Introduction To Healthcare and Public Health in The US

Introduction to Healthcare
and Public Health in the US

Delivering Healthcare (Part 1)
Lecture c
This material (Comp1_Unit2c) was developed by Oregon Health and Science University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Learning Objectives
Describe the organization of healthcare at the
federal, state and local levels (Lecture a)
Describe the organization of the VA system and
Military Health System (Lecture b)
Describe the structure and function of hospital
clinical and administrative units (Lecture c)
Describe different types of long term care
facilities, with an emphasis on their function
(Lecture d)

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Health IT Workforce Curriculum
Version 3.0/Spring 2012
Introduction to Healthcare and Public Health in the US
Delivering Healthcare (part 1)
Lecture c
Learning Objectives
Describe not only hospitals but also outpatient
clinics.
Relevant facilities include:
Individual and group physician practices
Health maintenance organizations (HMOs),
preferred provider organizations (PPOs)
Urgent or immediate-care clinics
Hospitals
Hospital systems
3
Lecture c
Sole Proprietorship Clinic
Functions as a small private office
Run by a single physician with a small staff
Owner assumes all obligations/liabilities
This type of practice is increasingly rare

4
Lecture c
Group Practice Clinic
Partnership includes 2 or more physicians
Corporate group practice: a corporation owns
the practice, and physicians are employees
Independent Practice Association (IPA)
Practice is a legal entity (e.g., corporation)
Each physician has a separate office
Physicians own the practice
May contract with HMOs to provide
healthcare

5
Lecture c
Managed Healthcare
HMO
Provides discounted healthcare via provider network
Physicians are paid per patient
Patient gives co-payments for service, obtains
referrals for specialty care
PPO
Similar to an HMO, but physicians are independent
Patient pays fees but does not need referrals
Point-of-service plan
Works as a combination of HMO and PPO
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Lecture c
Urgent Care Centers
Also called immediate care centers
For acute illness or injury not serious enough for a
hospital emergency room (ER)
Capability is intermediate between retail clinic
and ER
Service is available on walk-in basis
Extended hours
Advantageous for US healthcare system
Provide more healthcare for more people
Reserve ERs for life-threatening emergencies

7
Lecture c
Community Health Centers
Provide primary care for disadvantaged people
Treat those who cannot pay and/or have no insurance
(e.g., poor, homeless, migrant workers)
Found in all 50 states and territories
Usually rely on public financing
Improve healthcare access for all
Reserve ERs for true emergencies
Community mental health centers also exist
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Lecture c
Community Hospitals
Defined as non-federal, short-term,
general public hospitals
Provide general or specialty care
Operate on for-profit or nonprofit basis
Well-suited for routine illness/surgery
Provide cost-effective and accessible
care
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Lecture c
Teaching/Research Hospitals
Large institutions affiliated with medical schools
Employ state-of-the-art medications, surgical
procedures, equipment, technology
Treat complex medical problems, rare diseases
Teach physicians and other healthcare providers
Support and perform medical research
Provide critical care for the community
Accept uninsured patients
Example: Massachusetts General Hospital
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Lecture c
Critical Access Hospitals
Certified for reimbursement by Medicare
Typically are licensed acute-care hospitals in
rural locations
Sometimes health clinics are eligible
Reimbursement may save the hospital from
closing

11
Lecture c
Healthcare Accreditation
Joint Commission certifies medical care facilities
Oldest and largest healthcare accrediting body
Independent nonprofit organization
Evaluates more than 18,000 US healthcare
organizations and programs of all types
Goal is to improve effectiveness, safety, and value
of healthcare
Organizations must undergo periodic site visits to
identify and resolve problems
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Lecture c
Hospital Clinical Structure:
Overview
Hospitals contain specialized areas
General inpatient care is provided in wards
Immediate care is provided in the ER
Surgery is performed in the operating room (OR)
Critical care is given in intensive care units (ICUs)
and critical care units (CCUs)
Hospitals employ specialized personnel
Physicians and nurses provide healthcare
Ancillary personnel assist with technical tasks
13
Lecture c
Hospital Setup: ER
ER is open 24 hours, 7 days a week
Treats various types of injuries
Ranging from ankle sprain to drug overdose
Severity is assessed by a process called
triage
Patients are treated completely or sent to other
hospital areas
14
Lecture c
Hospital Setup: OR
Surgery is done in the OR
Sterile environment is required
Surgical team includes variety of healthcare
workers (surgeons, nurses, anesthesiologists)
OR contains surgical instruments, monitoring
equipment, emergency equipment
Surgery centers also function as ORs
Are freestanding, not part of a hospital
Perform operations on outpatient basis
Are subject to Joint Commission certification
15
Lecture c
Hospital Setup: ICU/CCU
ICUs treat patients with severe disease or
injury (e.g., pneumonia, traumatic injury)
CCUs are for cardiac (heart) disease
Patients come from ER, OR, or another
hospital
Various interventions are performed
Sophisticated equipment is used
16
Lecture c
Personnel Who Provide
Serious Acute Care
Emergency medicine
Goals: save lives of patients, provide short-term care
Patients receive care at the accident scene by
emergency medical technicians (EMTs) or
paramedics, who are more highly trained than EMTs
ER care is a physician specialty
Critical care
Goals: treat life-threatening conditions, provide
longer-term care
ICU and CCU care are also physician specialties
17
Lecture c
Other Hospital Personnel
Surgeons perform operations, sometimes special types (for
example, orthopedic surgery, plastic surgery)
Anesthesiologists monitor patients in the OR and treat pain
(for example, in the ICU or during childbirth)
Other physician specialties exist (for example, internal
medicine, cardiology, obstetrics/gynecology, psychiatry)
Medical subspecialties also exist (for example, pediatric
cardiology)
Registered nurses (RNs), licensed practical nurses (LPNs),
and physician assistants (PAs) may also specialize
Pharmacists evaluate and dispense medications
18
Lecture c
Ancillary Personnel
Nursing assistants work under the direction of RNs and
LPNs
Technicians help with treatment or diagnosis (for
example, phlebotomists, x-ray and ultrasound
technicians, laboratory personnel)
Therapists facilitate rehabilitation (for example, physical,
occupational, respiratory, or speech)
Other workers educate and counsel (for example,
dietitians, nutritionists, diabetes educators, social
workers)
19
Lecture c
Hospital Corporate Structure
Governing board (board of directors) provides oversight
Chief executive officer is responsible for daily operations
Administration also includes chief officers, department
heads, patient care managers
Medical staff and ancillary personnel provide healthcare
and technical services
Nonmedical services are also critical (for example,
cooks, laundry workers)
Business office does paperwork (for example, billing,
scheduling)
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Lecture c
Hospital Financing
Ownership may be public or private
Public hospitals are funded by the
government, may have limited resources
Private hospitals are run by private entities,
may have greater resources (for example,
finances, equipment)
Either type of hospital may be for-profit or
nonprofit
21
Lecture c
Hospital Systems
A hospital system is 2 or more hospitals owned by a
corporation, with a single board of directors
A network is a group of hospitals, physicians, and
other entities that collaborate to provide care in a
community
Example of a hospital system: Greenville Hospital
System University Medical Center in South Carolina
Has multiple locations
Research and teaching organization
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Lecture c
Summary Lecture c
Medical facilities range from single-physician offices to
large hospital systems
Most of the US population has a managed care plan
Community centers and clinics offer a range of services
Hospitals treat patients; also fill teaching, research, and
charitable roles
All healthcare facilities must prove efficacy and safety
Healthcare providers work as a team to optimize medical
care
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Lecture c
References Lecture c
References

Aetna. POS health insurance plan choices. http://healthinsurance.aetna.com/health-plans/point-of-service. Published
2011. Accessed April 6, 2011.
American College of Emergency Physicians Foundation. Emergency care for you.
http://www.emergencycareforyou.org/EmergencyManual/WhoTakesCare/Default.aspx. Accessed April 7, 2011.
American Heart Association. Managed health care plans.
http://www.americanheart.org/presenter.jhtml?identifier=4663. Published 2011. Accessed April 7, 2011.
American Hospital Association. http://www.aha.org. Accessed April 6, 2011.
AmericanHospitals.com. Hospital locator: all hospitals are not created equal.
http://www.americanhospitals.com/hospitals/hospitalsequal.htm. Accessed April 5, 2011.
Association of American Medical Colleges. Teaching hospitals. https://www.aamc.org/about/teachinghospitals.
Accessed April 8, 2011.
Centers for Medicare and Medicaid Services. Community mental health centers.
https://www.cms.gov/CertificationandComplianc/03_CommunityHealthCenters.asp. Accessed April 8, 2011.
Feigenbaum E. Organizational structure of hospitals. http://smallbusiness.chron.com/organizational-structure-
hospitals-3811.html. Published 2011. Accessed April 7, 2011.
Greenville Hospital System University Medical Center. http://www.ghs.org. Accessed April 8, 2011.
Health Careers Center. http://www.mshealthcareers.com. Accessed April 8, 2011.
Medline Plus. Emergency medical services. http://www.nlm.nih.gov/medlineplus/emergencymedicalservices.html.
Updated August 10, 2010. Accessed April 7, 2011.
National Association of Community Health Centers. http://www.nachc.org. Accessed April 7, 2011.

24
Lecture c
References Lecture c (continued)
References (continued)

National Institute on Aging. AgePage: hospital hints.
http://www.nia.nih.gov/HealthInformation/Publications/hospitalhints.htm. Updated April 20, 2010. Accessed April 7,
2011.
Rural Assistance Center. CAH frequently asked questions.
http://www.raconline.org/info_guides/hospitals/cahfaq.php#whatis. Updated October 26, 2010. Accessed April 7, 2011.
Rust ME, Luepke EL. Practice organizations and joint ventures. In: American College of Legal Medicine. Legal
Medicine. 6th ed. Philadelphia: Mosby; 2004.
Society of Critical Care Medicine. MyICUCare.org. Critical care questions.
http://www.myicucare.org/Critical_Care_Questions/Pages/default.aspx. Accessed April 7, 2011.
The Joint Commission. http://www.jointcommission.org. Accessed April 8, 2011.
Torpy JM. Intensive care units. JAMA. 2009;301(12):1304.
United States Department of Labor. Bureau of Labor Statistics. Occupational outlook handbook, 2010-11 edition.
http://www.bls.gov/oco. Accessed April 7, 2011.
Urgent Care Association of America. http://www.ucaoa.org/index.php. Accessed April 6, 2011.
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Lecture c

Introduction To Healthcare and Public Health in The US

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