HEALTH CARE DELIVERY SYSTEM

Similar documents
Benefits. Benefits Covered by UnitedHealthcare Community Plan

Place of Service Code Description Conversion

Covered Benefits Matrix for Children

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:

KY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for

Essential Health Benefits Addendum. Office of the Insurance Commissioner Washington State

Descriptions: Provider Type and Specialty

Medicaid Benefits at a Glance

Medi-Cal Program. Benefit. Benefits Chart

Place of Service Codes (POS) and Definitions

SERVICES COVERAGE LIMITS/ EXCLUSIONS Alcohol, Drug, and Substance Abuse Services

OVERVIEW OF YOUR BENEFITS

Blue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.

Kaiser Permanente Group Plan 301 Benefit and Payment Chart

TABLE OF CONTENTS. Primary Care 3. Child Health Services. 10. Women s Health Services. 13. Specialist Health Services 16. Mental Health Services.

Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION

MEDICAL SERVICES AND HEALTH CARE FACILITIES

Services Covered by Molina Healthcare

Services Covered by Molina Healthcare

Schedule of Benefits

Corporate Partners Program

Super Blue Plus 2000 WVHTC High Option-B (Non-Grandfathered) $200 Deductible

Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers

Benefit Explanation And Limitations

17.1 PRODUCT INFORMATION. Fidelis Care s Metal-Level Products

Covered Benefits Matrix for Adults

Schedule of Benefits HDHP WITH HSA MASSACHUSETTS

IV. Benefits and Services

Highlights of your Health Care Coverage

Xl. PUBLIC HEALTH PERSONAL HEALTH

1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS

Covered Services List

Business-Facts Summary- Healthcare NAICS Summary

SUMMARY OF P-5-5 BENEFITS AND SCHEDULE OF COPAYMENTS

Blue Cross Premier Bronze

HEALTH PLAN BENEFITS AND COVERAGE MATRIX

HPHC Insurance Company, Inc. THE HPHC INSURANCE COMPANY DEDUCTIBLE TIERED COPAYMENT PPO PLAN MAINE

High Deductible Health Plan (HDHP)

GIC Employees/Retirees without Medicare

NOTICE OF PRIVACY PRACTICES

Telemedicine services $0 copay Not applicable Primary care provider (PCP) CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance CYD/Coinsurance

IMPORTANT INFORMATION:

Covered Services List and Referrals and Prior Authorizations for MassHealth Members enrolled in Partners HealthCare Choice

Early and Periodic Screening, Diagnosis, and Treatment Program EPSDT Florida - Sunshine Health Annual Training

Basic Covered Benefits and Services

Public Act No

MMA Benefits at a Glance

2017 Comparison of the State of Iowa Medicaid Enterprise Basic Benefits Based on Eligibility Determination

Early and Periodic Screening, Diagnosis and Treatment

AMERICAN INDIAN 638 CLINICS PROVIDER MANUAL Chapter Thirty-nine of the Medicaid Services Manual

Schedule of Benefits-EPO

Benefit Explanation And Limitations

$10 copay. $10 copay. $10 copay $5 copay $10 copay $5 copay. $10 copay. No charge. No charge. No charge

Healthcare, and Types of Health Care Organizations. Dr. Waddah D emeh

UNIVERSITY OF MICHIGAN BZK Effective Date: 01/01/2018

SECTION II YOUR HEALTH BENEFITS

EMERGENCY RULES SFY 2013 REIMBURSEMENT RATE REDUCTIONS

MyHPN Solutions HMO Gold 7

MASTER DEGREE CURRICULUM. MEDICAL SURGICAL NURSING (36 Credit Hours) First Semester

PART IIIB DIPLOMA AND CERTIFICATE PROGRAMS CURRICULA

The Healthy Michigan Plan Handbook

The MITRE Corporation Plan

RFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS

Kaiser Permanente (No. and So. California) 2018 Union

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65

Your Out-of-Pocket Type of Service

COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE

Healthcare Eligibility Benefit Inquiry and Response. 270/ Companion Guide

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 S 2 SENATE BILL 750* Health Care Committee Substitute Adopted 6/12/18

New to Medicaid? 22 Medicaid Services You Should Know About

Post Acute Care. Kyle Devine, M.S.W. Bureau Chief

Skilled nursing facility visits

Central Care Plan Medical and Prescription Plan Comparison Grid

CALIFORNIA Small Group HMO Aetna Health of California, Inc. Plan Effective Date: 04/01/2007. Aetna Value Network* HMO $30/$40

ABOUT THE CONE HEALTH NETWORK OF SERVICES

HOME BANK - S2395 NON-GRANDFATHERED CONSUMER DRIVEN HEALTH PLAN BENEFIT SHEET

Covered (blood, blood components, human blood products, and their administration) Covered (Some restrictions)

2018 Summary of Benefits

RSNA EMPLOYEE BENEFIT TRUST PLAN II S2502 NON GRANDFATHERED PLAN BENEFIT SHEET

Central Care Plan Medical and Prescription Plan Comparison Grid

Complete Senior Care Enrollment Agreement

Department of Veterans Affairs VHA DIRECTIVE Veterans Health Administration Washington, DC December 7, 2005

SUMMACARE BRONZE 4000Q-15 SCHEDULE OF BENEFITS

Care in Your Home. North West CCAC

Medicare & Medicare Supplemental Insurance (Medigap)

UNIVERSITY OF THE CUMBERLANDS MEDICAL BENEFITS SCHEDULE

Molina Healthcare of Illinois Prior Authorization Codification List Q ILUM182.1

Floyd Healthcare Management Inc. Community Benefits Summary

RYAN WHITE HIV/AIDS PROGRAM SERVICES Definitions for Eligible Services

Aetna Health of California, Inc.

EXCLUSIVE CARE SUMMARY OF COVERED BENEFITS Select Medicare Eligible Supplement Plan

Your Out-of-Pocket Type of Service

Summary of Benefits. New York: Bronx, Kings, New York, Queens and Richmond Counties

UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California

BCBSTX Admission Type Definitions Grouper Version 33

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived 30% after deductible

HEALTH SAVINGS ACCOUNT (HSA)

UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California

UnitedHealthcare SignatureValue TM Offered by UnitedHealthcare of California

Benefits Why AmeriHealth Caritas VIP Care Plus Was Created

Transcription:

HEALTH CARE DELIVERY SYSTEM

Health Care Delivery System A Health Care System is a method for delivering health care. A systems theory is defined as a set of interacting units with relationships among them.

Hospitals can be operated by government agencies, University or College Medical Centers, be public, private, religious, and be for profit or not-for-profit

General Hospital Facility where patients are hospitalized a short time (few days to a few weeks) Provide a wide range of diagnostic, medical, surgical, and emergency services Most small town hospitals are classified as general hospitals

Specialty Hospitals Provide care for specific chronic illnesses or ages. (examples: burn, cancer, children, psychiatric) Patients are usually hospitalized for a long time.

Government Agencies The federal, state, and local governments provide health services. Government hospitals provides care for veterans who served in the armed forces- (example- King Veterans Home) These services are funded by taxes and/or patient fees!

Nonprofit / Volunteer Agencies Supported by donations, membership fees, fundraisers, and federal or state grants Provide health services at national, state, and local levels Most focus on specific diseases or health professionals The American Red Cross and American Heart Association are examples of this type of agency

Religious Funding is based on religious support and/or patient fees. St. Elizabeth s Hospital in Appleton, WI is an example. Two charitable foundations help Affinity Health System accomplish its mission of living out the healing ministry of Christ with a special emphasis on serving those in need. St. Elizabeth Hospital Community Foundation focuses on programs and facilities in Affinity s northern region, and Mercy Health Foundation focuses on Affinity s southern region.

University or College Medical Center Found in schools and colleges Services provided: emergency care, tests, health education, counseling Maintain safe and sanitary school environments Health Services - Offers quality medical care to all UWSP students, including lab work, pharmacy, immunizations, minor surgical procedures, physical therapy and physical exams, most of which are prepaid through tuition and fees

Long Term Care Facilities Generally care for elderly, disabled, and individuals with chronic or longterm illness who need nursing services and personal care Individuals receiving care are called residents Nursing homes, community based residential facilities (CBRF), assisted living facilities

Extended Care Facility This health care facility functions as a bridge between hospital and home or other long-term care facility when no longer acutely ill. Provide skilled nursing and rehabilitation care

Clinics/Medical Offices Privately owned offices to large complexes operating as corporations and employing many different doctors and other health care professionals. Some treat a wide variety of illnesses/ages, others specialize and deal with only certain age groups or conditions. Examples: dental offices, pediatrics, cardiology, obstetrics, optical centers

Home Health Care Provide care in patient s home Personal care (bathing, dressing) therapy, homemaking (food preparation, cleaning, washing), nursing, etc. Home health services can be offered by health departments, hospitals, private agencies, government agencies, nonprofit agencies, volunteer groups Affinity Visiting Nursing, Theda Care Home Health

Hospice care This organization helps care for terminally ill patients (less than 6 months to live) Most common diagnosis for these patients is cancer Philosophy is to help the terminally ill patient live each day to the fullest - usually at home or hospice facility Patients are kept comfortable and free from pain Involves family. Provide psychological, social, spiritual, and financial counseling for both patient and family.

Mental Health Facilities Deal with mental diseases and disorders Examples: Guidance and counseling centers Psychiatric clinics and hospitals Chemical abuse treatment centers Physical abuse treatment centers

Rehabilitation Centers Provide care directed at helping physically or mentally handicapped patient obtain maximum self-care function Can include hospitals, clinics, and/or private centers. Patients may stay in these facilities or be treated on an outpatient basis (patient does not require hospitalization but is under a physician s care.) Services can include physical, occupational, recreational, speech, and hearing therapies

Emergency Medical Services Emergency Medical Services extend medical care from the point of injury to the emergency department of a hospital or trauma center. The EMS focuses on rapid response to sudden illness and injury. May use ambulance or helicopter

Laboratories Laboratories perform tests on blood, body fluids, and tissues. Laboratories may be free-standing or found in a clinic or hospital. Labs help to diagnose disease and help to determine appropriate treatment.

Industrial Health Care Centers Located in large industries or companies Provide health care for employees of the industry Provide basic exams, teach accident prevention/safety, provide emergency care

World Health Organization An international agency sponsored by the United Nations Founded in 1948 Concerned with world health problems and publishes health information, compiles statistics, and investigates serious health problems worldwide

US Public Health Department Is a federal agency that has 6 major responsibilities: Performing research for diseases that kill, handicap, or cripple Preventing & treating alcohol and drug abuse Preventing and controlling diseases that are transmitted by insects, animals, air, water, and people.

US Public Health Department (continued) FDA (Federal Drug Administration - Checks food and drugs that consumers purchase for safety Planning more effective ways to deliver health services Making quality care available and affordable by encouraging health personal to work in undeserved areas. The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.

The Public Health Department Provides services to local communities Responsible for reporting communicable diseases, public health nursing, health education, environmental sanitation (methods used to keep the environment clean Keeps records including immunization records, health inspections, birth records, and death statistics. Also provides maternal and child health services