Healthcare Services

Objective
In this lesson, you will learn about features of the healthcare system and how to
access health services in your community.

Introduction
• healthcare
A __________________ system
____________ is a network of people, agencies, and resources that deliver
medical care to patients.
• medical _______________,
Whenever you visit a doctor or seek ___________ treatment consumer
you are a ______________ in
the system.
➢ As a healthcare consumer, it's important to know how to navigate the system. With this
knowledge, you will make better decisions about your health, which can lead to lower costs and
improved
_______________ treatment
________________ for you over time.

Healthcare Professionals
Healthcare professionals are people who provide medical services to you.

Three categories of care providers:

Primary Care
primary
A ____________ care
________ provider is your first point of contact when receiving medical care. This
genral
person can be your family physician, school nurse, or dentist. They provide ______________ and
preventitive
__________________ care to keep you healthy.

physicains
_______________, or doctors, take care of your basic medical needs.
diagnosis
➢ When a doctor provides a ________________, you are getting a professional opinion
about what is happening to you.
prescription
➢ A ____________________ is an authorization that allows you to obtain medicine or
treatment.
refferals
➢ _________________ are necessary when the primary care doctor must send you to a
doctor with more expertise on a certain medical issue.

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 regestered
________________ nurses
____________ (RN) are __________ ___________________ (NP) are

licensed healthcare professionals. They provide registered nurses with additional formal training

direct care through observation, assessment, and education beyond that of an RN. They are

and counseling. RNs are graduates of a nursing authorized to______________ medications and

supervision
program and work under the ______________ make diagnoses similar to a doctor, and are not

of a doctor. required to work under a doctor's supervision.

________________ ________________ carry _________________ are doctors who specialize in

out routine clinical procedures as directed by a the maintenance of children's health. They are the
doctor. They take patients' medical histories, first point of contact for kids from the time the kids
draw blood, and give injections. are born until they reach adulthood.

______________ and dental assistants treat conditions of the ________ and ________ and teach
preventive oral care.

Secondary Care
When physicians look for further assistance in diagnosing or treating a problem, they might refer a patient to a
medical specialist.
Medical Specialist Treats
allergies

endocrinologist

pathologist body tissues and organs

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 Tertiary Care
Tertiary care is a highly specialized level of care that involves _____________ ______________
at a cutting-edge facility. The facility might be a _______________ ____________ or a
_______________ _______________. A tertiary care provider commonly works with patients
over an extended period, using the latest ideas in science and technology. The ideas are
sometimes ___________________ in nature.

Healthcare Facilities
An ______________ is a person who stays An __________________ is a person who receives services
in the hospital _______________ while but is not admitted to the hospital. Outpatients are
receiving medical services. allowed to ___________ ________ the ________ ______.

General Practice
A doctor's office that is operated by a physician who is commonly self-employed. The doctor sees people
on an _______________ ____________ and is usually associated with a ___________ ___________for
referrals or inpatient services, if needed.

Group Practice
A group practice is the same as a ______________ practice, but there are two or more doctors who share a
common office space. The doctors also _________ ________________ such as equipment, supplies, and
________________.

Clinic
A clinic is a place where physicians and medical staff perform __________________ services. A visit to a
clinic might involve tests or minor surgical procedures such as tonsil removal. These services are too
involved for a doctor's office visit but not serious enough for an overnight hospital stay. Some patients also
go to clinics to receive ____________ ________ from their family physician or pediatrician.

Convenient Care Clinic

Retail health clinics, or convenient care clinics, are located in __________, ___________________, and
_______________. They are intended to be low-cost, quick alternatives for routine medical care. They are
usually staffed with nurse practitioners or physician's assistants who treat _________ _______________.
When more complex issues arise, the patients receive _____________.

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 Hospital
A hospital is a place for treating ___________ __________ ___________. Hospitals usually operate 24
hours a day and offer inpatient services for recovery from accidents, illness, or major ___________. Many
hospitals have ___________ ______________ to handle serious situations and trauma.

Emergency Room
When patients have ____________ or life-threatening ____________ or ___________, they might be
brought to an emergency room (ER). Some arrive by ____________, depending on the situation. Medical
staff work quickly under pressure in the ER to treat acute conditions. Emergency rooms are often
connected to ___________.

Urgent Care Center

Patients who are sick or have experienced _________ ____________ might visit an urgent care center.
These centers are available to patients when their primary care physicians cannot be reached. No
appointment is necessary. Patients in an _________ _______ center need prompt attention, but their
condition is not serious or life-threatening. Some refer to urgent care as after-hours care.

Other Facilities
Facility Description
birthing center creates a family-centered birthing experience, staffed by midwives and obstetricians
drug treatment
center
assisted living
center
nursing home similar to assisted living, but has a 24-hour nursing staff to help with medical issues

home health
care

hospice

Telehealth
Instead of driving to a traditional facility, some patients are turning to the ______________. They are able to
video conference with ___________ _________, transmit images, and access their medical records online.
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Understanding Health Insurance
____________ _______________ is a plan where you receive help with your medical costs from private
companies or from the government.

Traditional Health Insurance Plans

A ___________ _________________ ______________ charges you a monthly premium, or fee. By collecting
the fee, the insurance provider agrees that it will help you with your ____________ __________ under
_____________ _________________.

• Deductible: the amount of money you must pay before health insurance will begin to pay

• Co-Pay:

• Co-Insurance:

• Out of pocket:

Trent had an overnight stay in a hospital. The hospital bill came to $1,500. Trent's insurance plan
has a deductible of $1,000 and a co-pay of $15. After Trent pays the deductible, his insurance plan
will pay for 80 percent of the remaining bill. Trent will be responsible for the other 20 percent. In
other words, Trent's plan has an 80/20 co-insurance clause. How much will Trent pay out of pocket
for this bill?

$1,500 hospital ________

–$1,000 Trent’s ______________

$500 ← apply 80/20 __________________ to this amount

$500 × 0.80 = $400 insurance provider owes this much

$500 × 0.20 = $100 Trent owes this much

$15 ← Trent’s ____________

Trent owes $__________ in all ($1,000 (deductible) + $100 (co-insurance) + $15 (co-pay)).
The insurance provider owes $_______.

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Managed Care Plans
Managed care plans are health insurance plans that are generally less ________________ than traditional
plans but can result in fewer ______-____-____________ expenses for patients.

Health Maintenance Organization (______)

Members pay a monthly or yearly premium to cover all their medical expenses, with little to no
deductible. Members must have a ____________ _______ _____________ in the network who acts as a
__________________. This doctor makes decisions on referrals, usually to specialists within the network.
HMOs commonly have small co-payments for office visits and prescriptions.

Preferred Provider Organization (______)

Members pay a monthly or yearly premium, but PPO members are ______ ______________ to have a
primary care doctor acting as a gatekeeper. Unlike HMO members, PPO members can see a doctor or a
specialist ___________ __ _______________. They can even go outside their network, but they should
expect to pay more out of pocket for this choice. PPOs offer more ________________ than HMOs, but that
flexibility comes at a higher price. Members usually have to manage their own paperwork when they
choose out-of-network services.

Point of Service Plan (______)

Combine features of both _______ and __________. POS members pay a monthly or yearly fee. Like HMO
members, POS members are required to choose a primary care doctor within the network. This doctor
becomes the point of service and makes all _____________, either inside or outside the network.
Members can obtain services _____________ _____ _____________, but they should expect to pay more
and to handle their own paperwork when filing claims.

Visiting a Primary Care Physician

Before choosing a doctor, it's a good idea to ask around. If friends and family are satisfied with their physician,
then it is likely that you'll be satisfied too.

Bedside Manner
Bedside manner is the way that doctors ____________ and ________________ with their patients. The doctor
should be _____________ and _________________, help you feel at ease, and involve you in decision making.

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At the Doctor
When you visit a primary care doctor, take an ___________ ________ in your visit.
Know and understand your ____________ ___________ before you go.
→ Your history might include immunization records, _______________, medications, injuries, recent
illnesses, and your daily habits.
→ You might even be asked about the history of your close ___________ members.
→ Information that you give to your physician is protected by ___________ ________, so be sure to
share information openly and honestly. This will help in obtaining an accurate diagnosis.
o Although your medical information is _______________, with your parents' _______________,
your physician might share it with other professionals in the healthcare system, such as medical
specialists, health insurance companies, or the government.
o Your parents have a right to obtain copies of your medical records by contacting your physician.
The government's Office for Civil Rights sets national standards on health information security
through the __________ ___________ _________.

Patient's Bill of Rights

Patients seeking medical advice have certain rights and responsibilities. As healthcare has changed, different
kinds of _________ have been written. Some pertain to _______________________ relationships. Still others
describe the link between patients and ___________ _____________ companies.
➢ The Consumer Bill of Rights in Healthcare (1997)
➢ Affordable Care Act (2014)

Summary
How are primary care, secondary care, and tertiary care similar and how are they different?

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