ࡱ> 68345q`  CbjbjqPqP  ::0 ```D'ļļļļD/m2& $hh`c@w'd`.H`ܿ Ǘļ.(v@=0moV.o4o`0"+.m///T8///h| 1.03 Government Healthcare Agencies FocusAgencyFunctions/ServicesExample showing understanding of services providedInternationalWorld Health Organization (WHO)assess health trends compile statistics related to disease investigate health problems worldwide publish health informationNationalU. S. Department of Health and Human Services (USDHHS)compile statistics related to disease investigate health problems in the United States prevent disease by immunizations provide comprehensive health services publish health informationNational Institutes of Health (NIH)Worlds leading research organization Research includes: AIDS, Alzheimers disease, arthritis, cancer, diabetes, and heart diseaseCenters for Disease Control and Prevention (CDC)Disease control Implement disease prevention policies Maintain national statistics of diseases Monitor the cause, spread and control of diseasesDisease prevention Environmental control Immunization Workplace safetyFood and Drug Administration (FDA)Regulates safety of food and cosmetics Regulates safety and efficacy of drugs, biological products and medical devicesAgency for Healthcare Research and Quality (AHRQ)Investigate quality of healthcare delivery Establish standards for healthcare treatmentOccupational Safety and Health Administration (OSHA)Create job safety standards Implement job safety standards OSHA standards specific to healthcare include: - personal protective equipment - blood borne pathogens - hazard communication - ergonomics 1.03 Government Healthcare Agencies StateN. C. Department of Health and Human Services (NCDHHS) (USDHHS)Provides services: Adoption Deaf/blind services Emergency services Food and nutrition services In-Homes Aides Medicaid Mental health services Pregnancy services Senior centers Vital recordsProvides information: Disease and health information End of life issues Environmental health Minority health Safety Teen issues WellnessLocalCounty Health Department (USDHHS, NCDHHS)Provides services Communicable disease control Health inspections Immunizations Laboratory services Oral health Woman and child healthProvides information Health education Statistics related to health, birth and death  1.03 Private Healthcare Agencies Type of Business PlanFunction/ServiceExamplesNot-for-profit (nonprofit) Supported by donations fees fundraisers grantsFocus on one disease condition or a related group of disorders Participate in research, patient services, and public awareness For-Profit Expect monetary profit Use profit for agency growth and to increase servicesProvide diagnostic and therapeutic patient services Inpatient patients stay overnight to receive medical care and treatment  Outpatient Patient receives ambulatory care Patient does not stay overnight in the facility  1.03 Health Conditions Scenarios Directions: Determine the most appropriate agency (agencies) for the care of each patients condition(s) and why. List your answers in the space provided. An elderly woman is leaving the hospital following a long hospital treatment and recovery from a CVA. She has left hemiparesis. Prior to her hospitalization, she lived alone. What services for continued care will she need after her hospital discharge? What agency (agencies) will best provide the care she needs? ____________________________________________________________________________________________________________________________________________________________________________________________________________ A 16 year old male suffered a knee injury during a high school football game. He was first treated by the Certified Athletic Trainer. He was transported to the hospital and was seen in the Emergency Department. The next day he received an outpatient MRI. Surgery was completed the next week. He wore a knee brace for six weeks. What services might he need? What healthcare providers will care for him? What agency (agencies) will best provide the care he needs? ____________________________________________________________________________________________________________________________________________________________________________________________________________ A 5 year old female has cerebral palsy as a result of premature birth. She needs multiple rehabilitative services weekly. She wears bilateral ankle foot orthotics. She receives specialized education services. Because of her multiple medical problems, she requires the services of many medical specialists. What services for continued care will she need? What agency (agencies) will best provide the care she needs? ____________________________________________________________________________________________________________________________________________________________________________________________________________ A 36 year old woman has had neck pain for two weeks. What services for care does she need? What agency (agencies) will best provide the care she needs? ____________________________________________________________________________________________________________________________________________________________________________________________________________ Frank fell while putting shingles on the roof. He thinks he broke his leg. He is bleeding from his forehead and his left forearm. What services for care will he need? What agency (agencies) will best provide the care he needs? __________________________________________________________________________________________________________________________________________________________________________________________________________________ 1.03 Key Terms Study Guide: Key TermsDefinitionsco-insurancethe percentage of the bill for services that the policy holder must pay co-payment (co-pay)a specific amount paid by the patient for each medical service, such as $15.00 for each doctor visit or each prescription filleddeductibleamount the patient must pay before the insurance starts to pay for servicesgroup planthe insured and, usually, their employer share the amount of the premiumHealth Maintenance Organization (HMO)insurance method that focuses on prevention of disease, must see providers from an approved listIndemnity Plan traditional health insurance plan with freedom to visit physician of choiceindividual planthe insured pays the total amount of the premium Medicaidgovernment payment of healthcare services for people with low income, children who qualify for services and people who are disabled or blindMedicare government payment for healthcare for patients over 65, any person with a disability that has received social security benefits for at least 2 years, or anyone with end stage renal diseaseMedigapa private insurance policy that pays the difference between the medical charge and the amount that Medicare paysOut-of-Pocketmedical bill that is not covered by insurance and must be paid by the patientPreferred Provider Organization (PPO)group of healthcare providers that provide services to a specific group, often at a reduced ratepremium the periodic amount paid to an insurance company for healthcare or prescription drugsprivate Insurance the insured pays a monthly premium for insurance planreimbursementamount paid to patient toward the cost of healthcare servicesTRICAREmilitary health plan that provides services for active duty personnel and their families, survivors of military personnel and retired military personnel and their familiesVeterans Health Administrationprovides healthcare services to anyone who served in the military Workers Compensationhealth insurance plan the pays for the healthcare of workers injured on the jobcost containmentmethods used to control the cost of healthcarediagnostic related groups (DRGs)system to classify diagnoses into similar groups and is used to determine the amount of Medicare payment to a healthcare providerfor-profit agencyfacility that operates for a monetary profitGovernment agencyagency sponsored by the government and supported by taxesHealth Information Management Systems (HIMS)management of personal healthcare information by the healthcare agencyIn-patient Careservices provided to a patient within a hospitalmanaged care healthcare system designed to reduce cost of healthcareOutpatient Careservices that do not require the patient to stay overnight in the hospitalpreventative carethe focus is to promote good health and to prevent illnesstelemedicinehealthcare services provided from a distant place 1.03 Government Healthcare Finances Directions: Record notes about healthcare private finances while viewing the PowerPoint presentation.  1.03 Private Healthcare Finances Directions: Record notes about healthcare private finances while viewing the PowerPoint presentation.  1.03 Health Insurance Math Directions: Based on your knowledge of healthcare insurance, complete the following math problems. You may write your answers on this paper. Please show your work. How much does the health insurance company pay if a person has a $4,000.00 hospital bill and a $500.00 deductible? How much does the insurance company pay if the person has a $4,000.00 bill, a $500.00 deductible, and an 80/20 co-insurance? Johns employer gave him a $2,250.00 bonus to buy optional medical, dental, and disability insurance. The total cost for the year of optional insurance is $2,868.00. Will you have a deficit or excess of flexible bonus money? What amount of money will be reimbursed or deducted from Johns bi-monthly paycheck? How much does the health insurance pay if a person has a $7,800.00 hospital bill and a $1,500.00 deductible? How much will the individual pay if the person has a $5,300.00 hospital bill, a $300.00 deductible and an 80/20 co-insurance? Your employer gave you a $3,333.00 bonus to buy optional medical, dental, group life insurance, accidental death, and disability insurance. The total cost for the year of optional insurance is $2,868.00. Will you have a deficit or excess of flexible bonus money? What amount of money will be reimbursed or deducted from your monthly paycheck? 1.03 Healthcare Finance Crossword ACROSS 5 Amount paid to patient by the insurance company toward the cost of healthcare services 7 Provides healthcare services to anyone who served in the military 8 A private insurance policy that pays the difference between the medical charge and the amount that Medicare pays 9 Military healthcare plan 10 Insurance method that focuses on prevention of disease 12 The insured pays a monthly premium for insurance plan 13 Traditional health insurance 14 Government payment for healthcare services for people with low income 15 The insured and their employer share the amount of the premium 16 The periodic payment to an insurance company for healthcare services 17 The insured pays the total amount of the premium  DOWN 1 The percentage of the bill for the healthcare services that the policy holder must pay 2 Health insurance plan that pays for the healthcare services of workers injured while on the job 3 Government payment of healthcare services for people over 65 4 Medical bill that is not covered by insurance and must be paid by the patient 6 A specific amount paid by the patient for each medical service 11 Amount the patient must pay before the insurance starts to pay for services 18 Group of healthcare providers that provide services to a specific group  1.03 Trends that affect healthcare services Directions: Record notes and state examples about healthcare trends while viewing the PowerPoint presentation. TrendsNotesExamplesTechnology Telemedicine Robotic surgery Health Information Management Systems (HIMS)  Epidemiology Study of disease Changes in treatment Patient awareness  Geriatric Care Adult day care Independent living facilities Nursing homes Retirement homes TrendsNotesExamplesWellness Weight management Health foods Nutrition Stress reduction Healthy behaviors  Cost Containment Outpatient care Diagnostic related groups (DRGs) Managed care Preventative care Energy conservation   Government Healthcare Financing _________________________________________________________________________________________________________________________________________ Medicare _________________________________________________________________________________________________________________________________________ Medicaid _________________________________________________________________________________________________________________________________________ TRICARE _________________________________________________________________________________________________________________________________________ Medicare A _________________________________________________________________________________________________________________________________________ Medicare B _________________________________________________________________________________________________________________________________________ Medicare C _________________________________________________________________________________________________________________________________________ Veterans Health Administration _________________________________________________________________________________________________________________________________________ Medicare D _________________________________________________________________________________________________________________________________________ Medigap ___________________________________________________________________________ Private Healthcare Financing ___________________________________________________________________________________ Private Insurance _________________________________________________________________________________________________________________________________________ Insurance Out-of-Pocket _________________________________________________________________________________________________________________________________________ Workers Compensation _________________________________________________________________________________________________________________________________________ Health Maintenance Organization (HMO) _________________________________________________________________________________________________________________________________________ Preferred Provider Organization (PPO) _________________________________________________________________________________________________________________________________________ Indemnity Plan _________________________________________________________________________________________________________________________________________ #$Dvwx" # $ % f ! 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