Health -Care Providers Structure / Operation

Health-Care ProvidersStructure/Operation

Health-Care Facilities

• Primary Care– General Practice– General paediatrics– Dental Care– Visiting Nurses

• Secondary Care– Ambulatory Specialists

• Tertiary Care– Hospitals/Long Term Care Providers

General Practice

• Population wide care• Registration• Prevention/Treatment• Social Role of Physician• Density per 1000 population– CZ 0,7; Germany 0,65; Greece 0,28; – Norway 0,81; Sweden 0,62; UK 0,79; USA 0.3

Challenges

• Aging population• Changing competencies– Nursing care– Physiotherapy

• GP + Technology

Reimbursement

• Salaried GP• Fee for service• Capitation payment

Ambulatory Specialists

• Position– Hospitalits– Independent

• Reimbursement– Salaried– Fee for service– Payment per case

HospitalsBeds/1000 popul Employee/bed Nurse/bed

CZ 7,11 1,87 0,76

Germany 8,25 1,81 0,81

Netherlands 4,69 3,61 1,01

Norway 3,35 6,39 2,55

UK 3,34 6,45 NA

USA 3,08 6,25 2,27

Hospital structure

• Local ( Internal medicine +)• Regional ( average 10 specialties) • University Hospitals• Special Hospitals• Ownership– State/Municipality– Church– Private non for profit– Private for profit

Hospital department

• Outpatient– Acute – Clinics

• Inpatient– ICU – centralised/decentralised– Standard wards

Director

CMO

Head of Dept.

Ward Physician

Physicians

CNO

Head Nurse – Dept.

Ward Sister

Nurses/Porters

Head Therapists

Unit therapists

COO/CFO

Outpatient Care

• No formal limitation to patients• Low level of centralisation of Acute Care• Time management

Hospital reimbursement

• Budgeting• FFS• Case mix - DRG

Long Term CareBeds/1000 population

Beds/1000 seniors

Employees/1000 population

Employees/1000 seniors

CZ 6,5 43,3 3,6 2,4Germany 10,3 50,3 7,8 3,8Netherlands 10,4 68,5 11,7 7,7Norway 9,3 62,9 19,2 13UK 8,8 55,4 NA NAUSA 5,4 41,9 15,4 11,9

Medical Records vs. Medical Students

• Legal protection of contents – confidentiality• Only with the patient´s consent• Electronic/paper• Entries to be signed and confirmed by a

hospital employee• High level of protection– Patients ID (personal number)– Dg + treatment

Infection Prevention

• Vaccination• Clothing• Hand Hygiene– Hospital obliged to arrange– Hand + stethoscopes

• Special situations– Face masks– Pregnant students

Hospital Security and Patient Safety

• Individual badges• Doors• Awareness – strangers• Special precautions– Psychiatry– Paediatrics, neonatology– Infectious diseases