Accessing Reliable Health Care

Why is it important to access Reliable health Care?

When you are sick or injured you may need immediate help!

Knowing where to get medical help!

How to pay for it can save time, hassle, stress, & money.

WHAT TO KNOW ABOUT HEALTH-CARE PRACTITIONERS AND PROVIDERS

Health-Care Provider-trained professional who provides people with medical care.

Physician- an independent health-care provider who is licensed to practice medicine.

Physician’s Job Description- obtain medical histories, perform physical examinations, give diagnoses & licensed to prescribe medications (some physicians are licensed to perform surgery).

Two Types of Physicians

Medical Doctor (M.D.)- is a physician who is trained in a medical school and has a medical doctoral degree (can choose to work in primary care or specialist area)

Doctor of Osteopathy (D.O.)- is a physician who is trained in a school of osteopathy and has a doctor of osteopathy degree (can choose to work in primary care or specialist area).

Medical Terminology

Osteopathy- uses common medical procedures, but also places emphasis on the relationships between body systems. (These doctors “osteopaths” are trained that the body systems are all connected and if one system is disturbed it can affect other systems.

Medical TerminologyPrimary Care- is general health care. The first health care provider that a patient contacts is the primary physician to provide basic care. Also, primary care physicians can refer patients to specialists.

Medical Terminology

Specialist- is a professional who has specialized training in a particular area.

(Two-thirds of physicians are specialists)

Health-Care Practitioners-an independent health-care provider who is licensed

to provide general or specialized care for a specific area of the body.

Podiatrist- a doctor of Podiatric Medicine (DPM) who specializes in the care and treatment of feet.

Optometrist- is an eye care professional who is specially trained in a school of Optometry. This doctor can examine eyes and prescribe corrective lenses or exercise for a patient with eye problems.

Dentist- is a doctor of Dental Surgery (DDS) or doctor of Medical Dentistry (DMD) who specialized in the care and treatment of the teeth and mouth.

ALLIED PROFESSIONAL- IS A TRAINED HEALTH-CARE PROVIDER WHO

PRACTICES UNDER THE SUPERVISION OF A PHYSICIAN OR HEALTH-CARE

PRACTITIONER.

I.E. AUDIOLOGISTS, DENTAL HYGIENISTS, PHARMACISTS, PHYSICAL

THERAPISTS AND RADIOLOGISTS.

Choosing Health-Care Providers

Check telephone book (Health-Care Providers) listed in yellow pages of telephone directory.

Check local chapters such as the American Medical Association (AMA), and the America Dental Association (ADA), which keep lists of their members.

Inquire Hospitals- have lists of physicians recommended/or offer other recommendations.

PRIMARY-CARE PHYSICIAN

To choose primary-care physician who will provide basic medical care and help prevent illness.

Family Practitioners, Pediatricians, Internists

Should be familiar with patient’s medical history/health-care needs.

May refer patient to a specialist if further diagnosis or treatment needed.

Health Insurance!!!!

Health Insurance- financial protection that provides benefits for sickness or injury.

1st Patient buys insurance.

2nd Health Provider- agrees to pay or reimburse the cost of care

3rd Insurance Provider- predicts that they will collect more money in premiums than it will pay out in claims.

Health Insurance TerminologyPremium- amount paid for the insurance coverage

Claim- is a bill from the health-care provider.

Insurance Policy- is a legal document that outlines the terms of the insurance coverage.

Deductible- is the amount that must be paid by the individual before the insurance pays the claims.

Co-payment-is the portion of the medical fee the individual must pay whether or not there is a deductible.

* Private Insurance Policies must be paid by the individual, or the employer , or even both parties (some pay

entire cost of medical, others pay a portion).

Managed Care- control the types of health care individuals receive and the amount paid for care.

TWO TYPES OF MANAGED CARE

1. Health Maintenance Organizations (HMOs)2. Preferred Provider Organizations (PPOs)

Health Maintenance Organization- a business that organizes health care services for its members.

Try to provide lowest cost

Except for an emergency or with approval

Only covers services from the HMO

HMOs encourage preventive health care

Preferred Provider Organization- a business that has a contract with a group of health-care

providers who agree to provide services at a reduced rate.

Individuals must select preferred providers/ or pay higher cost for health services

Government Insurance

Medicare-insurance for people 65 years and older. Also, for individuals who received social security disability benefits for two or more years.

Medicaid- insurance for people with low incomes.

Two Kinds of Expenses

Covered Expense- is a medical expense that is paid for under the terms of a health insurance plan.

Excluded Expense- is a medical expense that a health insurance plan will not pay.

Recommendations for Evaluating Health Insurance

Study health insurance carefully by looking at terms and conditions such as what is covered and not covered!!!

Shop around for health insurance and ask questions!!!

Choose a plan that is the most comprehensive coverage ad is affordable!

Pre-existing Conditions- is a health problem that a person had before being covered by the insurance.

Some insurance providers will not sell you insurance if you have any disabilities or pre-existing conditions (considered high risk)!

Make Yourself Insurable!!!

Get routine check-up/immunizations

Learn to do breast or testicular self-exams

Get plenty of rest. sleep, and physical activity

Eat appropriate amounts of healthy foods, limit amount if sugar, sodium intake, avoid drugs, alcohol, and tobacco

Control stress, drive safely and wear a seatbelt

More than 40 million people in the U.S. do not have health insurance. Therefore, in case of an emergency, it can become very expensive to seek treatment in a hospital emergency

room or trauma center.

Living without Health Insurance

Life transitions: new job, self-employment, unemployment, marriage, divorce, or graduation from college (could affect your health insurance)

Being Uninsured May Not Be a Matter of Choice

Expensive Health Insurance Premiums

Be eligible for Health Insurance

Unemployment

Rising Health-Care costs(difficult for employers to offer)

Chronic Health conditions/not eligible (high-risk category)

Group Health Insurance

Self-employed: trade groups, labor unions, associations, chambers of commerce, or other groups that offer health insurance programs.

Some states offer health insurance pools for people with certain chronic diseases, agriculture workers, asbestos removal workers and scuba divers.

27.3% of ages 18-24 years old are uninsured

Children’s Health Insurance Program (CHIP) created in 1997

Short-Term Health Insurance Policies

People temporarily out of work and looking for a job

Maximum 6 months and is renewable for one time

Plan to leave a job may convert group plan to individual plan.

Consolidated Omnibus Budget Reconciliation Act (COBRA)- gives worker’s the right to continue their employer’s health benefits for limited period of time because of job loss, reduction in hours worked, death, divorce, or other life events.

Health-Care Facilities

Location of Facility

Hours

Services Provided

Fees they charge

What To Know About Health-Care Facilities

Hospital- is a healthcare facility where people can receive medical care, diagnosis, and treatment in an inpatient or outpatient center.

Inpatient Center- is treatment that requires a person to stay overnight at a facility.

Outpatient Center- is treatment that does not require a person to stay over night at a facility.

Ambulatory Surgery Center- facility where surgery is performed on an outpatient basis. (health insurance recommend outpatient surgery/care because it is one-third less cost than inpatient care.

Urgent-Care Centers

Do not need an appointment for these centers

Fees are less than hospital emergency rooms

Physician’s Office

Physician’s Office- facility that provides routine health care. i.e. diagnosis, simple testing, treatments, examinations or minor surgeries. (nurse, practitioners and physician’s assistants)

Types of Hospitals

Private Hospital- owned by private individuals

Voluntary Hospitals- owned by community/organization (does not operate by profit)

Government- operated by federal, state, or local government through the benefit of a special populations. i.e. Veterans Administration

Health Centers

Health Center- facility that provides routine health care to a special population. i.e. low income families.

Mental Health Clinic- facility that provides services for people who have mental disorders. (majority of mental health clinics are open 24 hours).

Laboratories

Laboratories- these are medical laboratories that perform diagnostic test, such as blood or urine tests. (also can be part of hospitals) i.e. Dental Laboratories-make crowns, or bridges used to repair teeth.

Extended-Care Facility

Extended-Care Facility- facility that provides nursing, personal and residential care

People who need assistance with daily living

Examples are nursing homes and convalescent homes

Home-Health Care Organizations offer nursing care, medical treatment, and therapy in the home.

Home-Health Care

Home-Health Care- agencies that provide care in a patient’s home. Services: nursing, rehabilitation therapy, bathing, housekeeping, and food preparation.

Who offers Home-Health Care?

Health Departments, Hospitals, Private Agencies and Volunteer Groups

Hospice

Hospice- is a care for the terminally ill and their families. (In-Home Care)

Provides 24 hour service, contact, and support continues for at least one year after a family member dies.