Download Physician - Warren Hills Regional School District

Accessing Reliable Health Care
Why is it important to access
Reliable health Care?
When you are sick or injured you may
need immediate help!
Knowing where to get medical help!
How to pay for it can save time, hassle,
stress, & money.
WHAT TO KNOW ABOUT HEALTH-CARE
PRACTITIONERS AND PROVIDERS
Health-Care Provider-trained professional who provides people with medical
care.
Physician- an independent health-care provider who is licensed to practice
medicine.
Physician’s Job Description- obtain medical histories, perform physical
examinations, give diagnoses & licensed to prescribe medications (some
physicians are licensed to perform surgery).
Two Types of Physicians
Medical Doctor (M.D.)- is a physician who is trained
in a medical school and has a medical doctoral degree
(can choose to work in primary care or specialist area)
Doctor of Osteopathy (D.O.)- is a physician who is
trained in a school of osteopathy and has a doctor of
osteopathy degree (can choose to work in primary care or
specialist area).
Medical Terminology
Osteopathy- uses common
medical procedures, but
also places emphasis on
the relationships between
body systems. (These
doctors “osteopaths” are
trained that the body
systems are all connected
and if one system is
disturbed it can affect
other systems.
Medical Terminology
Primary Care- is
general health care.
The first health care
provider that a
patient contacts is
the primary physician
to provide basic
care. Also, primary
care physicians can
refer patients to
specialists.
Medical Terminology
Specialist- is a professional who has
specialized training in a particular area.
(Two-thirds of physicians are specialists)
Health-Care Practitioners-an
independent health-care provider who is licensed
to provide general or specialized care for a
specific area of the body.
Podiatrist- a doctor of Podiatric Medicine (DPM) who specializes in
the care and treatment of feet.
Optometrist- is an eye care professional who is specially trained in
a school of Optometry. This doctor can examine eyes and prescribe
corrective lenses or exercise for a patient with eye problems.
Dentist- is a doctor of Dental Surgery (DDS) or doctor of Medical
Dentistry (DMD) who specialized in the care and treatment of the
teeth and mouth.
ALLIED PROFESSIONAL- IS A TRAINED
HEALTH-CARE PROVIDER WHO
PRACTICES UNDER THE SUPERVISION OF
A PHYSICIAN OR HEALTH-CARE
PRACTITIONER.
I.E. AUDIOLOGISTS, DENTAL
HYGIENISTS, PHARMACISTS, PHYSICAL
THERAPISTS AND RADIOLOGISTS.
Choosing Health-Care Providers
Check telephone book (Health-Care Providers) listed in
yellow pages of telephone directory.
Check local chapters such as the American Medical
Association (AMA), and the America Dental Association
(ADA), which keep lists of their members.
Inquire Hospitals- have lists of physicians
recommended/or offer other recommendations.
PRIMARY-CARE PHYSICIAN
To choose primary-care physician
who will provide basic medical
care and help prevent illness.
Family Practitioners, Pediatricians,
Internists
Should be familiar with patient’s
medical history/health-care needs.
May refer patient to a specialist if
further diagnosis or treatment
needed.
Health Insurance!!!!
Health Insurance- financial
protection that provides benefits for
sickness or injury.
1st Patient buys insurance.
2nd Health Provider- agrees to pay
or reimburse the cost of care
3rd Insurance Provider- predicts that
they will collect more money in
premiums than it will pay out in
claims.
Health Insurance Terminology
Premium- amount
paid for the
insurance coverage
Claim- is a bill
from the healthcare provider.
Insurance Policyis a legal
document that
outlines the terms
of the insurance
coverage.
Deductible- is the
amount that must
be paid by the
individual before
the insurance pays
the claims.
Co-payment-is the
portion of the
medical fee the
individual must
pay whether or not
there is a
deductible.
* Private Insurance Policies must be paid by the
individual, or the employer , or even both parties (some pay
entire cost of medical, others pay a portion).
Managed Care- control the types of health care individuals receive
and the amount paid for care.
TWO TYPES OF MANAGED CARE
1. Health Maintenance Organizations (HMOs)
2. Preferred Provider Organizations (PPOs)
Health Maintenance Organizationa business that organizes health
care services for its members.
Try to provide lowest cost
Except for an emergency or with approval
Only covers services from the HMO
HMOs encourage preventive health care
Preferred Provider Organization- a business
that has a contract with a group of health-care
providers who agree to provide services at a
reduced rate.
Individuals must select preferred providers/
or pay higher cost for health services
Government Insurance
Medicare-insurance for people 65 years and
older. Also, for individuals who received
social security disability benefits for two or
more years.
Medicaid- insurance for people with low
incomes.
Two Kinds of Expenses
Covered Expense- is a medical expense that
is paid for under the terms of a health
insurance plan.
Excluded Expense- is a medical expense that
a health insurance plan will not pay.
Recommendations for Evaluating
Health Insurance
Study health insurance carefully by looking at terms and conditions such as what is covered and
not covered!!!
Shop around for health insurance and ask questions!!!
Choose a plan that is the most comprehensive coverage ad is affordable!
Pre-existing Conditions- is a health problem that a person had before being covered by the
insurance.
Some insurance providers will not sell you insurance if you have any disabilities or preexisting conditions (considered high risk)!
Make Yourself Insurable!!!
Get routine check-up/immunizations
Learn to do breast or testicular self-exams
Get plenty of rest. sleep, and physical activity
Eat appropriate amounts of healthy foods, limit amount if sugar, sodium intake, avoid drugs,
alcohol, and tobacco
Control stress, drive safely and wear a seatbelt
More than 40 million people in the U.S. do not have health
insurance. Therefore, in case of an emergency, it can become
very expensive to seek treatment in a hospital emergency
room or trauma center.
Living without Health Insurance
Life transitions: new job, self-employment,
unemployment, marriage, divorce, or graduation from
college (could affect your health insurance)
Being Uninsured May Not Be a Matter of Choice
Expensive Health Insurance Premiums
Be eligible for Health Insurance
Unemployment
Rising Health-Care costs(difficult for employers to offer)
Chronic Health conditions/not eligible (high-risk category)
Group Health Insurance
Self-employed: trade groups, labor unions,
associations, chambers of commerce, or other groups
that offer health insurance programs.
Some states offer health insurance pools for people with
certain chronic diseases, agriculture workers, asbestos
removal workers and scuba divers.
27.3% of ages 18-24 years old are uninsured
Children’s Health Insurance Program (CHIP)
created in 1997
Short-Term Health Insurance Policies
People temporarily out of work and looking for a job
Maximum 6 months and is renewable for one time
Plan to leave a job may convert group plan to individual
plan.
Consolidated Omnibus Budget Reconciliation
Act (COBRA)- gives worker’s the right to continue their
employer’s health benefits for limited period of time
because of job loss, reduction in hours worked, death,
divorce, or other life events.
Health-Care Facilities
Location of Facility
Hours
Services Provided
Fees they charge
What To Know About Health-Care Facilities
Hospital- is a healthcare facility where people can
receive medical care, diagnosis, and treatment in an
inpatient or outpatient center.
Inpatient Center- is treatment that requires a person
to stay overnight at a facility.
Outpatient Center- is treatment that does not require
a person to stay over night at a facility.
Ambulatory Surgery Center- facility where surgery is
performed on an outpatient basis. (health insurance
recommend outpatient surgery/care because it is onethird less cost than inpatient care.
Urgent-Care Centers
Do not need an appointment for these centers
Fees are less than hospital emergency rooms
Physician’s Office
Physician’s Office- facility that provides routine
health care. i.e. diagnosis, simple testing,
treatments, examinations or minor surgeries.
(nurse, practitioners and physician’s assistants)
Types of Hospitals
Private Hospital- owned by private individuals
Voluntary Hospitals- owned by community/
organization (does not operate by profit)
Government- operated by federal, state, or
local government through the benefit of a
special populations. i.e. Veterans Administration
Health Centers
Health Center- facility that provides routine
health care to a special population. i.e. low
income families.
Mental Health Clinic- facility that provides
services for people who have mental disorders.
(majority of mental health clinics are open 24
hours).
Laboratories
Laboratories- these are medical laboratories that
perform diagnostic test, such as blood or urine
tests. (also can be part of hospitals) i.e. Dental
Laboratories-make crowns, or bridges used to
repair teeth.
Extended-Care Facility
Extended-Care Facility- facility that provides
nursing, personal and residential care
People who need assistance with daily living
Examples are nursing homes and convalescent
homes
Home-Health Care Organizations offer
nursing care, medical treatment, and therapy
in the home.
Home-Health Care
Home-Health Care- agencies that provide care
in a patient’s home. Services: nursing,
rehabilitation therapy, bathing, housekeeping,
and food preparation.
Who offers Home-Health Care?
Health Departments, Hospitals, Private
Agencies and Volunteer Groups
Hospice
Hospice- is a care for the terminally ill and
their families. (In-Home Care)
Provides 24 hour service, contact, and
support continues for at least one year
after a family member dies.