What you know about health care probably has to do with sitting in a waiting room anticipating your annual physical. Maybe there are a few hanging ferns, and copies of People, Parents, and “Curious George.” Behind the reception desk, detailed files catalog every visit you’ve ever had with your doctor. But this is just the office visit and only one small part of a complex series of interactions between you, the doctor, and more than a dozen other health care professionals you’ll probably never see.
How you got to that office visit has changed quite a bit over the last 20 years. Up until the early 1970s, health care in the United States depended on a “fee-for-service” system: You visited a physician’s office, were treated, and paid the bill. The same was true for hospital expenses. In the early ’70s, the rise of managed care plans to cover “medically necessary and appropriate care,” changed the way we get and pay for health care. Now, employers and employees share the expense of health care, and a focus is put on preventing illness and staying healthy. Managed care, however, is not without its share of critics- including doctors who lament the notorious paperwork and smaller salaries and patients who bristle at the lack of choices. The rising cost of health care is forcing some employers to look at alternative health plans; many patients, meanwhile, are taking health matters into their own hands with alternative forms of medicine.
Despite the diverse array of paths in this field, the health care system consists of the following five areas:
Branch Hospital or clinic administration
Administration is the behind-the-scenes “care” in health care. Administrators provide the resources, procedures, and scheduling that enable service providers to carry out the business of caring for patients. Some of the functions of hospital or clinic administration are:
Unlike marketing in other industries, health care marketing professionals look at complex questions such as, “How are we going to expand our patient population?” and “If we merge with another hospital to cut costs, what does that mean for us?” Working with community leaders, physicians, and other members of the staff, the marketing department establishes a strategy and a mission statement designed to keep the facility focused on its main goal: quality patient care.
Running a hospital is an expensive proposition. Everything from personnel to pills must be accounted for, so administrators work closely with the chief financial officer to keep the bottom line healthy. Using data that helps forecast revenues, finance officers can assess the impact of large capital expenses like x-ray machines or other scanning devices.
In order to make management decisions, administrators examine data about the patients treated, and the people and organizations paying for that care. Information about patient demographics help administrators determine who gets what services at what prices. For example, the mix of third-party payers vs. fee-for-service can influence changes in the fees charged to patients.
Within a hospital or clinic, medical directors are usually physicians who have become executives. They monitor the delivery of health care services, including treatment time, emergency care, and nursing support. Two important functions of care administration are quality assurance (QA) and resource management.
Quality assurance (QA)
QA administrators need to make sure that doctors, nurses, and other medical staff are qualified to do their jobs. In order to achieve their goals of quality assurance, they may establish a credentials committee to screen new physicians or audit departmental procedures to make sure that the staff follows OSHA regulations.
One of the toughest tasks of care administrators is to evaluate medical needs. When a doctor requests an expensive resource, the medical director must weigh necessity against cost by asking questions such as, “How many patients will benefit from this over time?”, or “Will newer, more effective, and less expensive equipment be available soon?”
Direct care involves several components. It can teach others how to best care for themselves through proper diet, exercise, and attention to emotional health, and it can also mean administering medication, treatment, or performing surgery. There are several components to direct care.
Syrupy blue liquid that soothes your cough may be called “medicine,” but medicine, as a field, refers to the treatment of disease and injury by doctors of medicine (M.D.s) or by osteopathic doctors (D.O.s). General practice (like your family doctor’s services), ER surgery, obstetrics, neurology, psychiatry, and anesthesiology are just a few of the more than 30 specializations within the field.
The mission of an allied health care professional is to support and complete the work of physicians and other specialists. Examples of allied health professionals include x-ray technicians, radiology directors, cardiac catheter laboratory managers, physical therapists, and certified registered nurse anesthetists, and other nursing staff.
Staying healthy isn’t limited to the body. Over the past decade, the role that mental and emotional health plays in physical well being has changed dramatically. The field of mental health is focused on gaining a better understanding of how the mind affects physical health. For example, when a person complains of insomnia and disrupted sleep patterns, mental health professionals may look for signs of stress or depression in that individual.
Because a person’s employer usually pays for most health care in the United States, the unemployed or underemployed may not have access to adequate health coverage. Social services refers to a variety of state and federal programs available to those who would not otherwise be able to afford care. The federal programs Medicare and Medicaid are two examples of social services. Other examples include state programs that educate young mothers about proper child care, mental health counseling for substance abusers, and programs that provide meals, medicine, or other support for people with HIV/AIDS.
Characters like Frankenstein, Jekyll and Hyde, and the Bionic Man fascinate the public with their portrayals of scientific discovery. While rarely as dramatic as Dr. Frankenstein’s experiments, research conducted through observation and innovation is the foundation of medical progress. There are three subcategories of research in health care: basic, clinical, and epidemiological.
Scientists who create drugs, look for cures, and work on preventive measures for disease are all involved in basic research. Some win the Nobel Prize for their work, while others spend their lifetimes examining one small aspect of disease. Basic research is the cornerstone of the dramatic advances we often hear about on the nightly news.
The goal of clinical research is to evaluate detection, diagnosis, and treatment measures through experiments conducted with patients. For example, clinical chemists perform tests to monitor how an experimental treatment impacts a subject. These researchers often work closely with pharmaceutical and biotech companies to conduct clinical trials on a new treatment.
Using data from studies of people’s health habits over a long period of time, epidemiologists make advances in preventive health care. One famous study is the Framingham Heart Study, which examined two generations of families in the town of Framingham, Massachusetts. The epidemiologists working on that study discovered many of the things we know now about the connections between heart disease, smoking, and exercise.
A person with a bunion on her toe can’t just walk into an operating room and offer the surgeon $50 to remove it. In order for a surgical procedure to take place, the patient must navigate a path through the health care infrastructure. Here are four of the support services that contribute to patients’ interactions with the system:
The objective of health insurance is to systematize the way in which health care costs are paid. Insurance providers help their policy-holders pay medical expenses, and without insurance, getting quality care is difficult and expensive. Insurance premiums pay for a designated range of services. Visiting a dentist in private practice to fix a broken tooth may cost an uninsured patient $200.
Public health refers to a collection of national government agencies together known as the U.S. Public Health Service (USPHS). Among others, USPHS agencies such as the National Institutes of Health and the Centers for Disease Control focus on the health needs of the entire country. On a state and local level, department of public health officials are responsible for sanitation, water safety, and sewage treatment. The Surgeon General’s warning that secondhand smoke may harm nonsmokers is one element of the Public Health Service’s mission to prevent disease and improve prenatal care.
At your next office visit, you’re almost as likely to see your physician using a Palm Pilot as a standard paper chart. Computerized patient charts assist nurses by automatically graphing vital signs, recording notes, downloading patient data from remote databases, and planning care programs. Sophisticated software systems can manage electronic medical information and patient records, including doctors’ handwritten notes, which can be scanned in. Online scheduling services allow health care professionals to coordinate and schedule appointments using secure Internet connections. In addition, health care I/S departments are now using high-speed data lines, digital imaging techniques, and three-dimensional technology, to develop new ways of seeing inside the human body.