Lecture 5 & 6 Hospitals (history, types), Vul Pops & Health Insurance Basics_1

Lecture 5 & 6 Hospitals (history, types), Vul Pops & Health Insurance Basics_1

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Frankie Augustin, M.S.H.A. PPD 230
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EMTALA EMTALA Emergency Medical Treatment and Active Labor Act passed by Congress in 1986 to combat “patient dumping.” Hospitals and ambulance services are REQUIRED to provide care to ANYONE needing emergency treatment regardless of ability to pay or citizenship or legal status Applies to all hospitals payment from DHS, CMS… practically all hospitals except Indian Health Services or military VA Hospitals EMTALA services are not reimbursed by the government…unfunded mandate? Huge financial deficit. Uncompensated care causes ED doors to close. Hospitals write it off as charity or bad debt. Wikipedia
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But EMTALA caused… But EMTALA caused… Departments are overused, overcrowded, & underfunded Overcrowding causes ambulances to be diverted Excessive uses increases healthcare expenditures Uninsured use ED as form of primary care Interestingly enough…there has been an increase of avoidable ED usage by the insured population due to: Lack of access to available appointment/past business hours Perceived convenience Positive attitude toward ED (“pro-ED”) California Healthcare Foundation. Overuse of ED by Uninsured Californians. October 2006
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ARTICLE U.S. Rule Limits Emergency Care for Immigrants http://www.nytimes.com/2007/09/22/wa
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What is a “Hospital” What is a “Hospital” “an institution with at least six beds whose primary function is “to deliver patient services, diagnostic and therapeutic, for particular or general medical conditions” (AHA, 1994; Shi and Singh, 2005).
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Hospitals must have… Hospitals must have… A license Beds An organized medical staff Provision of continuous nursing under the supervision of registered nurses A designated governing body Full time Chief Executive Officer: CEO Medical records maintained for all patients Pharmacy service Food service Facilities that meet current structural codes (legal, regulatory)
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Types of Hospitals Types of Hospitals Community – Can be private nonprofit or private for profit or public Available to the general public – Less than 30 days stay (short stay hospital) Public – Municipal, county, state and federal Owned agencies of federal, state, local govts. Specialty hospitals – Psych, rehab, childrens, cancer Rural Hospitals – Census Bureau definition of rural used (located in a county that that is not part of an MSA) Teaching hospitals – Offers one or more residency training program
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Hospital Beds by Type of Hospital 11% 5% 13% 11% 60% Non-Federal * Federal State and local gov't Private for profit Private non profit Total beds = 987,440 * = mainly psych and long term beds Source, Health, United States, 2003 p. 299, National Center for Health Statistics; Shi and Singh, 2005 Fig 8.3
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Why do these categories  matter? To some extent…
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This note was uploaded on 04/12/2009 for the course PPD 230 taught by Professor Augustin during the Spring '05 term at USC.

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Lecture 5 & 6 Hospitals (history, types), Vul Pops & Health Insurance Basics_1

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