Skip to Content

4.1 Health Industry Fundamentals

Understanding the basic components and culture of the Health Industry.

Critical Work Functions

    4.1.1 Understand the components of the Health Industry: the key stake holders, command and control processes, and workflow.
    • Provide an overview of the organization and infrastructure of the health care system, including policies and procedures.
    4.1.2 Understand the components of the Health Industry and services provided by each.
    • Identify the structure and function of various health care delivery systems.
    • Compare and contrast the structure and function of health care delivery systems.
    4.1.3 Understand the difference between independent practices and practices that require patient-referral (dependent).
      4.1.4 Understand the importance of licensure, registration, and certification requirements.
      • Differentiate between licensure, registration and certification.
      • Compare and contrast the limits of licensure, registration and certification.
      • Recognize the impact of scope of practice in the health care delivery system.
      • Explain the importance of continued licensure, registration, and certification.
      4.1.5 Maintain and improve professional knowledge and skills.
      • Articulate the need to remain current in the professional practice by: reading journal articles, studying text books related to the field, attending continuing education courses, participating in professional organizations, etc.
      • Critically evaluate and appropriately implement new techniques and technologies supported by research-based evidence.
      4.1.6 Understand the purpose, function and types of health insurance.
      • Identify various types of health insurance i.e. federal, state, private, etc.
      • Articulate the role and purpose of health care insurance.
      • Compare and contrast types of health insurance and their function and impact.
      4.1.7 Understand patient-billing processes and means of paying for care.
      • Identify the processes for payment of health care services.
      • Identify resources for payment support.
      4.1.8 Understand compliance issues with third party payer (insurance) requirements.
      • Describe the impact of third party payer requirements on patient care options.
      4.1.9 Differentiate between various health care delivery systems to include the following:
      • Practitioners Dependent – by referral
      • Independent
      4.1.10 Treatment Facilities
      • Hospitals
        • Critical Access and Long Term Acute Care
        • Medical and Surgical
        • Psychiatric and Substance Abuse
        • Specialty
      • Outpatient Centers
        • Ambulatory Surgery Centers
        • Home Health Care Services
        • Medical and Diagnostic Laboratories
        • Other Ambulatory Services
        • Primary Care Medical Home (PCMH)
        • Retail Health Clinics
        • Rural Health Care Facilities
      • Nursing and Residential Care Facilities
        • Residential Care Facilities (assisted living) for the Elderly
        • Residential Facilities for People with Disabilities
        • Skilled Nursing Facilities
      4.1.11 Discuss health professions requirements related to the following:
      • Education and continuing education requirements
      • Professional regulation (e.g., licensure, registration, certification) and facility/program accreditation requirements
      • State and federal legislation and regulations that govern the delivery of health services
      • Discuss the role and impact of related health care providers including Health industry product vendors
      • Health research organizations
      • Pharmaceutical research companies
      • Public health agencies
      4.1.12 Outline the role of the health care provider related to insurance processes.
      • Health insurance options (HMO, PPO, EOP, POS, etc.)
      • Medicaid/Medicare compliance guidelines
      • Record-keeping
      • Referrals
      4.1.13 Discuss the impact of health care standards on patient care.
      • Culture of safety
      • Patient-centric service
      • Quality outcomes
      • Service excellence