HEALTH CARE SYSTEMS - Principles of Health Sciences 1 – 1 - ثاني ثانوي

Link to digital lesson CHAPTER www.len.edu.sa 2 HEALTH CARE SYSTEMS Case Study Investigation Three patients presented to the emergency department. The first patient was complaining of fever, shortness of breath, and hemoptysis. The second has no complaints; he came simply for a blood lab workup to reassure him about his health. The third patient is a primigravid woman, pregnant after being married for 3 years with previous failure to conceive. She wants someone to check her baby's health after missing his movement for more than 12 hours. What kind of health care facility is suitable for the different needs of these three patients and where should you refer them to? LEARNING OBJECTIVES After completing this chapter, you should be able to: ⚫ Describe at least four (4) different types of health care facility. ⚫ Describe at least three (3) services offered by voluntary or nonprofit agencies. • Explain the purpose of organizational structures in health care facilities. • Understand some of the emerging issues in health care. • Analyze at least three (3) government health agencies and the services offered by each. I KEY TERMS bioethics clinics dental offices emergency care services epidemiology health clusters health insurance plans hospitals laboratories optical centers Preferred Providers Networks (PPN) technology long-term care facilities voluntary agencies government health agencies medical city وزارة التعليم Ministry of 24 CHAPTER 2 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 24 14/10/2022 10:12

2:1 HEALTH CARE FACILITIES The Saudi health care system consist of many agencies, facilities, and personnel involved in the delivery of health care. According to Kingdom of Saudi Arabia Ministry of Health (MOH) 2020 statistics, the health care industry employs more than half a million workers in multiple different health care careers. In the Ministry's 2030 Vision, the Health Sector Transformation Program's Workforce Initiative stressed that future focus will be on raising the ratio of clinical staff (especially nursing) to the general population, ensuring resources and expertise in the health sector, supporting professions such as finance, health economics, planning, and the legal field, and increasing the number of subsidized medical training locations for graduates. Health care spending in the Kingdom has reached more than 79 billion SAR in 2021 or 7.82 percent of the total budget spend. To improve spending efficiency, the 2030 Vision aims to provide health care through a health clusters system, by integrat- ing primary, secondary, and specialized care, and eliminating duplication of services. A health clus- ter is an integrated network of health care facilities under one administrative structure, each serving around one million people, with mobility of med- ical professionals within the system. Many different health care facilities provide ser- vices that are a part of the industry called health care (Figure 2-1). A basic description of the various facilities will help provide an understanding of the many different types of services included under the umbrella of the health care industry. HOSPITALS AND HEALTH CARE CENTERS Hospitals and health care centers are the major types of health care facilities. They vary in size and the types of services provided. Some health care centers are small and serve the basic needs of a community; these centers are commonly known as primary health care centers. Others are large, complex centers offering a wide range of services, including diagnosis, treatment, education, and research. Hospitals are also classified as private or proprietary (operated for profit), nonprofit or vol- untary, and government, depending on the sources of income received by the hospital. There are many different types of hospitals. Some of the more com- mon ones include: وزارة التعليم Ministry of Eduction 2022 1444 (A) (B) EMS FIGURE 2-1 Emergency care (A) and ambulance ser- vices (B) are among the many different health services provided in Saudi Arabia. HEALTH CARE SYSTEMS 25 | GE44.PATHWAYS.G02 S2.HLTH.SB.indb 25 14/10/2022 10:12

FIGURE 2-2 Treating a child at a specialty pediatric (children's) hospital. General hospitals: treat a wide range of condi- tions and age groups. They usually provide diag- nostic, medical, surgical, and emergency care services for acute care. ⚫ Specialty hospitals: provide care for special conditions or age groups; examples include burn hospitals, oncology (cancer) hospitals, pediatric (children's) hospitals (Figure 2-2), OB/GYN hospitals (these hospitals specialize in the care of women during pregnancy and childbirth, and in the diagnosis and treatment of diseases of the female reproductive organs), psychiatric hospitals (dealing with mental diseases and dis- orders), orthopedic hospitals (dealing with bone, joint, or muscle diseases), cosmetic surgery, and rehabilitative hospitals (offering services such as physical and occupational therapy). ⚫ Government and military hospitals: operated by local government and military forces agencies; this type of hospital includes the many facilities located throughout the world that provide care for government and armed forces service per- sonnel and their dependents. ⚫ University or college medical centers: provide hospital services as well as research and education; can be funded by private and/or governmental sources. وزارة التعليم Mist 26 CHAPTER 2 2022 1444 GE44.PATHWAYS.G02 S2.HLTH.SB.indb 26 MEDICAL CITIES A medical city is a tertiary care medical center with multifacility and multi- disciplinary health care teams and administration, which provides advanced medical care and interventions. Each medical city includes most of the previ- ously mentioned facilities. Examples for some medical cities include: ⚫ King Abdulaziz Medical City. ⚫ King Saud University Medical City. • Prince Sultan Military Medical City. ⚫ King Fahad Medical City. . King Abdullah Medical City. 14/10/2022 10:12

LONG-TERM CARE FACILITIES Long-term care facilities mainly provide assistance and care for elderly patients, usually called residents. However, they also provide care for indi- viduals with disabilities or handicaps, and individuals with chronic or long- term illnesses. CLINICS Clinics are health care facilities that can be found in many types of health care. Some clinics are composed of a group of medical or dental doctors and other personnel who share a facility. Other clinics are operated by private groups who provide special care. Examples include: Specialty clinics: provide care for specific field of medicine, such as der- matology, ophthalmology, or dental clinics. ⚫ Rehabilitation clinics: offer physical, occupational, speech, and other similar therapies. ⚫ "One-day" surgical centers: perform minor surgical procedures and some cosmetic surgeries; these clinics are called "one-day" surgical cen- ters because patients are sent home immediately after they have recovered from their operations, usually on the same day. DENTAL OFFICES Dental offices vary in size from offices that are privately owned by one or more dentists to dental clinics that employ a group of dentists. In some areas, major retail or department stores operate dental clinics. Dental services can include general care provided to all age groups, or specialized care offered to certain age groups, or for certain dental conditions like orthodontics (teeth straightening). OPTICAL CENTERS Optical centers can be individually owned by an ophthalmologist or optome- trist, or they can be part of a large chain of stores. They provide vision exam- inations, prescribe eyeglasses or contact lenses, and check for the presence of eye diseases or vision abnormalities. EMERGENCY CARE SERVICES Emergency care services provide special care after accidents or sudden (acute) illness. Facilities providing these services include ambulance services, both private and governmental; rescue squads, frequently operated by fire depart- ments; emergency care clinics and centers; emergency departments operated by hospitals; and helicopter or airplane emergency services that rapidly trans- port patients to medical facilities for special care. وزارة التعليم Minister Eduction 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 27 HEALTH CARE SYSTEMS 27 | 14/10/2022 10:12

LABORATORIES Laboratories are often a part of other facilities but can operate as separate health care services. Medical laboratories can perform special diagnostic tests such as blood or urine tests. Dental laboratories prepare dentures (false teeth) and many other devices used to repair or replace teeth. Medical and dental offices, small hospitals, clinics, and many other health care facilities frequently use the services provided by laboratories. checkpoint Name four different types of health care facility. 2:2 HEALTH SECTOR GOVERNANCE AND AGENCIES Following the 2030 Vision, health governance is being radically reformed to advance the objective of improving the quality and value of care, in line with international best practices. As such, clear and distinct markers will differen- tiate the roles of health care regulator and monitor, provider, and financier. The MOH is being redefined as the regulator and monitor of the health sec- tor (Figure 2-3). Alongside the Ministry, government health agencies have roles in legislation, making sure that the rules are followed, and supervision. Some examples of government health agencies include: FIGURE 2-3 Ministry of Health in Riyadh. Healthcare Development Holding Company (HDH): approved by the Saudi Cabinet, HHC is committed to implementing a modern health care model that focuses on providing health care services via health clusters, a set of independent health companies that focus on providing health care services. ⚫ The National Health Insurance Center (NHIC): most health care facilities require a fee for ser- vices. NHIC purchases health services provided by the HHC or its subsidiaries and provides free insurance coverage for beneficiaries, including all Saudi citizens. Public Health Authority (PHA): serves the public by working to monitor, measure, evaluate, control, and prevent any risk factors related to public health, including communicable and noncommunicable diseases, inju- ries, and other health challenges. PHA does this by presenting innovation and evidence-based solutions, preparing a generation of public health and وزارة التعليم Mines 28 CHAPTER 2 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 28 14/10/2022 10:12

health education experts for practice, and acting as a resource for all the health initiatives intended to promote wellness in the Kingdom. ⚫ Saudi Food and Drug Authority (SFDA): is in charge of consumer awareness on all matters related to food, drugs and medical devices, and all other products and supplies. SFDA regulates, oversees, and controls food, drugs, and medical devices, as well as setting mandatory standards, whether the items are imported or locally manufactured. The control and/ or testing activities can be conducted in the SFDA or other agency's labo- ratories (sfda.gov.sa). Saudi Commission for Health Specialties (SCFHS): a scientific commis- sion that regulates health care-related practices and practitioners accredi- tation at all levels in Saudi Arabia (scfhs.org.sa). ⚫ Council of Health Insurance (CHI): provides governance and regulation of the private health insurance sector. Enhances the effectiveness and effi- ciency of health services for beneficiaries, and enablesg stakeholders to achieve fairness, transparency, and excellence (chi.gov.sa). • ⚫ National Unified Procurement Company for Medical Supplies (NUPCO): responsible for procurement, logistics and supply chain man- agement for pharmaceutical, medical devices, and supplies for govern- mental hospitals in Saudi Arabia (www.nupco.com). ⚫ Saudi Health Council (SHC): sets regulations to ensure coordination and integration between health-related agencies to improve and enhance health care (shc.gov.sa). checkpoint 1. Name three (3) ways that national government agencies provide services to the health care community. 2. What responsibilities does the Saudi Food and Drugs Authority have? VOLUNTARY OR NONPROFIT AGENCIES Voluntary agencies, frequently called nonprofit agencies, are supported by donations, membership fees, and fundraisers. They provide health services at national, regional, and local levels. Examples of nonprofit agencies include the: ⚫ King Salman Humanitarian Aid and Relief Center (KSrelief), which pro- vides humanitarian aid and relief to those in need outside of the Kingdom's borders (ksrelief.org). Zahra Breast Cancer Association (zahra.org.sa). ENAYAH - a charitable health society for patient care (enayah.sa). وزارة التعليم Ministry of EductION 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 29 HEALTH CARE SYSTEMS 29 | 14/10/2022 10:12

وزارة التعليم Minist 30 CHAPTER 2 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 30 Saudi Cancer Society (www.saudicancer.org). Saudi ADHD Society (adhd.org.sa). Saudi Alzheimer's Disease Association (alz.org.sa). Naqa - Purity, anti-smoking charity (www.naqa.org.sa). Prince Fahad bin Salman Charity Association for Renal Failure and Patient Care (Kellana). As indicated by their names, many such organizations focus on one specific disease or group of diseases. Each organization typically studies the disease, provides funding to encourage research directed at curing or treating the disease, and promotes public education regarding the information obtained through research. These organizations also provide special services to victims of disease, such as purchasing medical equipment and supplies, providing treatment centers, and supplying information regarding other community agencies that offer assistance. Nonprofit agencies employ many health care workers in addition to using volunteers to provide services. checkpoint What is the King Salman Humanitarian Aid and Relief Center? 2:4 ORGANIZATIONAL STRUCTURE All health care facilities must have some type of organizational structure. The structure may be complex, as in larger facilities, or simple, as in smaller facili- ties. Organizational structure always, however, encompasses a line of authority or chain of command. The organizational structure should indicate areas of responsibility and lead to the most efficient operation of the facility. A sample organizational chart for a large general hospital is shown in Figure 2-4. This chart shows organization by department. Each department, in turn, can have an organizational chart similar to the one shown for the nursing department in the figure. A sample organizational chart for a small medical office is shown in Figure 2-5. The organizational structure will vary with the size of the office and the number of people employed. In both organizational charts illustrated, the lines of authority are clearly indicated. It is important for health care workers to identify and understand their respective positions in a given facility's organizational structure so they will know their lines of authority and understand who are the immediate supervisors in charge of their work. Health care workers must always take questions, reports, and problems to their immediate supervisors, who are responsible for providing the necessary assistance. If immediate supervisors cannot answer the question or solve the problem, it is their responsibility 14/10/2022 10:12

Hospital Board Chief Executive Officer (CEO) (President) (Administrator) Maintenance/ Central Business Pharmacy Dietary Nursing Laboratory Radiology Therapy Volunteers Housekeeping Supply Office Medical Director Administration Personnel Public Relations Accounts Medical Social Records Services Medical Physical Occupational Recreational Staff Chief Nursing Officer (CNO) Nursing Education Surgery Inpatient Care Emergency Room Clinics Nursing Supervisors RNs Head or Charge Nurses (Unit Managers) Patient Care Technicians (PCTs) Medical Secretanes LPNs LVNs RNs or Unit Coordinators Volunteers FIGURE 2-4 A sample hospital organizational chart. Physician Office Manager Administrative Assistant (Receptionist) Qualified Nurses Maintenance/ Housekeeping Laboratory Business Dept./ Insurance Nursing assistants Medical Assistants FIGURE 2-5 A sample medical office organizational chart. وزارة التعليم Minestiger Education 2022 1444 GE44.PATHWAYS.G02.S2.HLTH SB.indb 31 HEALTH CARE SYSTEMS 31 | 14/10/2022 10:12

to take the situation to the next level in the organizational chart. It is also important for health care workers to understand the functions and goals of the organization. checkpoint 1. What does organizational structure encompass? وزارة التعليم Mines of 32 CHAPTER 2 2022-1444 2:5 HEALTH INSURANCE The cost of health care is a major concern of everyone who needs health ser- vices. World Bank statistics show that the cost of health care is around 5.2 percent of Saudi Arabia's gross national product (GDP, the total amount of money the country's population spent on all goods and services). To pay for the costs of health care, most people rely on health insurance plans. WHAT IS HEALTH INSURANCE? Health insurance is a type of insurance whereby an individual's family pays a regular sum of money (a premium) to an insurance company, and in return the company pays some or all of the costs of their medical treatment. Without insurance, the cost of an illness can mean financial hardship for an individual or family. . Having health insurance leads to increased attendance for medical check- ups in Saudi Arabia. By increasing the chances of a person going for a medical check-up, health insurance has the potential to save costs on curative health. ⚫Health insurance can lower inpatient and outpatient treatment costs and can reduce the severity of illness because people are treated earlier. Health insurance plans are offered by either government or private agen- cies. The National Health Insurance Center (NHIC) is a government agency that provides free insurance coverage for beneficiaries, including all Saudi citizens. The Council of Health Insurance (CHI) approves private insurance companies to participate in the cooperative health insurance business, and third-party administrative companies to handle cooperative health insurance claims. Common insurance terms include: ⚫ Deductibles: amounts that must be paid by the patient for medical ser- vices before the policy begins to pay. ⚫ Co-insurance: requires that specific percentages of expenses are shared by the patient and insurance company; for example, in an 80-20 percent co-insurance plan, the company pays 80 percent of covered expenses, and the patient pays the remaining 20 percent. GE44.PATHWAYS.G02.S2.HLTH.SB.indb 32 14/10/2022 10:12

Co-payment: a specific amount of money a patient pays for a particular service. ⚫ Assignment of benefits: an agreement that assigns the benefits of health insurance to a physician or health care facility so they can collect payment directly from the insurance company. Many individuals have insurance coverage through their places of employ- ment (called employer-sponsored health insurance or group insurance), where the premiums are paid by the employer. In most cases, the individual also pays a percentage of the premium. Private policies are also available for purchase by individuals. A Preferred Providers Network (PPN) is a group of health service provid- ers approved by the CHI and identified by the health insurance company to provide the service to the insured person. The CHI has developed seven key objectives for a health insurance policy to promote preventive therapy and enhance the quality and efficiency of health care services for health insurance beneficiaries. These objectives are: ⚫ Protection of beneficiaries: early and exploratory examination, vaccines. ⚫ Health promotion: women's and children's health, dentistry, psychologi- cal health. ⚫ Reduction of disease complications: congenital malformations, acquired valvular heart disease kidney dialysis, comprehensive diabetes program. ⚫ Improvement of beneficiaries' functions and capacities: vision, rehabil- itation, surgical procedures. ⚫ Facilitating beneficiaries access to services for home care, telemedicine, insurance drug formulary. ⚫ Empowerment of beneficiaries: hospitalization, outpatient clinics visits, emergency treatment. ⚫ Enhancement of the quality and efficiency of the service: medical equip- ment, chronic diseases. Consumer responsibility for health care costs continues to increase as both consumers and health care plans struggle to control cost. It is essential for individuals to take an active role and become responsible consumers of health care. Some ways consumers can meet this responsibility include: ⚫ Take an active role in maintaining good health: Maintain a healthy life- style by eating a healthy diet, exercising regularly, getting adequate rest, avoiding tobacco and drugs, getting immunizations to prevent disease, practicing wellness, and obtaining screening tests for early detection of disease. Evaluate different health care plans: Compare different plans based on cost, benefits, and quality of care and choose the plan that will provide quality care at the most reasonable cost. وزارة التعليم Ministry of Eduction 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 33 HEALTH CARE SYSTEMS 33 | 14/10/2022 10:12

وزارة التعليم Mins 34 CHAPTER 2 2022-1444 GE44.PATHWAYS.G02 S2.HLTH.SB.indb 34 ⚫ Research quality of care: Use resources available on the Internet and media to see which health care providers are rated high for quality care, and try to use these providers whenever possible; seek recommendations from friends and family and check credentials for any health care provider. . Make informed decisions regarding health care: Ask questions regard- ing different treatments and choose care based on their own values and beliefs; choose health care providers who make every effort to provide information about choices available and the risks and benefits of each choice. ⚫ Use health care plan benefits wisely: Be informed about what co-insur- ance, deductibles, and other costs are with any plan and try to minimize these costs; for example, a visit to an urgent care center is usually much cheaper than a visit to an emergency room for many acute illnesses. ⚫ Make every effort to save money on health care costs: Use in-network physicians and facilities whenever possible; price medications to see if a generic equivalent- or lower-priced mail-order is available; check medical bills carefully for accuracy, and question any charges that do not seem appropriate. ⚫ Help prevent medical errors: Question any care that does not seem appro- priate; keep track of test results, and ask for explanations about abnormal results; check medications to ascertain they are correct. It is essential to remember that all health care consumers have the right and responsibility to fully participate in all decisions related to their health care, and if they are unable to participate, they have the right to be represented by parents, family members, or guardians. checkpoint 1. What do the initials NHIC stand for? 2. What is a Preferred Providers' Network? 14/10/2022 10:12

Today's Research Nature as a Pharmacy? Tomorrow's Health Care Throughout history, many medicines have been derived from natural resources. Examples include aspirin, which comes from willow bark; penicillin, which comes from fungus; and the cancer drug paclitaxel, which comes from the Pacific yew tree. Recognizing this, many scientists believe that nature is a pharmaceutical gold mine and are exploring the vast supply of materials present in the oceans and on the earth. One compound, halichondrin B, labeled "yellow slimy" by researchers, is an extract taken from a deep-sea sponge found in New Zealand (Figure 2-6). Scientists created a synthetic version of the active component in halichondrin B, called E7389. After extensive testing, the drug eribulin, which was created from this compound, was approved as a treatment for metastatic breast cancer. By creating synthetic versions of the compounds, scientists are preserving natural resources while also benefiting from them. Other natural products are now being tested and modified. As scientists continue to explore all that nature has to offer, it is possible they will find cures for many cancers, diseases, and infections. FIGURE 2-6 The drug eribulin has been created from a marine sea sponge. 2:6 IMPACT OF EMERGING ISSUES ON DELIVERY SYSTEMS Technology, applying scientific knowledge for practical purposes to find answers and fix problems, has brought about a massive and welcome change to the health care industry. Patients now have access to some of the best diagnostic tools and new cutting-edge treatments: The digitalization of health records has made for quick, secure, and acces- sible information to remote providers. ⚫ Mobile app technology allows patients to easily obtain accurate informa- tion and track their own health status over time. . Another example of technology in health care is 3-D printing, which is used to create prosthetics, hearing aids, and more (Figure 2-7). ⚫ Virtual reality devices help depression and isolation in older patients. Developments in technology are constantly streamlining and improving how patients interact with their health care providers. وزارة التعليم Ministry of Education 2022-1444 GE44.PATHWAYS.G02 S2.HLTH SB.indb 35 HEALTH CARE SYSTEMS 35 | 14/10/2022 10:12

وزارة التعليم Mi 36 CHAPTER 2 2022 1444 GE44.PATHWAYS.G02 S2.HLTH.SB.indb 36 Epidemiology is the study of disease in populations. Epidemiological meth- ods are used for disease surveillance to identify which health hazards are the most important. They also identify risk factors that may represent critical control points in health and food/drug production systems. Bioethics aims to investigate and study how health care decisions are made. It is a core component of ensuring that medical practices and procedures benefit society as a whole. Deciding who gets what is a main task for medical ethics. Should scarce health care resources be divided according to need, ability to pay, potential for economic productivity, or some other criteria? Should doctors at the bedside be the gatekeepers, or should financial managers or others make the rules from a distance? checkpoint What is epidemiology? Case Study Investigation Conclusion These patients each presented to the emergency department of a general hospital. The first patient was complaining of fever, shortness of breath, and hemoptysis. She has acute symptoms for infection, so she needs emergency care and intervention, and close follow-up. The second patient only wants an annual check-up, which should be done at the primary care center's clinic. The third patient needs to be checked as an emergency, with ultrasound and labs, then referral for close OBGYN care. FIGURE 2-7 Plastic face shields can be manufactured using a 3-D printer. 14/10/2022 10:12