【正文】 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(yī)學(xué)中，進(jìn)行手術(shù)時同時使用磁振造影並整合各種影像技術(shù)是目前最熱門的醫(yī)療概念。新式的「未來手術(shù)室」中，安裝有全球首套MRXO解決方案，即完全整合磁振造影 (MR)、Ｘ光及電腦斷層掃描 (CT)系統(tǒng)，大幅減少病患危險並簡化醫(yī)師的手續(xù)，可望提高手術(shù)成功率。 ? 這項由日本東海大學(xué)、飛利浦醫(yī)療系統(tǒng)事業(yè)部合力推動的「未來手術(shù)室」，已經(jīng)由日本東海大學(xué)的松前教授、津具醫(yī)師、山本醫(yī)師共同在手術(shù)室同時使用 MR(磁振造影 )和 X光影像技術(shù)，來進(jìn)行神經(jīng)外科手術(shù)。 5 MRXO ? 在「未來手術(shù)室」中執(zhí)行手術(shù)，可依執(zhí)刀醫(yī)師與病患狀況，在數(shù)分鐘內(nèi)將病患從手術(shù)臺搬移到磁振造影、電腦斷層掃描或Ｘ光診斷系統(tǒng)，增加手術(shù)精密度與成功率。在磁振造影和電腦斷層掃描區(qū)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 mon 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 bats fraud and abuse in health insurance and health care delivery by alerting users to conduct a prehensive review of a practitioner’s, provider’s, or supplier’s 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 13 Continuum of Care ? A plete 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 prehensive care for severely injured adult and pediatric patients with plex, multisystem trauma. ? Level II: broad range of subspecialists are oncall 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 inhouse 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 preestablished criteria.