Introduction to Vocational Nursing

1
Introduction to Vocational Nursing

• Chapter 7
• The Health Care System

2
The Health Care System

• Health care providers
• Health care facilities
• Health care services
• Health care regulation
• Health care financing

3
PROVIDERS

• All of these make health care services available
  to those who want need them
• People physicians, dentists, nurses, etc
• Primary health care provider is usually a
  patients 1st contact with the health care system
• Institutions hospitals, MD offices, clinics,
  etc provide health care to patients through
  their employees
• Organizations HMOs, PPOs, other health
  insurance carriers

4
Health Care Facilities

• Buildings or locations where health care is
  provided
• Hospitals
• Nursing homes
• Rehab centers
• Surgical centers
• Dialysis centers
• MD ofc
• Health clinics
• Local health departments
• Industrial health centers

5
Types of Hospitals

• Classified by ownership-
• public or private
• for profit or nonprofit
• Types of services offered
• general or all ages
• speciality such as psychiatric, pediatric
• Size
• lt 25 beds up to gt 500
• Length of patient stay
• short-term or acute
• LTC or average length of stay gt 25 days such as
  rehab facilities

6
Patient Care Units

• Acute Care
• Specialty coronary, pediatric, etc
• Amount of care patients need- Progressive patient
  care
• Intermediate care med-surg units, post partum
  units
• Intensive care coronary care units, neonatal
  intensive care units
• Self-care units rehab units
• Long term care nursing homes

7
Health Care Service

• Term used to describe the actual delivery of
  health care by health care workers
• Includes prevention, diagnosis, treatment of
  illness
• Providing care during an illness
• You will be a member of a team providing health
  care services

8
Regulation, Approval Accreditation

• Regulation methods designed to control the
  quality cost of health care
• Approval minimum regulatory standards that a
  facility must meet to admit pts approval by
  individual state departments of health-mandatory

• Accreditation a process in which an accrediting
  agency uses their written standards of excellence
  to examine the operations of a health care
  facility or organization go above beyond
  minimal standards JCAHO usually voluntary

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• Hospitals approval is mandatory, accreditation
  is voluntary UNLESS the hospital wants to sponsor
  medical ed programs or receive payment from
  Medicare several other insurance plans, then it
  is mandatory.

• LTC facilities same as hospitals
• Home Community Health care organizations same
  as hospitals
• Any facilities receiving Medicare and/or Medicaid
  monies are strictly regulated by these agencies

10
CQI

• Continuous quality improvement
• The overall plan for improving the quality of
  care
• Quality assurance sets minimal standards of care
• Quality improvement- helps the organization to go
  above beyond minimum standards of care
• Peer review examination of a persons work by
  others people in equal standing. Nurses
  reviewing the charting performance of other
  nurses.

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RISK MANAGEMENT

• INTENDED TO HELP REDUCE FINANCIAL LOSS IN A
  FACILITY
• ACCOMPLISHED BY IDENTIFYING SITUATIONS THAT
  RESULT IN
• longer lengths of stay
• pt, visitor or staff injuries
• pt care injuries
• BASED ON THESE FINDINGS POLICIES ARE ADJUSTED TO
  PREVENT LOSS

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HEALTH CARE FINANCING

• How Health Care is Paid For
• PRIVATE INSURANCE
• indemnity, BCBS
• prepaid, HMO

• GOVERNMENT INSURANCE
• medicare-totally federally funded for persons
  65 or older
• medicaid federal state funded covers poor
  of any age

13
Controlling Health Care Costs

• Prior to 1983 health care costs were pd by the
  retrospective payment method
• MD could order any procedure or test thought
  necessary it was paid for, no questions asked
• In 1983 DRGS or diagnosis related groups were
  introduced

• Prospective payment method where costs for health
  care were set in advance
• Based on a MDC or major diagnostic category
• Example a set amount would be paid for any one
  who comes in for an appendectomy
• Table 7-3

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Health Care the US Government

• Dept. of Health and Human Services
• CDC agency to which communicable diseases are
  reported
• FDA-protects the public from unpure unsafe
  foods, drugs cosmetics

• HRSA health care resource problems
• NIH research agencies
• IHS health of Native American Indians Alaskan
  natives
• CMS administers various programs such as
  medicare, medicaid

15
Private Organizations

• Adult child day care centers
• Meals on Wheels
• AA, MADD, etc
• Nontraditional approaches herbs, vitamins, etc
• National organizations American Heart
  Association, etc
• Local/community blood drives, BBQ to raise
  money for individuals without health insurance

16
Health Care Concerns

• Access to health care for all?
• Health care providers, nurse shortage
• Unreimbursed care
• Health care financing