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Health-Care Providers Structure/Operation Health-Care Facilities • Primary Care – General Practice – General paediatrics – Dental Care – Visiting Nurses • Secondary Care – Ambulatory Specialists • Tertiary Care – Hospitals/Long Term Care Providers General Practice • • • • • Population wide care Registration Prevention/Treatment Social Role of Physician Density per 1000 population – CZ 0,7; Germany 0,65; Greece 0,28; – Norway 0,81; Sweden 0,62; UK 0,79; USA 0.3 Challenges • Aging population • Changing competencies – Nursing care – Physiotherapy • GP + Technology Reimbursement • Salaried GP • Fee for service • Capitation payment Ambulatory Specialists • Position – Hospitalits – Independent • Reimbursement – Salaried – Fee for service – Payment per case Hospitals Beds/1000 popul Employee/bed Nurse/bed CZ 7,11 1,87 0,76 Germany 8,25 1,81 0,81 Netherlands 4,69 3,61 1,01 Norway 3,35 6,39 2,55 UK 3,34 6,45 NA USA 3,08 6,25 2,27 Hospital structure • • • • • Local ( Internal medicine +) Regional ( average 10 specialties) University Hospitals Special Hospitals Ownership – – – – State/Municipality Church Private non for profit Private for profit Hospital department • Outpatient – Acute – Clinics • Inpatient – ICU – centralised/decentralised – Standard wards Director CMO CNO Head of Dept. Head Nurse – Dept. Ward Physician Ward Sister Physicians Nurses/Porters COO/CFO Head Therapists Unit therapists Outpatient Care • No formal limitation to patients • Low level of centralisation of Acute Care • Time management Hospital reimbursement • Budgeting • FFS • Case mix - DRG Long Term Care Beds/1000 population Beds/1000 seniors Employees/ 1000 population Employees /1000 seniors Netherlands 6,5 10,3 10,4 43,3 50,3 68,5 3,6 7,8 11,7 2,4 3,8 7,7 Norway UK USA 9,3 8,8 5,4 62,9 55,4 41,9 19,2 NA 15,4 13 NA 11,9 CZ Germany Medical Records vs. Medical Students • • • • Legal protection of contents – confidentiality Only with the patient´s consent Electronic/paper Entries to be signed and confirmed by a hospital employee • High level of protection – Patients ID (personal number) – Dg + treatment Infection Prevention • Vaccination • Clothing • Hand Hygiene – Hospital obliged to arrange – Hand + stethoscopes • Special situations – Face masks – Pregnant students Hospital Security and Patient Safety • • • • Individual badges Doors Awareness – strangers Special precautions – Psychiatry – Paediatrics, neonatology – Infectious diseases