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Healthcare Organization and Delivery (People delivering care (Doctors (MD…
Healthcare Organization and Delivery
U.S. Payment System
Third party payer system:
Provider
delivers care to the
patient
, and a
third entity
pays for the service
Some terms
Socialized medicine: The government owns all hospitals and pays all providers from general tax revenue
Services are provided at a low cost
Also known as a national health system
Single payer system: Hospitals and providers are private, but government pays for services (private insurance companies do not exist)
Also known as a national healthcare system
Types of healthcare delivered
Inpatient vs. outpatient
Inpatient: involves staying overnight at a facility
Outpatient: No overnight stay required
Primary, secondary, and tertiary care
Primary: Common illnesses and disabilities
#
Mainly outpatient
Consists of majority of care
Secondary: Problem requires specialist care
Can be inpatient or outpatient
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#
Tertiary: Complex and rare cases
Typically inpatient
#
Requires specialized equipment offered at large urban teaching hospitals
Types of facilities
Outpatient
Examples: Private practice clinic, hospital health clinic, community health center, emergency department of a hospital, urgent care centers, retail clinics, ambulatory surgery center
Inpatient
Examples: hospitals, skilled nursing facilities, long term acute care hospitals (LTACHs), and inpatient rehab facilities (IRFs)
Types of hospitals
General hospitals: Provide a wide range of services
Specialty hospitals: Devoted to a single specialty (i.e. orthopedics) or a children's or psychiatric hospital
People delivering care
Doctors (MD and DO)
Nurses
Physician's assistants
Home health aides
Fragmentation
Often viewed as a result of so many different facilities
Another common blame: lack of a PCP gatekeeper preventing patients from going directly to specialists