1,Chapter 1: Health Care Delivery Systems Feipei Lai National Taiwan University,2,Health Care Delivery Systems,History of Medicine and Health care Delivery Continuum of Care Health Care Facility Ownership Health Care Facility Organizational Structure Licensure, Regulation, and Accreditation,3,Introduction,Health care delivery has been greatly impacted by escalating costs, resulting in medical necessity requirements, review of appropriateness of admissions, and requirement for administration of quality and effective treatments.,4,MRXO,在臨床醫學中，進行手術時同時使用磁振造影並整合各種影像技術是目前最熱門的醫療概念。新式的未來手術室中，安裝有全球首套MRXO解決方案，即完全整合磁振造影(MR)、光及電腦斷層掃描(CT)系統，大幅減少病患危險並簡化醫師的手續，可望提高手術成功率。 這項由日本東海大學、飛利浦醫療系統事業部合力推動的未來手術室，已經由日本東海大學的松前教授、津具醫師、山本醫師共同在手術室同時使用MR(磁振造影)和X光影像技術，來進行神經外科手術。,5,MRXO,在未來手術室中執行手術，可依執刀醫師與病患狀況，在數分鐘內將病患從手術台搬移到磁振造影、電腦斷層掃描或光診斷系統，增加手術精密度與成功率。在磁振造影和電腦斷層掃描區域有拉門。,6,History of Medicine & Health Care Delivery,History of medicine Evolution of health care delivery in the United States,7,History of medicine,In 1994, scientists discovered the genes responsible for many cases of hereditary colon cancer, inherited breast cancer, and the most common type of kidney cancer.,8,Evolution of health care delivery in the United States,1991 The Workgroup on Electronic Data Interchange (WEDI) was created to reduce health care administrative costs through implementation of the electronic data interchange (EDI), which uses national standards to transmit data for reimbursement purposes.,9,Evolution of health care delivery in the United States,1996 The Health Insurance Portability and Accountability Act (HIPAA) was passed. It mandates administrative simplification regulations that govern privacy, security, and electronic transaction standards for health care information.,10,Evolution of health care delivery in the United States,1996 The Healthcare Integrity and Protection Data Bank (HIPDB) was created which combats fraud and abuse in health insurance and health care delivery by alerting users to conduct a comprehensive review of a practitioners, providers, or suppliers past actions.,11,Healthcare Integrity and Protection Data Bank,Access to information in the HIPDB is available to entities that meet the eligibility requirements defined in Section 1128E of the Social Security Act and the HIPDB regulations. In order to access information, eligible entities must first register with the Data Bank. HIPDB information is not available to the general public. However, information in a form that does not identify any particular entity or practitioner is available.,12,Healthcare Integrity and Protection Data Bank,http:/www.npdb-hipdb.hrsa.gov/ Estimates of annual losses due to health care fraud range from 3 to 10 percent of all health care expenditures-between $30 billion and $100 billion based on estimated 1997 expenditures of over $1 trillion and 2.5 trillion for 2009.,13,Continuum of Care,A complete range of programs and services is called a continuum of care, with the type of health care indicating the health care services provided. Primary care Secondary care Tertiary care,14,Primary care services,Include preventive and acute care, are referred to as the point of first care, and are provided by a general practitioner or other health professional who has the first contact with a patient seeking medical treatment, including general dental, ophthalmic 眼科的, and pharmaceutical services.,15,Primary care services,Annual physical examinations Early detection of disease Family planning Health education Immunizations Treatment of minor illnesses and injuries Vision and hearing screening,16,Secondary care services,Provided by medical specialists or hospital staff members to a patient whose primary care was provided by a general practitioner who first diagnosed or treated the patient.,17,Tertiary care services,Provided by specialized hospitals equipped with diagnostic and treatment facilities not generally available at hospitals other than primary teaching hospital or Level I, II, III or IV trauma centers.,18,Trauma centers,Level I: provides the highest level of comprehensive care for severely injured adult and pediatric patients with complex, multi-system trauma. Level II: broad range of sub-specialists are on-call and promptly available to provide consultation or care.,19,Trauma centers,Level III: physicians are advanced trauma life support (ATLS) trained and experienced in caring for traumatically injured patients; nurses and ancillary staff are in-house and immediately available to initiate resuscitative measures.,20,Trauma centers,Level IV: critically injured patients who require specialty care are transferred to a higher level trauma system hospital in accordance with pre-established criteria.,21,Tertiary care,Burn center treatment Cardiothoracic and vascular surgery Inpatient care for AIDS patients Magnetic resonance imaging (MRI) Neonatology level III unit services Neurosurgery Organ transplant,22,Tertiary care,Pediatric surgery Positron emissions tomography (PET) Radiation oncology Services provided to a person with a high-risk pregnancy Services provided to a person with cancer State-designated trauma centers Trauma surgery,