The Health Care System
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Identify changes that have occurred in how health care is delivered.
- In the United States during the 1700s, 1800s and early part of the 1900s, most people who needed health care received it in their homes. Most care was provided by family members and a family doctor.
Today, health are is delivered in the home through home health care agencies and hospice organizations. In addition, people can go to health care facilities such as hospitals, sub-acute care units, long-term care facilities and assisted-living facilitiesto receive health care. The family doctor is now the general practioner or family physician and in my cases he or she is supported by a team of specialists.
Describe the different types of health care organizations.
- Hospital- a health care facility that provides treatment for people with acture medical or surgical conditions.
- Sub-acute Care Unit (skilled nursing unit, skilled nursing facility)- a unit within a hospital or a long care facility or a separate facility that provides care focused on rehabilitation and helping the patient to move from hospital to home care.
- Long-Term Care Facility- a health care facility that provides care for people who are unable to care for thenselves at home, yet do not need to be hospitalized; some times referred to as a "nursing home".
- Assisted-Living Facility- type of long-term care facility that provides residents with limited assistance with tasks such as medication administration, transportation, meals and housekeeping.
- Home Health Care Agency- an agency that provides skilled care in a person's home.
- Hospice Organization- a health care organization that provides care for people who are dying and their families.
Briefly explain the structure of a health care organization.
- Governed by a Board of Trustees, who sets policies to ensure that the care offered by the organization is safe, of good quality and meets the needs of the community.
- An Administrator or Chief Executive Officer(CEO) usually manages the organization and is the link between the board and the organization.
- The Medical services division is led by a Medical Director and is resposible for the the doctors on staff.
- Nursing services is headed by a Director of Nursing (DON) or Chief Nursing Officer (CNO) and is responsible for all aspects of the organization that have to do with patient or resident care.
- Business services is led by a Business Director and usually oversees admissions, billing, payroll and may also oversee maintenance and house keeping.
- The Ancillary services division typically contains the departments in the organization that provide patient or resident services, such as social services and dietary services.
List some of the goverment and private agencies that provide oversight of the health care system.
- The Department of Health and Human Services (DHHS) is the primary government agency responsible for protecting this nation's health The DHHS oversees government agencies such as the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the Cneters for Medicare and Medicaid Services (CMS).
- The Joint Commission is a private, nonprofit agency that sets national standards for all types of health care organizations and officially recognizes (accredits) Orgs that meet these standards.
- Occupational Safety and Health Administration (OSHA) an agency within the Dept of Labor that establishes safety and health standards for the workplace, to protect the safety and health of employees.
Describe how the survey process is used to monitor the quality for care given by health care organization.
The survey is an inspection of a health care organization or facility done to ensure that care is being provided according to standards and regulations. The survey is performed by officials referred toas the survey team or surveyors.
What does it mean for a facility if deficiency citations are included in the report at the end of the survey process? What circumstances follow?
- Deficiency citations are statments that identify the standards that were not met as well as the survey team's findings that indicate how the facility failed to meet the standards.
- The facility must respond by submitting and carrying out a formal plan of correction that outlines specific actions that the facility will take to fix the problems.
- Consequences of not regaining compliance status include, loss of accredittaion status, substantial fines, an inability to qualify for Medicare or Medicaid payments, an admission ban and/or closure.
Discuss how health care is paid for.
- Private and group insurance policies are on way that individuals pay for health care.
- Due to the increasing costs of medical care the insurance industry has taken measures to control costs through a precertification (preapproval) process or managed care system (PPO & HMO).
- Medicare is government funded insurance for People who are 65 or older. Long term care facilities must complete a Minimum Data Set report for each person in their care in order to receive reimbursements. Medicare also started a reimbursement program based on DRGs.
- Medicaid is goverment funded insurance for people with low incomes pay.
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