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Health Care Systems Worksheet

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what is the largest growing industry in the country?
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health care
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how many different health care careers does our DHO text say that there are in the medical industry?
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more than 200
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public hospitals
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are funded by local, state and federal funds. As a result, they cannot turn anyone away.
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private hospitals
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are owned and governed by a person or many people who are managing the finances. Most require a fee for services. Because they are privately owned, private hospitals have the right to refuse treatment. By law, however, they must stabilize anyone who is in an emergency situation and may then send him or her to a public hospital.
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general hospitals
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treat a wide range of conditions and age groups—provide diagnostic, medical, surgical, and emergency care.
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specialty hospitals
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provide care for special conditions or age groups. (burn hospital, cancer center, etc)
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government hospitals
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operated federal, state and local government agencies, Veteran’s Administration Hospital, state psychiatric facilities)
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university or college medical centers
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provide hospital services along with research and education (can be funded with private and or government sources)
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Non profit hospital
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Nonprofit are supported by donations, membership fees, fundraisers, and federal or state grants. For profit require a fee for services. A nonprofit hospital means the facility does not pay either state or local property taxes or federal income taxes because it is considered a charity, and proves certain community benefits in accord with state and federal guidelines.
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Profit owned hospital
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A for-profit, or investor-owned, hospital means the facility is either owned by private investors or is owned publicly by shareholders and is part of a company that issues shares of stock to raise revenue to expand the hospital activities
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Long term care facility
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provide assistance and care for mainly elderly patients, but also for individuals with disabilities and chronic illness. The residents live there for an extended period of time. Examples- nursing homes, extended care facilities and assisted living facilities.
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Residential care facility
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designed to provide basic physical and emotional care to individuals who can no longer care for themselves.
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Extended care facility
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designed to provide skilled nursing care and rehabilitative care to prepare for return home or other long-term care facility.
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independent living, assisted living
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allow individuals who can care for themselves to rent or purchase an apartment in the facility. Provides services such as meals, housekeeping, laundry, transportation, social events, and basic medical care like medication administration.
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medical offices
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vary from offices that are privately owned by a doctor to large complexes that employ many doctors. (Offer diagnosis, examinations, treatments, basic lab testing, minor surgery, etc….)
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dental offices
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offices owned by one or more dentists
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urgent car for emergency care clinic
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clinic that provides first aid or emergency care to ill or injured patients.
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outpatient clinic
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clinic usually operated by a hospital that provides care to patients who are not admitted to the hospital. THESE ARE ALSO CALLED AMBULATORY FACILITIES. Can be surgical centers, urgent care centers, optical centers
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health department clinic
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Clinic that offers pediatric care, treatment of sexually transmitted diseases, respiratory diseases, immunizations, etc….
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optical centers
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Facility that provide vision exams, prescribe eyeglasses or contact lenses and check for eye disease
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emergency care services
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Provide special care for accidents or sudden illness in hospitals or in free standing clinics for minor care emergencies
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laboratories
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Perform special diagnostic tests such as blood and urine tests
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home health care
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Provide care in a patient’s home
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hospice
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Provide care for terminally ill persons in the hospital, home or a specialty center.
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mental health facilities
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Deal with emotional problems or mental disorders.
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genetic counseling centers
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Facility that works with couples who are pregnant or planning to be pregnant and provide prenatal screening. Sometimes called fertility clinics
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rehabilitation facilities
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Provides care directed at helping pt with physical or mental disabilities to obtain maximum self-care and function may be occupational, physical, speech or recreational therapies
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Industrial health care center or occupational health clinics
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Health centers located in large companies or industries for first aid, education and screening
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school health services
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Provide health services at schools or colleges; can include emergency care, education, heath screenings etc
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health maintenance organizations
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both health care delivery systems and types of health insurance. Provide total health care directed toward preventative health care for a fee that is usually fixed and prepaid.
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WHO
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World Health Organization -international agency sponsored by United Nations to compile statistics and addresses diseases around the world
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USDHHS
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US Department of Health and Human Services -national agency deals with health problems in US
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NIH
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National Institutes of Health -division of the USDHHS, researches diseases
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CDC
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Centers for Disease Control and Prevention -division of USDHHS, concerned with causes, spread and control of diseases.
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FDA
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Food and Drug Administration -federal agency responsible for regulating food and drug products
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AHCPR
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Agency for Health Care Policy and Research -federal agency to research the quality of health care delivery
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OSHA
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Occupational Safety and Health Administration – establishes and enforces standards to protect workers from job related injuries and disease
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health departments
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directed by the USDHHS -immunization for diseases, environmental health and sanitation, communicable diseases, statistics and records
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VA
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Veteran’s Administration: or US Department of Veteran’s Affairs: VA operates the nation’s largest integrated health care system, with more than 1,700 hospitals, clinics, community living centers, domiciliaries, readjustment counseling centers, and other facilities.
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voluntary agencies/non profit agencies
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They are supported by donations, membership fees, fundraisers and federal or state grants.
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three agencies that are nonprofit
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American Cancer Society American Red Cross American Heart Association
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American Heart Association
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They study diseases, provide funding to encourage research, promote public health education
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HOSA
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is a nonprofit student organization that promotes career opportunities in health care.
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health insurance plans
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Help pay for the cost of health care. 15% of the gross national product (money spent on goods and services in the US) is on health care.
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Why are health insurance plans so important in this country?
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Without insurance, the cost of illness can cause financial disaster for an individual or family
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insurance premium
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Fee the individual pays for health coverage that is made to the insurance company.
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deductible
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Amounts that must be paid by the patient for medical services before the policy begins to pay. (may be $500, $1000, $2000 etc depending on your policy requirements.—lower deductibles usually have higher premiums)
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co-insurance
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Requires that specific percentages of expenses are shared by the patient and insurance company
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80/20%
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The company pays 80% of covered expenses, the patient pays 20%
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co-payemnt
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Specific amount of money a patient pays for particular service. $10 per physician visit. (called a co-pay)
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employee sponsored
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employer assisted health insurance coverage for employees. The employer often pays all or part of the premium.
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private insurance
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purchased by an individual
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supplemental insurance
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works in combination with other insurance. It’s not designed to stand on its own or provide basic, primary health coverage. Example a cancer policy
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medicare
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most people over 65, those with SS disability over 2 years, any person with end stage kidney disease
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medigap
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pay expenses not covered by Medicare. Must be eligible for Medicare. Offered by private insurance companies for a premium
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medicaid
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Individuals with low incomes Children who qualify for public assistance Individuals who are physically disabled or blind
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SCHIP
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provides healthcare to children of working families that earn too little income to afford private insurance but too much to qualify for Medicaid.
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worker’s compensation
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provides treatment for employees injured on the job
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TRICARE
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formerly CHAMPUS- health insurance plan for active duty military and their family, survivors of military personnel, and retired members of armed forces.
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managed care
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an effort to provide quality care at the lowest possible cost.
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Health Maintenance Organization (HMO)
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• Monthly fee (premium) paid for membership • Fee stays the same regardless of amount of health care used • Premium paid by employer or individual • Focus on preventive health care • Participants required to use ONLY HMO-affiliated healthcare providers
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Preferred Provider Organization (PPO)
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• Monthly fee (premium) paid for membership • PPO contracts with health providers and agencies to provide health care at reduced rates. • PPOs usually require a deductible and co-payment • If non-affiliated provider used, the PPO may require co-payments of 40 – 60%
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government- medicare
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Provides health care for: Individuals over the age of 65 Person with disability for two or more years Three types of coverage: Type A for hospital insurance Type B for medical insurance Type D for pharmaceutical expenses Individuals pay a premium and deductible for Type B coverage Medicare only pays 80% of services
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government- medicaid
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Jointly funded by federal and state government, but operated by individual states States establish eligibility standards, payment rates, etc. Usually pays healthcare for: Individuals with low incomes Children who qualify for public assistance Individuals who are physically disabled or blind
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Diagnostic-Related Groups (DRGs)
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Government effort to control costs for Medicare and Medicaid Patients with certain diagnoses classified in one payment group Limit placed on cost of care Agency only gets the set amount, so makes every effort to stay within the expense limit allowed
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Government- worker’s compensation
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Health insurance plan for workers injured on the job Administered at the state level Payments made by employers and the state Plan also reimburses for wages lost because of on-the-job injury.
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Government- TRICARE
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U.S. Government health insurance plan for military personnel. Provides civilian health care for active duty military members and their families, survivors of military personnel, and veterans
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HIPAA
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the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs.
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What is one reason the Health Insurance Portability and Accountability Act was passed? (HIPAA)
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Individuals with chronic illnesses often can not find insurance coverage if their place of employment changes.
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What are the five main components of HIPAA?
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1. Health care access, portability and renewability: limits exclusions on pre-existing conditions to allow for continuance of insurance even with job changes 2. preventing health care fraud and abuse: administrative simplification and medical liability reform. Sets up methods to prevent fraud and abuse and reducing costs of administration by adopting a single set of electronic standards instead of a wide variety of formats in health care. 3. Tax related health provisions: promotes medical savings accounts 4. application and enforcement of group health plan requirements sets up standards for group health to offer portability, access and renewability 5. Revenue offsets. Changes IRS code for expenses
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PPO
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preferred provider organization
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HMO
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health maintenance organization
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HIPAA
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health insurance portability and accountability act
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LTC
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long term care
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ADL
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activity of daily living
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AHA
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american heart association
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HOSA
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health occupations students of america