An understanding of the type and model of the health care business helps establish the foundational knowledge to delve into the different health care entities providing services in the industry. The service entities fall into several categories: education and research, suppliers, insurers and payors (finacers), government, and providers of health care services.
As one will see, the health care industry consists of more than hospitals and doctor?s offices. It is an integrated delivery system of service providers who each have a role in ensuring quality and affordable care is provided to meet the needs of the patient and consumer.
What you will cover
1. Health Care Services
1) Types of business ownership in health care
a) What is a business?
(1) Provides a product or service to a consumer in an effort to create revenue or profit
b) What does it take to produce a product?
(a) Resources (people, time, and money), equipment, and materials
c) Public (government run)
d) Not-for-profit (board of directors)
e) For-profit (shareholders)
f) Types of business models
(a) Solo practice: single owner who establishes a business and accepts all liability, debts, and profits on their personal income tax
(b) Medical group (general partnership or limited partnership): two or more owners who establish a business and share mutual liability, debt, and profits depending on how the medical group contract is written. Taxes are filed under the business and then also reported on personal taxes as income.
(c) Corporation, S Corporation, or Limited Liability: an HC organization established by one or more investors. No one person assumes the liabilities, debts, or profits; instead the corporation assumes all of it. The corporation files its own tax returns.
a. Describe the services within the health care industry.
1) The U.S. health care system is a complex delivery system comprised of many organizations that each have a role in ensuring quality of care.
a) Education and Research
(a) Medical and dental schools
(b) Nurse training programs
(c) Research organizations
(d) Private foundations
(e) Professional associations
(f) Trade associations
(g) Government-funded research
(a) Pharmaceutical companies
(b) Multipurpose suppliers
(c) Biotechnology companies
c) Insurers and Payors (financers)
(a) Commercial insurers
(b) Government-sponsored plans
(c) Employer-sponsored plans
(a) Health policy development
(b) Public health agencies
e) Providers of health care services
(a) Finding care at the right level based on the needs of the patient
(b) Preventive care and public health: protecting and improving the health of populations and not just individuals
a. Local (city or county) health departments
b. State departments of health and human services
c. Non-profit organizations
d. Community programs
e. U.S. Centers for Disease Control and Prevention
(c) Primary care (ambulatory care): fully mobile patients bring themselves in for care of non-life-threatening issues
a. Private physician office
b. Community clinics
c. Urgent care centers
d. Public health offices
e. School-based health centers
f. Adult day care
(d) Subacute or long-term care: provision of health care services and housing services provided over an extended period of time to individuals who have a temporary or chronic illness or have suffered an injury or disability
a. Home care
b. Nursing homes
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