Assignment

Overview

Begins to look at the health care industy as a business where providers, services, and products are provided to consumers in an effort to create revenue while maintaining quality standards. The types of business ownership (public, not-for-profit, and for-profit) and business models (solo-practice, medical group, and corporation) are reviewed with an emphasis on the pros and cons of each.

An understanding of the type and model of the health care business helps establish the foundational knowledge to delve into the different health care entities providing services in the industry. The service entities fall into several categories: education and research, suppliers, insurers and payors (finacers), government, and providers of health care services. As one will see, the health care industry consists of more than hospitals and doctor's offices. It is an integrated delivery system of service providers who each have a role in ensuring quality and affordable care is provided to meet the needs of the patient and consumer.

What you will cover

1. Health Care Services

1) Types of business ownership in health care

a) What is a business?

(1) Provides a product or service to a consumer in an effort to create revenue or profit

b) What does it take to produce a product?

(a) Resources (people, time, and money), equipment, and materials

c) Public (government run)

d) Not-for-profit (board of directors)

e) For-profit (shareholders)

f) Types of business models

(a) Solo practice: single owner who establishes a business and accepts all liability, debts, and profits on their personal income tax

(b) Medical group (general partnership or limited partnership): two or more owners who establish a business and share mutual liability, debt, and profits depending on how the medical group contract is written. Taxes are filed under the business and then also reported on personal taxes as income.

(c) Corporation, S Corporation, or Limited Liability: an HC organization established by one or more investors. No one person assumes the liabilities, debts, or profits; instead the corporation assumes all of it. The corporation files its own tax returns.

a. Describe the services within the health care industry.

1) The U.S. health care system is a complex delivery system comprised of many organizations that each have a role in ensuring quality of care.

a) Education and Research

(a) Medical and dental schools
(b) Nurse training programs
(c) Research organizations
(d) Private foundations
(e) Professional associations
(f) Trade associations
(g) Government-funded research

b) Suppliers

(a) Pharmaceutical companies
(b) Multipurpose suppliers
(c) Biotechnology companies

c) Insurers and Payors (financers)

(a) Commercial insurers
(b) Government-sponsored plans
(c) Employer-sponsored plans

d) Government

(a) Health policy development
(b) Public health agencies

e) Providers of health care services

(a) Finding care at the right level based on the needs of the patient
(b) Preventive care and public health: protecting and improving the health of populations and not just individuals

a. Local (city or county) health departments
b. State departments of health and human services
c. Non-profit organizations
d. Community programs
e. U.S. Centers for Disease Control and Prevention

(c) Primary care (ambulatory care): fully mobile patients bring themselves in for care of non-life-threatening issues

a. Private physician office
b. Community clinics
c. Urgent care centers
d. Public health offices
e. School-based health centers
f. Adult day care

(d) Subacute or long-term care: provision of health care services and housing services provided over an extended period of time to individuals who have a temporary or chronic illness or have suffered an injury or disability

a. Home care
b. Nursing homes
c. Assisted living facilities
d. Skilled nursing rehabilitation facilities

(e) Acute care: individuals in need of immediate live saving care or treatment

a. Emergency rooms
b. General or community hospitals
c. Teaching hospitals and academic medical centers
d. Specialty hospitals

i. Cardiac
ii. Cancer
iii. Outpatient surgical centers
e. Trauma centers

(f) Auxiliary services: services that supplement or support other providers of health care services. These providers can be found within an acute setting provider or standalone outpatient providers.

a. Pharmacy
b. Diagnostic clinics
c. Radiological clinics
d. Medical equipment suppliers

(g) Rehabilitative services: services provided to individuals who have experienced a debilitating injury, illness or disease in efforts to recover to a state of normalcy.

a. Outpatient rehab centers
b. Acute rehabilitation centers

(h) End-of-life care: medically obvious that death is imminent. Efforts are made to keep the person free from pain.

a. Hospice

f) Other delivery systems

(a) Mental health facilities
(b) Dental facilities
(c) Military and veterans facilities
(d) Indian health service facilities

b. Identify providers, services, and products that support the health care industry.

1) Integrated Delivery System (IDS): coordinated, comprehensive, and integrated management and delivery of health services
2) Examples of IDS

a) Staff HMOs such as Kaiser Permanente
b) Accountable Care Organizations (ACO)
c) Medical homes

3) Issues within the health care system an IDS will address

a) Lack of coordination between different levels and settings of care
b) Duplicated or inefficient services and infrastructure
c) Health care not provided at optimal or most appropriate level or setting
d) Multiplicity of health care payers and payment mechanisms

4) How does the U.S. health care delivery system differ from other countries?

a) Health care expenditures
b) Life expectancy
c) Infant mortality rates
d) Life style choices

(a) Ch. 3 of Basics of the US Health Care System contains tables that compare nations on this information from 2005 to 2010.