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Basic health care services includes in and out-of-area emergency services, inpatient hospital and physician care, outpatient medical services, laboratory and radiology services, and preventive health services. Basic health care services shall also mean limited treatment of mental illness and substance abuse in accordance with minimum standards prescribed by the state health commission and it shall not exceed the level of services mandated for insurance carriers. "Health care services" means any medical or remedial care or service, including supplies delivered in connection with the care or service that is recognized under state law.

At every turn, patients, providers and payers experience a fragmented system that is fraught with challenges. As an example, a study from 2012 found hospital readmissions are estimated to cost Medicare $26 billion per-year, $17 billion of which is potentially avoidable. Another study found that an estimated 8 to 12% of patients admitted to hospital in the EU suffer from adverse events while receiving healthcare, But it doesn't have to be that way – Healthcare Services & Solutions (HSS), a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, is focused on improving the healthcare experience. We're working hard to offer services that help solve the problems faced by patients, providers and payors as they navigate the healthcare maze. The range of home health care services a patient can receive at home is limitless. Depending on the individual patient's situation, care can range from nursing care to specialized medical services, such as laboratory workups. You and your doctor will determine your care plan and services you may need at home. A new study found death rates rose slightly among heart failure and pneumonia patients at hospitals participating in CMS' readmissions reduction program. This is the second study to find this correlation. 

Modern Healthcare

The challenges facing the country's health care system from issues with access to rising costs is considerable and complex. The science of health care delivery focuses on how patients actually receive care. From using engineering principles to determine the most efficient way to schedule patient appointments to research focusing on the most successful, cost-effective means for delivering treatment, this discipline's aim is to enhance the patient's experience with health care by improving quality, outcomes and cost.

Modern Healthcare is the industry's leading source of healthcare business and policy news, research and information. We report on important healthcare events and trends, as they happen, through our weekly print magazine, websites, e-newsletters, mobile products and events. Our readers use that information to make informed business decisions and lead their organizations to success. It's for this reason that Modern Healthcare magazine is ranked No. 1 in readership among healthcare executives and deemed a "must-read" by the who's who in healthcare. American health care cries out for the discipline of health care delivery science because — as a whole — U.S. health care is disintegrated, uncoordinated and expensive. Health care delivery and systems in the United States are changing rapidly. The CMS is interested in developing a new assessment tool. The tool is intended to replace similar items on the existing Medicare assessment forms, including the Outcome and Assessment Information Set, MDS, and IRF-PAI tools.

Any initiatives from states and the federal government to ensure the solvency of Medicare and Medicaid programs are likely to affect post-acute care settings in great measure. In coming years, there may be massive changes in health care payment methodology, systems of delivery, and continuity of care. Post-acute care settings, including LTC, will see widespread implementation of electronic documentation and medical record keeping. The American Recovery and Reinvestment Act of 2009 alone dedicated some $19 billion toward assisting health care entities and providers with implementation of electronic medical records.

It is clear that our current system will need to change to keep up with the large numbers of aging baby boomers who will create the biggest demand on the Medicare system the program has experienced since its inception. Physical therapists will continue to have an important role in the delivery of care in post-acute care settings. Knowledge of evidence-based interventions, which are both clinically effective and fiscally efficient, will be especially important. Health promotion and wellness efforts should become standard practice for geriatric physical therapists as our society shifts toward a more preventive model of health care delivery. The post-acute care environments, especially LTC, offer many opportunities for physical therapists to make substantive contributions to changes in how the aging adult regains function and is able to have a meaningful, productive quality of life.

As legislators continue to grapple with health care reform, Mayo Clinic is "just doing it" — starting with our own medical practice. We constantly strive to perfect our own processes and procedures because we believe that health care providers have a responsibility to lead this effort. By creating the center, Mayo Clinic is emphasizing the need to invest more resources into this discipline and accelerate the pace of improvement.

Modern Healthcare leads the market in editorial excellence and is honored to receive awards from ASBPE, ASHPE American Business Media, Trade Association and Business Publications International and the Association of Health Care Journalists, affirming Modern Healthcare's status as the best source for healthcare business and policy news, research and information.


Primary Care

A nursing model is presented for comprehensive interdisciplinary primary health care practice, education, and research. A unique aspect of this model is the partnership with the community, which is an essential component for operationalization of the model. Use of this model will provide an opportunity for cost-effective, acceptable, accessible, and holistic health care that better meets the needs of the community. Primary health care has emerged as a key element in the health care delivery system. A well-organized system of primary care is needed to reduce the fragmented, often parallel approaches currently seen in the delivery of health care. Important aspects of primary care include not only comprehensive services and continuity of care to the individual client but health assessment and intervention to meet the community needs as a whole.

Secondary Care

Health care services, at such centers are provided by medical specialists. They may not have first contact with patients. Depending on the policies of the National Health System, patients may access these services through physician referral or self-referral.  This healthcare is provided by the medical specialists and other health problems that do not have direct contact with a patient like urologists, dermatologists, cardiologists etc. According to National health system policy, the patient required primary care professional’s referral to proceed further for secondary care. Depends on countries to countries, the patient cannot directly take secondary care because sometimes health system imposed a restriction of referral on a patient in terms of payment.
Secondary health care providers include cardiologists, urologists, dermatologists and other such specialists. The health care services include acute care, short period stay in a hospital emergency department for brief but serious illness. Secondary Healthcare refers to a second tier of health system, in which patients from primary health care are referred to specialists in higher hospitals for treatment. In India, the health centers for secondary health care include District hospitals and Community Health Centre at block level. There may be secondary care providers who do not work in hospitals - psychiatrists, physiotherapists, respiratory therapists, speech therapists and so on.  Secondary care is usually (but not always) delivered in a hospital/clinic with the initial referral being made by the primary care professional.  Secondary health care can also refer to ongoing services not necessarily provided in the hospital, such as psychiatrists, physiotherapists and occupational therapists.

Tertiary Care

This is a specialized consultative health care for inpatients. The patients are admitted into these centers on a referral from primary or secondary health professionals. Tertiary health care is provided in a facility that have personnel and facilities for advanced medical investigation and treatment. This type of healthcare is known as specialized consultative healthcare usually for inpatients and on referral from primary and secondary healthcare for advanced medical investigation and treatment. Following examples of tertiary care services are plastic surgery, burn treatment, cardiac surgery, cancer management, neurosurgery, complex medical and surgical interventions etc. 

Highly specialized health care, often for inpatients and on referral from a primary or secondary health professional, is considered tertiary care. This often includes particularly complex medical or surgical procedures. Services provided include cancer management, neurosurgery, cardiac surgery and a host of complex medical and surgical interventions. Advanced diagnostic support services and specialized intensive care which cannot be provided by primary and secondary health centers are available at the tertiary health centers.

Healthcare System

A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies. The healthcare system is meant to keep people healthy and illness free. Its other purpose is to find cures for diseases. A healthcare system also sometimes referred to as health system, is a community or organizations that include people, resources and service to meet the health needs of society delivering health care services. A group of hospitals working together to deliver healthcare services to society with each of them having a different type of ownership and financial goals e.g. Public hospitals, Private and Non-profit hospitals
The side effects of the health care system are People being more resistant to diseases, Eradication of diseases and diseases becoming more resistant to medicine. There are some ways to make the health care system work alternatively.  Hospitals, clinic and community health agencies can be very different from other work environments. Healthcare systems are complex and there are many things you need to know about types of hospital systems, patient care, insurance, healthcare providers and legal issues.

Healthcare programs/ Health Insurance

  1. Traditional and Managed care. Within those categories, there are four basic types of plans:
  2. Traditional indemnity plans, which are now often called fee-for-service plans;
  3. PPO, or Preferred Provider Organizations;
  4. POS, or Point-Of-Service plans;
  5. HMOs, or Health Maintenance Organization;

Healthcare system is designed to ensure that even poor can get different levels of healthcare in a timely, cost-effective and seamless manner through various health programs offered by government. Insurance is provided by employees to make sure expenses will be incurred from any disease or pay the care provider directly. The age profile of your employees and the pre-existing conditions they have will determine which of the two options is more economical. A group rate may be cheaper as the premium you have to pay is based on the rate applicable to people with the same demographic profile.

Healthcare system is designed to ensure that even poor can get different levels of healthcare in a timely, cost-effective and seamless manner through various health programs offered by government. Insurance is provided by employees to make sure expenses will be incurred from any disease or pay the care provider directly. The National Small Business Association's (NSBA) 2015 Health Care Survey found that only 41% of firms with zero to five employees offer health care benefits, down from 46% a year ago. The situation is slightly better when all firms with less than 500 employees are considered with 65% of employers in this category offering insurance benefits. You will be better off with this option if your employees are more susceptible to chronic diseases. Don’t underestimate the benefits that health insurance brokers can bring to the negotiating table. They would be aware of the latest developments in the various laws and regulations governing the health insurance industry. They would also have extensive knowledge about the various plans available with different insurers. Raise this point with your tax consultant. Employers with less than 25 full-time employees who earn an average of $50,000 or less are eligible under certain conditions. These include contributing at least 50% of the total premium cost and obtaining coverage through the Small Business Health Options Program.

Healthcare Industry

The healthcare industry provides a variety of services to support the healthcare needs of a community or individuals. The healthcare industry classifies the different products it offers by sector. Hospitals and healthcare systems are continually changing their service offerings, and responding to various internal and external forces including reimbursement issues, advances in technology, and shifts in the populations they serve. A universally agreed-upon classification of sectors does not exist, so a non-exhaustive but inclusive and simplified classification of broad sectors will be used in this exploration. Health care industry plays an important part in the economy of a country. The health care industry determines the GDP or the gross domestic product of any country. It also determines exports status, employment, capital investment etc. Health care segment provides employment openings to many individuals directly associated with the health care sector or other associated sectors, related to the health care industry in some way or the other. Efforts are usually made to keep the dollars rolling within the country economic set up. The key sectors of healthcare industry can be broadly classified into following four sub-segments:

  • Health care services and facilities.
  • Medical devices, equipment, and hospital supplies manufacturers.
  • Medical insurance, medical services and managed care.

Pharmaceuticals & Related Segments

With the invention of latest technological developments, the world health care industry is catching up with the other leading industries of the world. World health care industry is one of the largest industries catering to the medical needs of innumerable people around the globe. Statistics show that in the year 2004, employment provided by the health care industry accounted for 13.5 million job opportunities. Out of the 13.5 million jobs, some of the people opted for self-employment while others remained salaried workers related to the health care. It has been predicted that between 2004 through 2014, increase in the health care jobs would be by approximately 19% or as many as 3.6 million job opening would be produced.

Healthcare Financing

The financial team must also raise funds for expenditures. This might involves fundraising, grants, loans or using internal funds. They will look at the cost and benefit of the investment and/or the kind of debt that they will incur. The senior manager will make the ultimate call on financing. In the case of the emergency room, the financial management team will bring someone in to determine how much a renovation would cost as well as how long it would take. Hospitals and healthcare providers have to make sure they’re compliant with a number of rules and regulations governing everything from patient privacy to outcomes from procedures. The financial team has a hierarchy, but in general, input is taken from all the managers at all levels when it comes to big investments in the business. Long-term investment decisions involve analyzing implementation strategies and determining how the investment might affect the financial future for the better or for the worse. Cutting corners here could land facilities in hot water, so it’s key to have the funds available to invest in meeting compliance guidelines. They may decide to use internal funds and then take out a small loan to cover the rest of the expenses, knowing that the long-term investment will bring them more revenue to ultimately help them pay back the loan. Every day, it becomes more challenging for hospitals to survive in the current healthcare climate, particularly regarding financial matters. It’s tough to find the money to fund care quality initiatives and other improvements while staying afloat.

With that in mind, Siemens Financial Services surveyed healthcare finance managers around the globe to find out about their top challenges in the current financial landscape. It chronicled the results in a new report. New medical technology is being developed at a rapid pace, but hospitals can’t always take advantage of its benefits, whether it’s due to cost constraints or an outdated IT structure. But because there’s increased pressure to use technology for improved patient outcomes, more facilities are exploring how they can come up with the money to implement new medical devices, interoperable electronic health records systems and other innovations.

The biggest economic challenges healthcare provider’s faces right now are fairly universal despite each facility’s location and size.
Healthcare Research

The multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately, our health and well-being. Health research has high value to society. It can provide important information about disease trends and risk factors, outcomes of treatment or public health interventions, functional abilities, patterns of care, and health care costs and use. The different approaches to research provide complementary insights. Clinical trials can provide important information about the efficacy and adverse effects of medical interventions by controlling the variables that could impact the results of the study, but feedback from real-world clinical experience is also crucial for comparing and improving the use of drugs, vaccines, medical devices, and diagnostics.

Pediatric Quality Indicators

These are concerned with many of the same aspects as previously mentioned, but concerning the pediatric population.

In-patient Quality Indicator (IQI)

This concerns the quality of patient care inside a hospital. Numbers studied reflect patient mortality rates in a given hospital caused by lack of care or surgical procedures.

Patient Safety Indicators (PSI)

These concern the quality of care of patients in a hospital, but unlike IQIs, they deal specifically mortalities related to avoidable complications, such as those caused by outdated hospital machinery.

Prevention Quality Indicator (PQI)

This is used to identify hospital admissions that could have been avoided through higher quality outpatient care. This is used primarily concerning patients who experience return visits.
Health services researchers come from a variety of disciplinary backgrounds. The workforce includes an array of professionals and disciplinary perspectives, including fields such as:

  • Social and behavioral sciences
  • Engineering.
  • Medicine, nursing, dentistry, pharmacy, and allied health.
  • Health care policy, research, administration, and management.
  • Epidemiology and biostatistics.

Healthcare Information Technology

Health IT (health information technology) is the area of IT involving the design, development, creation, use and maintenance of information systems for the healthcare industry. Automated and interoperable healthcare information systems will continue to improve medical care and public health, lower costs, increase efficiency, reduce errors and improve patient satisfaction, while also optimizing reimbursement for ambulatory and inpatient healthcare providers. Health information technology (health IT) specialists handle the technical aspects of managing patient health information. Depending on their position, health IT professionals might build, implement, or support electronic health records (EHRs) and other systems that store patient-related data. They know what data is needed, where it stored is, and how the data is used. 

All people have some ability to manage their health and the health of those they care for. However, with the increasing complexity of health information and health care settings, most people need additional information, skills, and supportive relationships to meet their health needs. Medical records and health information technicians, commonly referred to as health information technicians, organize and manage health information data. They ensure that the information maintains its quality, accuracy, accessibility, and security in both paper files and electronic systems. They use various classification systems to code and categorize patient information for insurance reimbursement purposes, for databases and registries, and to maintain patients’ medical and treatment histories.

Disparities in access to health information, services, and technology can result in lower usage rates of preventive services, less knowledge of chronic disease management, higher rates of hospitalization, and poorer reported health status. Both public and private institutions are increasingly using the Internet and other technologies to streamline the delivery of health information and services. This results in an even greater need for health professionals to develop additional skills in the understanding and use of consumer health information.

Healthcare Administration and Regulation

Every industry needs an army of talented executives, managers and administrators to be successful. In most situations, the people who focus on the specialized talents in an industry lack the business skills necessary to keep the industry profitable. Musicians have business managers and hospitals have healthcare administrators. There is a lot that goes into becoming a successful and qualified healthcare administrator and it all begins with a desire to lead and a comprehensive understanding of the healthcare industry. While the range of talents acquired by some of the best healthcare administrators can vary, the one thing that remains constant throughout the entire industry is the need for a Master in Healthcare Administration degree. There are many accredited and reputable universities throughout the country that offer the kind of educational background that people need to be successful in this field. In the end, it is a combination of educational process and practical workplace experience that makes a successful administrator.

Healthcare Quality Improvement Act of 1986 (HCQIA)

The Healthcare Quality Improvement Act (HCQIA) provides immunity for medical professionals and institutions during conduct assessments. The law originated partially due to a Supreme Court ruling involving abuse of the physician peer review process. To date, HCQIA continues to evolve as the act arises in courtrooms and justices deliver new rulings. Legislators enacted the law to protect medical professionals from peer review-related lawsuits and to encourage physicians to file official complaints after encountering unprofessional and dangerous peer conduct.


The Medicare program provides insurance coverage for almost 50-million American citizens. In 1945, President Harry Truman rallied Congress for funding to insure all United States citizens. Twenty years later, President John F. Kennedy finally succeeded in providing coverage for U.S. senior citizens. Today, the Congressional Budget Office forecasts that the program will survive indefinitely thanks to sweeping spending reforms.


President Johnson’s 1965 legislation also included a provision to provide insurance for low-income individuals. Medicaid provides coverage for over 70-million American citizens. In 2014, the program reimbursed hospitals for almost 50-percent of all medical expenses.

Medicaid covers various recipients, such as uninsured expectant mothers, temporarily unemployed workers and disabled individuals. Recently, new legislation has lowered the nation’s uninsured rate to under 9-percent, representing the highest coverage rate in U.S. history.

Children’s Health Insurance Program (CHIP)

Along with the Medicaid, the Children’s Health Insurance Program (CHIP) has created a strong foundation for delivering health coverage to children living in low-income households. The program originated with the Children’s Health Insurance Authorization Act of 2009 (CHIPRA) and has successfully provided services to many previously disqualified clients. The program has an extensive history of providing insurance to underprivileged children and receives funding from respective states and the federal government. Today, the Affordable Care Act (ACA) makes this service accessible to the largest number of low-income children in the country’s history.

Types of Home Healthcare

Doctor care

A doctor may visit a patient at home to diagnose and treat the illness (es). He or she may also periodically review the home health care needs.

Nursing care

The most common form of home health care is some type of nursing care depending on the person's needs. In consultation with the doctor, a registered nurse will set up a plan of care. Nursing care may include wound dressing, stormy care, intravenous therapy, administering medication, monitoring the general health of the patient, pain control, and other health support.

Medical social services

Medical social workers provide various services to the patient, including counseling and locating community resources to help the patient in his or her recovery. Some social workers are also the patient's case manager--if the patient's medical condition is very complex and requires coordination of many services.


While a patient is being medically cared for in the home, a homemaker or person who helps with chores or tasks can maintain the household with meal preparation, laundry, grocery shopping, and other housekeeping items.


Some patients who are home alone may require a companion to provide comfort and supervision. Some companions may also perform household duties.

Volunteer care

Volunteers from community organizations can provide basic comfort to the patient through companionship, helping with personal care, providing transportation, emotional support, and helping with paperwork.

Nutritional support

Dietitians can come to a patient's home to provide dietary assessments and guidance to support the treatment plan.

Pharmaceutical services

Medicine and medical equipment can be delivered at home. If the patient needs it, training can be provided on how to take medicines or use of the equipment, including intravenous therapy.

Home-delivered meals

Often called Meals-on-Wheels, many communities offer this service to patients at home who are unable to cook for themselves. Depending on the person's needs, hot meals can be delivered several times a week.