides care to
veterans
 US Public Health Department
 State Psychiatric hospitals – serve the mentally ill
 State Public Health Services – provide health education
materials
 US Department of Health and Human Services
(USDHHS) – protects health of all Americans by providing vital
human services
 National Institute of Health (NIH) – agency for conducting
and supporting medical research
 FDA – safety of foods, cosmetics, pharmaceuticals, biological
products
 OSHA – safety to prevent injury, illness, and death in the
workplace
Volunteer and Nonprofit Agencies
 American Cancer Society
 American Heart Association
 American Red Cross
 National Association of Mental Health
 National Foundation of the March of Dimes
 American Diabetes Association
 National Association of Mental Health
 National Coalition Against Domestic Violence
Health
Insurance Plans
Health Care Systems
Nearly every industrialized country has
a national health care system.
Some countries have public or national
health care systems, and other
countries have private health care
systems.
Public / National
Health Care Systems
• Mainly funded by taxes and social security
insurance.
• Advantage – Every citizen is guaranteed
health care regardless of economic status.
• Disadvantages – Health care is not always
comprehensive, and taxes may be higher.
• Norway, France, the United Kingdom, and
Canada
Private Health Care Systems
• Mainly funded by private insurance agencies
and out-of-pocket payments.
• Advantages – Coverage is often
comprehensive, taxes may be lower, and
economic growth is stimulated.
• Disadvantage – Not every citizen is
guaranteed health care.
• United States and Switzerland
Mixed Systems
• Very few countries have a purely
public or private system
• Most countries create a mixed system
by using various funding sources to
cover health care expenses.
• Example: Canada and the United
States
Health Insurance
The rising cost of health care is good
for the economy, but the expenses are
a burden for most individuals and
families.
In the 1920’s, the United States
developed a system of health insurance
to help cover the cost of medical
expenses.
Health Insurance Terms
 Premium – the amount paid to an insurance
agency for a health insurance policy
 Deductible - the amount that must be paid by the
patient before the insurance agency will begin to
make payments
 Co-payment - an amount paid by the patient for
a certain service
 Out-of-pocket - a medical bill that must be paid
by the patient
Individual and Group Insurance
 Individual insurance is when a person
purchases a policy and agrees to pay the
entire premium for health coverage.
 Group insurance is generally purchased
through an employer. The premium is split
between the employer and the person being
insured.
Managed Care
 Two primary concepts of managed care:
▫ To promote good health
▫ To practice preventive medicine
 Managed care plans offer medical services
through a system of health care providers.
The system of providers offers services at
reduced rates.
Managed Care
Health Maintenance Organizations
Preferred Provider Organizations
Point of Service
Health Maintenance Organizations
Clients must pay a premium, deductible,
and co-payments.
Clients must visit in-network doctors
and select a primary care physician.
HMOs urge clients to practice healthy
living and to receive preventive
treatments.
Preferred Provider Organization
 Clients must pay a premium, deductible, and
co-payments.
 Clients do not have to choose a primary care
physician.
 Clients may visit non-network physicians, but
coverage is greater with in-network
physicians.
 PPOs often have other fees and co-payments.
Point of Service
 Clients must pay a premium.
 Clients must chose a primary care physician.
 For in-network physicians, there is usually no
deductible and co-payments are low.
 Specialists may be non-network physicians,
but coverage may be limited
Government Programs
 In the 20th century, the United States
government began to realize the need for
public medical assistance.
 In 1965, President Lyndon B. Johnson
instituted two medical assistance programs to
help those without health insurance.
▫ Medicaid
▫ Medicare
Medicaid
 Income or needs based program
 Designed by the federal government, but
administered by state governments
 Usually includes individuals with low incomes,
children who qualify for public assistance, and
individuals who are blind or physically
disabled.
Medicare
Program for any citizen age 65 or older
Administered by the federal government
After an individual pays a deductible,
Medicare will cover 80% of all medical
expenses.
Medicare Services
 Part A: Hospital Care
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Hospitalization
Skilled nursing facilities
Home health care
Hospice care
Long-term care facilities
 Part B: Outpatient Services
▫ Medical expenses, including therapy, medical
equipment, and testing
▫ Preventive Care
Worker’s Compensation
Provides treatment for workers injured
on the job
Administered by the state
Reimburses the worker for wages lost
because of on-the-job injury