Personal Characteristics



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Health Care System Jigsaw - Part C




Government Agencies



You will become an expert on government health agencies. Make sure you find the answer to the questions below. Return to your group when instructed and teach this information to them.



  1. Explain what the World Health Organization does.



  1. Define DHHS. Name and define the purpose of its two main divisions.



  1. Name five services the health department provides.


  1. How are government services funded and whom do they employ?



  1. Which of the following is not an international organization?

March of Dimes


WHO
UNICEF
Red Cross

Health Care System Jigsaw - Part D





Non-Profit Agencies


You will become an expert on non-profit agencies. Make sure you find the answer to the questions below. Return to your group when instructed and teach this information to them.




  1. What is another name for a non-profit agency?


  1. How are they supported?


  1. At what level do they provide health services (local, state, national, etc)


  1. Give 4 examples of non-profit agencies.


  1. Name 4 things non-profit agencies do.


  1. What type of workers do non-profit agencies use?


Financing Health Care

TRADITIONAL (INDEMNITY) (PRIVATE) INSURANCE




  • Pays for all or part of a person’s health care

  • People pay a premium.

  • Premium = monies paid for insurance contract.


Deductible = predetermined amount that the insured must pay each year before the insurance company will pay for an illness or injury. The amounts vary and are stated in the policy.
HEALTH MAINTENANCE ORGANIZATION (HMO)


  • Provide health care services for prepaid fee.

  • Stress prevention.

  • Would rather treat early or before person is ill to prevent costly treatment and diagnostic tests.

  • Disadvantage is limitations placed on which doctors and facilities can be used.

PREFERRED PROVIDER GROUP

  • A group of doctors or hospital that agrees to provide health care at a reduced rate.

  • Usually offered by large companies.

  • Offers more flexibility to patients.

  • Patients pay lower rates if they select participating physician and facility.



MEDICARE


  • Provides care for people over age 65 and/or people with a disability who have received Social Security for more than 2 years.

  • There are two types of Medicare;

Type A or Hospital Insurance - pays for impatient

Care, skilled nursing care, and home health

care. Usually funded by Social Security taxes.

Type B or Medical Insurance - pays for physician

services, outpatient care, etc. Patient has to pay a

premium for Type B.

  • Medicare only pays 80% for all services.



MEDICAID


  • Federally-funded health insurance for people with low incomes.

  • Pays for the health care of welfare recipients, and people who are blind or disabled.

WORKER’S COMPENSATION

  • Pays both the medical bills and the wages for employee injured on the job. Administered by the state, and payments are made by employers and the state.



CHAMPUS


  • Provides care for military dependents and retired members of the armed service.



MANAGED CARE


  • Ensures that health care money is spent efficiently rather than wastefully.

  • Major principle is that all health care provided to a patient must have a purpose.




COST CONTAINMENT

  • Means of trying to control the rising cost of health care

  • Attempts at cost containment include:

1. Bulk purchasing

2. Outpatient services

3. Combining services and outpatient services

4. Diagnostic Related Groups (DRGs)
DIAGNOSTIC RELATED GROUPS

  • Patients admitted to hospitals are classified in one payment group.

  • Limit is placed on the cost of care.

  • If the cost of care is less than the amount paid, the agency keeps the extra money.

  • If the cost of care is more than the amount paid, the agency must accept the loss.




FINANCING HEALTH CARE


PLAN


DEDUCTIBLE & PREMIUMS

ADVANTAGES

DISADVANTAGES


ELIGIBILITY

Health Maintenance Organization















Preferred Provider Organization
















Medicaid
















Medicare















Workman’s Compensation

















Managed Care

















Traditional (Indemnity)


















Insurance Situations


You are a 38-year-old nurse in a local hospital. You are a single mother with four children. Your husband died in a car accident two years ago. You have just been told you will need a heart transplant in the next two years. Two of you children wear glasses. One child has asthma and another needs speech therapy. You make $47,000 a year. You have a house payment of $853 a month and your car is on its last leg. You have been depressed since the sudden death of your husband.


1

You are a 62-year-old cardiac surgeon and make $225,000 a year. You have a new young wife who needs to see a dermatologist because she spent too much time in the tanning booth and has skin cancer. You must also insure your five children from your first marriage. One of these children has a problem with drugs and needs therapy. Another child needs counseling because you left the home. You are an alcoholic and may need a new liver in a few years.


2


You are a 24-year-old surgical technologist making $21,000 a year. You have been diagnosed as HIV positive from unprotected sex, but do not want anyone to know for fear you will lose your job. The medicine you need to take is very expensive and the side effects may keep you out of work. You wear glasses, need several dental fillings, and live in an apartment.
3

You are a 32-year-old orthodontist making $150,000 a year. You are married, the parent of a two-year-old boy who had some complications at birth and needs physical therapy three times a week. He is doing quite well. Your wife wants her breasts enlarged. You need to have a root canal and both you and your wife wear contacts.


4

You are the 24-year-old punter for the Panthers and make $450,000 a year. You just got married and your wife has baby stars in her eyes. Twins run in both of your families. You wear contacts, your wife has asthma and you recently had a game injury and need surgery on your ankle. After that, you will need physical therapy for four to six weeks. You just bought your first home with house payments of $1500 per month. You have two sports cars, a truck, and a boat, and none are paid for. Your wife is a Panther’s Cheerleader.


5

You just got a job at the local hospital in housekeeping. You are 56 years old and lost your engineering job 6 months ago when your company downsized. You have a wife and three children. Two of your children are hyperactive and are on medication, which costs $200 a month. Both you and your wife wear glasses and your 16-year-old daughter wants contacts. No one has seen a dentist in the last year due to no money or insurance. Your wife just told you today, she might be pregnant because you got drunk about a month ago and did not use protection. You are worried about prostate cancer because your brother was diagnosed with it last month. Your house payment is $563 per month and you are driving an old van that it is paid for.
6

You are 72 years old, need new dentures, and have a rash on your back. You had a heart attack three month ago and your doctor has suggested open-heart surgery. Your hair has been falling out for the past year and you have considered hair transplants. You also would like a few wrinkles removed. You are a retired health occupation teacher and you make $43,000 a year. Your home and car are paid for but you need some new bifocals. You have never been married, but are still looking for love.
7

You just graduated from college and got a job as a dental assistant. You will be making $30,000 a year and feel like you are on top of the world. The first thing you want to do is have a complete physical. Your spouse and you have been trying to have a baby for the past three years with no luck yet. You may have to consult a fertility specialist. You and your spouse can get dental care free at your work. Your spouse broke his nose in a pick-up basketball game last week, and needs to have it repaired before Christmas. You are looking at new homes and furniture. Your spouse is still in graduate school and will not graduate until the spring. You are the primary breadwinner and are 26 years old.


8

You have a job as a radiology tech and make $28,000 a year. You would like to go back to school and specialize in nuclear medicine, which would mean a sizable increase in pay. You are getting married in June and want to have a tummy-tuck before the wedding. You also need two teeth capped and some new contacts. You have suddenly developed hives due to allergies, not wedding jitters. The doctor referred you to an allergist for multiple expensive tests. You have been having stomach problems, and he suggested you see a gastroenterologist. You are 29 years old and still live with your parents.


9

You are a 48-year-old medical technologist. You are going through menopause and are depressed because your youngest child just left home. You just realized you have a sexually transmitted disease you got from you spouse who left you six months ago. You doctor says you need a hysterectomy but he is afraid to do it with your depression. You need some counseling or psychological therapy. After the hysterectomy, you will need to take hormones. You need to have some teeth repaired, a facelift, and breast job to make you feel young and attractive again. You make $52,000 a year.


10

You are 32 years old and pregnant with sextuplets. The doctor put you to bed and on medication because your blood pressure is so elevated. You are a head nurse practitioner and make $65,000 a year. Your spouse just got laid off from work and you have $15,000 in savings. You will have to go to the hospital early and the medical bills will be enormous for you and the babies. They will have to go the intensive care nursery. You have 8 weeks of paid sick leave and vacation. Last night you rolled on your glasses in bed and they broke. You are very stressed and worried. Your spouse is looking for a job.
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