HSC 220 Chapter Notes - Chapter 5, 6, 11, 14, 16: Bundled Payment, Ibuprofen, Health Care
7 May 2018
School
Department
Course
Professor
Health Care Essentials – Final Exam Book Notes
Module 8 – Components of Private Insurance
No readings, Assignment 2
Module 9 – Health Care Organization
Chapter 5: How Health Care is Organized I –
Primary, Secondary, and Tertiary Care
I. Models of Organizing Care
1. Primary, Secondary, and Tertiary Care
1) Primary Care
1. Common health problems
a. Sore throat
b. Diabetes, Arthritis, Hypertension
c. Depression
2. Preventative measures
a. Vaccinations
b. Mammograms
3. Account for 80% to 90% of visits to a physician or other caregiver
2) Secondary Care
1. Problems require more specialized clinical expertise
a. Hospital care for a patient with acute renal failure
3) Tertiary Care
1. Apex of organizational pyramid
2. Management of rare disorders
a. Pituitary tumors
b. Congenital malformations
2. Two Contrasting Approaches to Organize a Health Care System around these
Levels of Care
1) Dawson Model
1. Based on the concept of regionalization: the organization and
coordination of all health resources and services within a defined
area
2. In a regionalized system, different types of personnel and facilities
are assigned to distinct tiers in the primary, secondary, and tertiary
levels, and the flow of patients across levels occurs in an orderly,
regulated fashion
find more resources at oneclass.com
find more resources at oneclass.com
3. Emphasizes the primary care base and a population-oriented
framework for health planning.
2) Alternative Model
1. More fluid roles for caregivers and more free-flowing movement
of patients across all levels of care.
2. Tends to place a higher value on services at the tertiary care apex
than at the primary care base.
3. The Regionalized Model: The Traditional British National Health Service
Case: Basil
Basil, a 60-year-old man living in a London suburb, is registered with
Dr. Prime, a general practitioner in his neighborhood. Basil goes to Dr.
Prime for most of his health problems, including hay fever, back spasms, and
hypertension. One day, he experiences numbness and weakness in his face
and arm. By the time Dr. Prime examines him later that day, the symptoms
have resolved. Suspecting that Basil has had a transient ischemic attack, Dr.
Prime prescribes aspirin and refers him to the neurologist at the local
hospital, where a carotid artery sonogram reveals high-grade carotid
stenosis. Dr. Prime and the neurologist agree that Basil should make an
appointment at a London teaching hospital with a vascular surgeon
specializing in head and neck surgery.
The surgeon recommends that Basil undergo carotid endarterectomy
on an elective basis to prevent a major stroke. Basil returns to Dr. Prime to
discuss this recommendation and inquires whether the operation could be
performed at a local hospital closer to home. Dr. Prime informs him that
only a handful of London hospitals are equipped to perform this type of
specialized operation. Basil schedules his operation in London and several
months later has an uncomplicated carotid endarterectomy. Following the
operation, he returns to Dr. Prime for his ongoing care.
1) Primary-Secondary-Tertiary Care Structure
1. Physician Services
a. Primary Care Level
i. Domain of general practitioners
ii. Practice in small-to-medium sized groups
iii. Main responsibility is ambulatory care
b. Secondary Care Level
i. Physicians in specialties such as:
1. Internal Medicine
2. Pediatrics
3. Neurology
find more resources at oneclass.com
find more resources at oneclass.com
4. Psychiatry
5. OBGYN
6. General surgery
ii. Located at hospital-based clinics
iii. Serve as consultants for outpatient referrals from
general practitioners
iv. Direct most patients back to general practitioners
for ongoing care
v. Provide care to hospitalized patients
c. Tertiary Care Level
i. Subspecialists such as:
1. Cardiac surgeons
2. Immunologists
3. Pediatric hematologists
ii. Located at a few tertiary care medical centers
2. Hospital Planning
a. Follow the same regionalized logic as physician services
b. District Hospitals
i. Local facilities
ii. Equipped for patient inpatient care needs
c. Regional Tertiary Care Medical Centers
i. Handled highly specialized inpatient care needs
3. Total Resource Planning
a. GP groups provided care to a base population of 5,000 to
50,000 persons, depending on the number of GPs in
practice
i. District hospitals had a catchment area population
of 50,000 to 500,000, while tertiary care hospitals
served as referral centers for a population of
500,000 to 5 million
b. Population focus
i. Except in emergency situations, all patients are first
seen by a general practitioner
1. May then steer patients toward more
specialized levels of care through a formal
process of referral.
2. Patients may not directly refer themselves to
a specialist.
4. Role of Non-Physician Health Professionals
a. Example: Nurses
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Health care essentials final exam book notes. Chapter 5: how health care is organized i . Basil, a 60-year-old man living in a london suburb, is registered with. Dr. prime, a general practitioner in his neighborhood. Prime for most of his health problems, including hay fever, back spasms, and hypertension. One day, he experiences numbness and weakness in his face and arm. By the time dr. prime examines him later that day, the symptoms have resolved. Suspecting that basil has had a transient ischemic attack, dr. Prime prescribes aspirin and refers him to the neurologist at the local hospital, where a carotid artery sonogram reveals high-grade carotid stenosis. Dr. prime and the neurologist agree that basil should make an appointment at a london teaching hospital with a vascular surgeon specializing in head and neck surgery. The surgeon recommends that basil undergo carotid endarterectomy on an elective basis to prevent a major stroke.
