02 by xiaopangnv


  Healthcare Services

     Schedule of Course
(Sep 18, 2006 ~ Jan 15, 2006)
        Oct 02, 2006
                                Slide 1
 Chapter 1 – –
Management and

                 Slide 2
                                 Key Definitions

  Not the absence of infection or the shrinking
  of a tumor; not the absence of disease.
  WHO, a state or condition of complete
  physical, mental, and social well-being, not
  merely the absence of disease.
  The maximization of the biological and clinical
  indicators of organ function and the
  maximization of physical, mental, and role
  functioning in everyday life.

                                               Slide 3
                                 Key Definitions

Health Care and Health Services
  Health services are specific activities
  undertaken to maintain or improve health or to
  prevent decrements of health.
  Services can be preventive, acute, chronic,
  restorative, or palliative in nature.
  Services can be divided into two basic types.
  Public health services are activities that are
  conducted on a communitywide or
  populationwide basis. Personal health
  services are activities directed at individuals.
                                                Slide 4
                                  Key Definitions

Health Services Organizations
  Health services are provided through a variety of
  organization arrangements.
  HSOs are entities that provide the organizational
  structure within which the delivery of health
  services is made directly to consumers, whether
  the purpose of the services is preventive, acute,
  chronic, restorative, or palliative.
  Services : from neonatal intensive care
  units(NICUs) and PICUs to CCUs , MICUs,
                                                 Slide 5
                                Key Definitions

Health Systems
 HSOs have significantly changed how they relate
 to one another.
 Mergers, consolidations, acquisitions, and
 affiliations between and among previously
 independent HSOs are pervasive.
 At the extreme end of the activity is vertical
 integration, in which HSOs join into unified
 organizational arrangements or systems of

                                             Slide 6
Changing structure of HSOs

                        Slide 7
                                 Key Definitions

 HSO/HS managers are people formally
 appointed to positions of authority in
 organizations or systems who enable others to
 do their direct or support work effectively, who
 have responsibility for resource utilization, and
 who are accountable for work results.
 Senior managers, presidents, or chief executive
 officers(CEOs) and vice presidents in HSOs have
 authority over and are responsible for entire

                                               Slide 8
Management Functions, Skills,
 Roles, and Competencies

                                Slide 9
        Managing in a Dynamic Environment
Health Insurance Plan
Restrictive reimbursement environment
Demographic shifts
Critical shortages and shifts of manpower
IT and high-tech cost
Development of Integrated networks of care
Importance of market niche strategies
Increasing number of physician executives in
Reduce the costs of administration of health
                                               Slide 10
              Management Competencies
Conceptual Competence
Technical Managerial / Clinical Competence
Interpersonal / Collaborative Competence
Political Competence
Commercial Competence
Governance Competence
  Establishing a vision
  Suitable performance
  Quality of health services & financial
                                           Slide 11
A Management Model for
      HSOs / HSs

                         Slide 12
Slide 13
                    Important relationships
A HSO/HS is a formal setting where outputs are
produced (objectives accomplished) through use
(conversion) of inputs (resources).
Managers and the management work that they
perform are the catalyst that converts inputs to
A HSO/HS (and its managers) interact with the
HSO’s/HS’s external environment; this makes
HSOs/HSs open systems because inputs are
obtained from the external environment and
outputs go into it.
                                              Slide 14
Chapter 2 - - The
  Health Care

                    Slide 15
Health Care Delivery, Past and

                                 Slide 16
Changes in the Delivery of Health Care
  A health care provider was trained as a
  generalist, rather than as a specialist
  Charlatans used to offer ineffective “cures” in
  exchange for money
  The home was the primary site for patient

                                                Slide 17
Changes in the Delivery of Health Care
  Health care professionals have to undergo intensive
  educational preparation
  Large facilities provide on-site patient care
  The family doctor is now called a “general
  practitioner” and is supported by a team of
  A holistic approach is now used: focuses on the care
  of the whole person - physically and emotionally

                                                    Slide 18
Health Care Organizations

                            Slide 19
Types of Health Care Organizations
  Probably the best known type of health care
  People who receive the services of a hospital
  are called patients
  A patient who has to stay at the hospital for
  one or more nights receives inpatient care
  A patient who goes home the same day
  receives outpatient care

                                              Slide 20
Types of Health Care Organizations
Sub-acute care units
  Also called a skilled nursing unit or a skilled
  nursing facility
  Provides care for a patient who has partially
  recovered but still requires skilled health care

                                                Slide 21
Types of Health Care Organizations
Long-term care facilities (nursing homes)
  For people who are unable to care for
  themselves at home, yet do not need to be
   Becomes the person’s home, either
  temporarily or permanently
  People being cared for in long-term care
  facilities are called residents

                                            Slide 22
Types of Health Care Organizations
Assisted-living facilities
  For people needing limited help
  Examples of help:
    Medications
    Transportation
    Meals
    Housekeeping

                                     Slide 23
Types of Health Care Organizations
Home health care agencies
  Provide skilled care in a person’s home
  People receiving care in the home health care
  setting are typically called clients
  Available for people of all ages with any
  number of medical needs

                                             Slide 24
Types of Health Care Organizations
Hospice organizations
  People can receive services when they know
  that they have 3 to 6 months to live
    To relieve pain
    To provide emotional and spiritual support
  Services are provided for both the dying
  person and the family

                                                  Slide 25
Structure of Health Care Organizations

                                     Slide 26
Structure of Health Care Organizations
  Usually governed by a board of trustees
  Has divisions in charge of certain aspects
  of the organization’s function
  An administrator or chief executive officer
  (CEO) is the link between the board and
  the organization

                                           Slide 27
Structure of Health Care Organizations
  Nursing services is headed by a director of
  nursing (DON) or chief nursing officer
  Care of patients or residents is provided
  by a health care team

                                           Slide 28
Government Regulation of the
    Health Care System

                               Slide 29
Purpose of Government Regulations
 Government regulations make sure that:
   Providers of health care are properly trained
   and competent
   Health care facilities meet standards of
   cleanliness and quality
   Quality health care is available to everyone

                                               Slide 30
Purpose of Government Regulations
 Omnibus Budget Reconciliation Act (OBRA) of

 Occupational Safety and Health Act of 1970

 Occupational Safety and Health Administration

                                              Slide 31
Paying for Health Care

                         Slide 32
Paying for Health Care
 Group insurance: insurance purchased at
 group rates by an employer or corporation

 Pre-certification (pre-approval) process: health
 care provider has to prove that a person’s
 medical condition meets certain criteria before
 starting treatment

                                              Slide 33
Paying for Health Care
 Managed care system: arrange contacts with
 various health care providers
 Preferred Provider Organization (PPO): health
 care providers contract with an insurance
 company to accept a standard payment
 Health Maintenance Organization (HMO):
 contract with health care providers to provide
 health care services for a prepaid fee

                                              Slide 34
Paying for Health Care
   People who are 65 years or older are eligible for
   Started Diagnosis-related Groups (DRGs): payment
   is specified according to the diagnosis
   Due to the DRG system, patients are discharged
   sooner and sicker

                                                   Slide 35
Paying for Health Care
   Designed to help people with low incomes to pay for
   health care

   Federally funded and state-regulated plan

   Medicaid reimbursements are given only to facilities
   approved by the state agency

                                                      Slide 36
End of Presentation

                      Slide 37

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