Student : Borgella J.

Jean Victor
Professor: Dr Pierre Larousse
Subject: Introduction to the Healthcare
Hospitals, clinic and community health agencies can be very different from other
work environments. Healthcare systems are complex and there are many things
you need to know about types of hospital systems, patient care, insurance,
healthcare providers and legal issues. This tutorial will help you learn basic
healthcare concepts so you can be successful on the job and understand the
system.
Why do you need to understand the healthcare system?
You need to know about the healthcare system so you can be effective on the job.
The image below shows the different groups you will be working with. As you work
with the healthcare team, you will need to know about hospital systems, types of
care, and the roles of each member of the healthcare team. As you work with
patients, you will need to understand different types of insurance, how to help
uninsured patients and how to protect patient rights and privacy. You also need to
know what community resources are available and how to access those services
for patients.

Healthcare Systems

In this part of the tutorial we will look at several aspects of the healthcare system
including:

Hospital systems

Types of patient care

Public health programs

Hospital Systems
A hospital system is a group of hospitals or facilities that work together to deliver
services to their communities. Different types of hospital systems have different
types of ownership and financial goals. Types of hospital systems include:

Public Hospitals
Public hospitals are funded and owned by local, state or federal governments

and receives money from the government. Some public hospitals are
associated with medical schools.
Non-profit Hospitals
Non-profit hospitals are often community hospitals and may be linked with a
religious denomination. The main goal of a non-profit hospital is to provide
service to the community.

Private Hospitals
Private hospitals are owned by investors. Their goal is to earn a profit. Private
hospitals tend to offer more profitable services such as rehabilitation, elective or
plastic surgery or cardiology. They try to avoid unprofitable services such as
emergency medicine, which can lose money due to uninsured patients.

Healthcare Systems

Types of Patient Care

There are several different types of care for patients, depending on their need.
Types of patient care are listed below. Click on the type of care to see a description.
Amber Meiwes is happy to tell you what's wrong with primary care in America: It's
hard to get any, and when you do, it's a health risk.
Can't Find a Doctor? You're Not Alone
During a long struggle with recurring stomach pain, Meiwes got used to waiting
three weeks to get in to see a doctorand then being hustled back out in mere
minutes. "They had way more patients than they really can see," says Meiwes, 29,
of Piedmont, Okla. "They would say, Take an antacid and go home." When she fell
ill on weekends, her only options were an after-hours clinic or the emergency room.
It took three years of office visits and ER visits before she got a diagnosis: inactive
gallbladder. "I got to the point where I wouldn't even go to the doctor anymore."
It's not supposed to work that way. A primary-care doctor is supposed to be the goto doc for almost every ailment from ingrown toenails to suspicious breast lumps
the trusted guide to the system who knows the patient, her medical history, her

family. Any time the patient must navigate the bumpy and often frightening path
through specialty care, it's these internists and family and general practice doctors
who make sure that nothing critical falls through the cracks. Indeed, study after
study has shown that patients fare better in areas of the country not
overpopulated by medical specialists and where primary-care physicians handle
the bulk of care. Yet increasingly, the system is fraying. Consider:
Twenty-nine percent of people with Medicare said they had trouble finding a
doctor who would take that insurance in 2007, up from 24 percent the year before.
That's 11.6 million people.
Two thirds of Americans say they have a hard time getting medical care on
nights, weekends, and holidays, according to 2007 survey by the Commonwealth
Fund.
Just 30 percent of Americans say they can get in to see their doctor on the same
dayputting the United States second to last among industrialized countries,
ahead of Canada, according to the Commonwealth Fund survey.
In California, almost half of emergency department patients surveyed in 2006 by
the California HealthCare Foundation said they thought their problem could have
been handled by a primary-care physician. Two thirds of those people said they
couldn't get an appointment with their doctor.
In Texas, 24 counties now have no primary-care doctors at all.
In Alaska, not one of the 749 private-practice physicians was taking new
Medicare patients for primary care in November 2007.
The shortages don't reflect a lack of doctors; the number of physicians per capita
rose 77 percent between 1970 and 2000. But given the choice, most new doctors
simply reject primary care. A specialist performing a procedurea colonoscopy,
sayis commonly paid three times as much for 30 minutes as a primary-care
physician who spends that time talking with patients about how to manage their
heart failure or diabetes. An internist or a family-practice physician might start off
making $100,000 to $150,000 a year, but specialists make about twice as much on
average, says David Dale, a Seattle internist who is president of the American
College of Physicians. And a typical medical student graduates with $130,000 in
debt.
As a result, the number of grads choosing residencies in family practice, internal
medicine, and pediatrics fell 7 percent from 1995 to 2006, according to

congressional testimony from the Government Accountability Office in February.

And while half of residents in internal medicine chose to go into primary care in
1998, now just 20 percent do. In the past few years, many have instead chosen to
join the growing ranks of "hospitalists," a new genre of internist who manages the
care of patients while they are in the hospital. Hospitalists may make $200,000 a
year to start, with fewer hours than a private practitioner and none of the start-up
costs or managerial headaches.
Those who remain find themselves struggling to make money even though they
can't meet demand. "The waiting list to get a physical with me is 14 months," says
Kate Atkinson, a family-practice physician in Amherst, Mass., who does home
visits, answers patients' E-mails within a few hours, and prides herself on being the
kind of doctor she'd like to go to. Atkinson sees 25 to 30 patients a day, yet she's
barely staying afloat, largely because of the cost of staff she needs to keep up with
insurance paperwork and Massachusetts's combination of low insurance
reimbursements and a high cost of living. "It's very frustrating," she says. Her
salary is supposed to be $110,000. But one month last year, she wasn't able to pay
herself at all.

Health Insurance

In this section we will look at:

How insurance works

Health insurance payers and plans

Uninsured patients

Before we go on, it will help to know a few health

Healthcare Team

Who is on the healthcare team?

Healthcare is a team effort. Each healthcare provider is like a member of the team
with a special role. Some team members are doctors or technicians who help
diagnose disease. Others are experts who treat disease or care for patients'
physical and emotional needs.
In this part of the tutorial you will learn about different types of healthcare
providers, their jobs and role on the healthcare team. You will also learn who the
team members are for patients with different chronic diseases. Healthcare team
members we will look at include:

Doctors

Physician Assistants

Nurses

Pharmacists

Dentists

Technologists and technicians

Therapists and rehabilitation specialists

Emotional, social and spiritual support providers

Administrative and support staff

Community health workers and patient navigators

insurance definitions:

Ethics and the Law

Anyone who works with patients or medical records needs to know some important
ethical and legal issues. In this section of the tutorial you will learn about patient
rights and responsibilities. You will also learn about HIPAA, an important law that
protects patient privacy.
You also know that one of your responsibilities is to keep patient information
private and secure. Protecting patient information is very important. If you are ever
unsure about how to handle patient information, ask your supervisor.
Patient Rights

What is the "Patient's Bill of Rights and Responsibilities"?

In 1997 a presidential commission created the Patient's Bill of Rights and
Responsibilities. The Patient Bill of Rights helps ensure quality healthcare. It also
protects patients and healthcare workers. They also give a way for patients to
address problems with the healthcare system.
What are a patient's rights?
According to the Consumer Bill of Rights and Responsibilities, patients have a right
to:

Accurate and easy to understand information about their health and

healthcare providers. If patients speak another language, have a physical or
mental disability or don't understand something, assistance must be provided
so they can make informed healthcare decisions.
Choose providers and plans that provide access to high-quality healthcare.
Emergency services whenever and wherever needed, without prior
authorization or financial penalty.
Know their treatment options and make decisions about their care. If
patients cannot make their own decisions, parents, guardians, family
members, or other designated individuals can represent them.
Respect and nondiscriminatory care from healthcare providers and
health plan administrators.
Private and protected health information. This means that patients
have the right to talk privately with a doctor and that only people involved
with their healthcare can see their medical records. Patients also have the
right to review and copy their medical records and ask that their records be
changed if they are not correct or complete.
Complain about healthcare or anything they feel dissatisfied with such as
wait times, operating hours, the conduct of healthcare personnel or the
quality of healthcare facilities. Patients also have a right to a fair, fast, and
objective review of any complaint against their health plan, doctors, hospitals
or other healthcare personnel.

It is generally believed that as many as 40 million Americans may be without health insurance of any
kind. The charge to the committee assumes access to a health plan or health insurance by all persons
with RA or SLE, but such access may be the most important determinant of care and outcome for all but
the most affluent.

Recommendation: Community-based samples that include nonmembers of health plans should be

included in longitudinal studies of differential disease course and functional status of RA and SLE
patients.