2. Access to Care

Question 1

2 major components for access to health care?

Answer 1

Ability to pay, availability of health care personnel/facilities that are accessible, culturally acceptable, and capable of providing timely, appropriate care

Question 2

Trend for health insurance coverage from 1930-2009?

Answer 2

1930s-1970s saw more insured people cuz of the growth of private health insurance and 1965 Medicare/Medicaid passage. Since 1980, number increased to twice as much cuz of decreasing private insurance coverage.

Question 3

Accountable Care Act is supposed to do what to uninsured rates?

Answer 3

Drop in half from around 50 million

Question 4

Why has private health insurance coverage decreased over the past decades? (3)

Answer 4

1) Skyrocketing cost of health insurance has made coverage unaffordable for many business, either drop insurance or shift cost of premiums/services onto employees. 2) Economy has shifted from high pay/unionized/full time to low pay/non-unionized/part time (less likely to be provided insurance) 3) Link of private insurance with employment means coverage interruption (unstable nature of employment)

Question 5

How has the erosion of private insurance coverage been countervailed?

Answer 5

Through major expansion of public insurance coverage through Medicaid and State Children’s Health Insurance Program (SCHIP)

Question 6

How is the transient nature of employment linked insurance compounded?

Answer 6

Difficulties in maintaining eligibility for Medicaid (a small increase in income can rule out qualification)

Question 7

Ethnicity of uninsured?

Answer 7

12% white, around 20% are black Asian, a third are Latino

Question 8

Uninsured can be divided into what 2 major categories?

Answer 8

Employed uninsured (75%, includes children/spouse of working person) and unemployed uninsured (and ineligible for Medicaid)

Question 9

Is insurance really necessary?

Answer 9

People lacking insurance receive less care and have worse health outcomes (increase risk of dying by 25%, accounts for 18k deaths/year in US)

Question 10

If you have Medicaid, how good is your access to care?

Answer 10

By no means guaranteed - Medicaid pays docs far less than MCARE/Private insurance, docs don’t accept. Having MCAID is like intermediate access between those with private and those without insurance

Question 11

What is underinsurance?

Answer 11

Health insurance coverage has limitations that restrict access to needed services (like, a fifth of insured Americans)

Question 12

4 phases of underinsurance?

Answer 12

Limits to insurance coverage, high deductibles/copayments, gaps in MCARE coverage, and lack of coverage for long-term care

Question 13

On average, what percentage does Medicare pay for the health care expenses? And what’s the deal with MCARE Part D?

Answer 13

About half. MCARE Part D requires beneficiaries to continue shouldering large out-of-pocket expenses for their meds.

Question 14

Do elderly in nursing homes qualify for MCAID?

Answer 14

Only when they’re buckass poor…gotta use up all your life savings then get qualified.

Question 15

Nonfinancial barriers to health care? (5)

Answer 15

Lack of prompt access, gender, race, relation between health status and health care, health status and income

Question 16

Explain lack of prompt access.

Answer 16

Growing shortage of PCPs, and less are accepting MCAID…inappropriate ED visits.

Question 17

Explain gender and access.

Answer 17

With MALE MDs, Women are more likely to be satisfied with care, are prescribed fewer diagnostic tests, are less likely to be counseled about prevention stuff, are more likely to have MCAID (docs turn them away), and have limited access to abortions.

Question 18

Explain race and access.

Answer 18

Higher proportion of minorities is uninsured/MCAID/poor, so they have health access problems. Studies have shown that blacks and Latinos receive fewer services even when compared to white people with same level insurance/income level.

Question 19

Why can explain disparities in access to care across racial groups that aren’t accounted for by socioeconomic status? (3)

Answer 19

1) cultural differences about value of medical care 2) ineffective communication (but sometimes even that doesn’t account for disparity) 3) YOU JUST RACIST, BITCH

Question 20

Explain relation between health care and health status.

Answer 20

Access to health care doesn’t itself guarantee good health - environment and life decisions factor in. EG of the coal miner who had excellent insurance but died of pneumonia/black lung disease.

Question 21

Explain health status and income.

Answer 21

IN GENERAL, lower income people are less likely to be healthy. Also, mortality rates are higher in states that have more unequal distribution of income.

Question 22

Black, Latino, Native American, and Asian mortality rates?

Answer 22

Black and Native American have higher mortality rates than whites, and Latinos and Asians have lower rates.

Question 23

Why doe Latinos have lower mortality rates?

Answer 23

Many Latinos are immigrants, and foreign-born people often have lower mortality rates than people born in the US at the same level of income. (Health Immigrant Effect)

Question 24

Problems for MD offices if they accept MCAID pts?

Answer 24

1) Too many MCAID pts, very little compensation, means can’t afford expenses to keep the office running and malpractice insurance 2) Fear of being sued by MCAID pts cuz they’re at high risk for stuff

Question 25

Who burdens the cost of MCAID? Who qualifies?

Answer 25

States, federal govt. Kids, pregnant women, disabled adults, and nursing home residents.

Question 26

Who is responsible for controlling spending?

Answer 26

STATE - sets limits on eligibility, benefits, and provider payments (broad federal guidelines)

Question 27

2 big outcomes of the new health care law?

Answer 27

In 2014, 1) Millions will be eligible for assistance with coverage 2) Insurance companies will no longer be able to deny coverage or charge higher premiums to people with pre-existing conditions

Question 28

How many people between 25-64 years die prematurely (in 2010) due to lack of health coverage in the US?

Answer 28

26k. Mostly CA, TX, FL, NY, and GA

Question 29

Which states substantially expanded MCAID eligibility in 2000? Results? (4)

Answer 29

NY, ME, and AZ. Reduced mortality, improved coverage, access to care, and self-reported health

Question 30

How many people are insured by MCAID?

Answer 30

60 million

Question 31

How bad is lack of insurance in TX?

Answer 31

1/3 residents lack health insurance, and HSN is imploding cuz of demands of too many people and too few resources

Question 32

Are uninsured people in TX employed or not?

Answer 32

Most are, but a lot are in the agricultural/service sector - lack benefits

Question 33

2 things that must happen for health insurance to be sustainable/affordable for Americans across the entire income distribution?

Answer 33

1) Cost containment and 2) shift in distribution of health care costs within the population

Question 34

What does the trend look like for amount spent on healthcare and the extra amount of income available for non-healthcare stuff?

Answer 34

Looks like overall society will have more income to mess around with despite healthcare increases (wealthier households more so than others). BUT an increasing number of families will have decreasing amounts of money, and it’s disproportionally felt by middle-income working families (wages are growing more slowly than cost of healthcare)

Question 35

Middle-income working families will be spending in health care in what ways? (3)

Answer 35

1) Out-of-pocket spending 2) Higher premiums 3) Wages that employers re-allocate into premiums as well as money out of the paycheck for public insurance programs. Most of money taken from employee actually comes from #3.

Question 36

How will the ACA increase coverage for US population?

Answer 36

Will require most Americans to have insurance, and many will gain coverage through 1) Expanded Medicaid eligibility and 2) subsidized private coverage for individuals with incomes up to 400% of poverty (starting 2014)

Question 37

What % of adults under 65 years was uninsured in 2010?

Answer 37

22%

Question 38

What’s the big difference in the distribution of personal health care expenditures by source of payment between 1998 and 2008?

Answer 38

the fractions are relatively similar (out of pocket, private insurance, MCARE/MCAID), BUT the expenditures have DOUBLED over the 10 year period

Question 39

How has the number of people below FPL changed from 1959 - 2010?

Answer 39

Declined through 1980, went up in 1981 recession, since beginning 0f 2000 the number and percentage of people has gone back up again

Question 40

How has the poverty rates of the US population varied (FROM AN AGE GROUP PERSPECTIVE)

Answer 40

Poverty rates in 1) older people have gone down substantially (social security and MCARE, drastic decrease from MCARE implementation in 1965) 2) Children have usually been the hardest hit, concentrated in that sector…1/5 of children in the country live below FPL)

Question 41

How is the private/public sector of health insurance changing over time recently?

Answer 41

Private sector is starting to shrink, public sector is expanding (even before affordable care act)

Question 42

How has median household income looked like since 1959 (BY RACE)?

Answer 42

Modest growth for all racial ethnic groups, but much lower starting points for Hispanic and black. Average median income has declined since 2006. One of the reasons for the emergence of public programs

Question 43

What group of people are the most uninsured?

Answer 43

Adults without dependent children

Question 44

Have the uninsured been uninsured over a short or long period of time?

Answer 44

LONG (>3 years)….More likely to defer care, get sick, get unemployable, more uninsurance, positive feedback

Question 45

For children’s access to care, what are they SIGNIFICANTLY less likely to have access to?

Answer 45

DENTAL care

Question 46

The uninsured get care from what sectors? (3)

Answer 46

1/3 out of pocket, federal govt (through neighborhood health centers/VA/etc), and through uncompensated care (from hospitals, docs, etc.)

Question 47

What’s EMTALA?

Answer 47

Emergency Medical Treatment and Labor Act (passed 1986), ensured public access to emergency services regardless of ability to pay. Obligates Medicare-participating hospitals that offer emergency services to provide medical screening examination or treatment for an emergency medical condition (EMC), including active labor..

Question 48

In general, are health outcomes in Canada better or poorer?

Answer 48

Socially disadvantaged use more services, still have poorer outcomes

Question 49

What’s CHIP?

Answer 49

Child Health Insurance Program - adopted in mid 1990s - Through grants to states

Question 50

2 access provisions in the ACA?

Answer 50

MCAID Expansion for poor and subsidizing insurance for near-poor and middle income.

Question 51

Explain MCAID expansion for poor.

Answer 51

States can VOLUNTARILY choose to expand their MCAID … Change MCAID so it’s not just for separate groups, but your SOLE ELIGIBILITY is ll drop to 90% (states will assume some costs). MCAID reimbursement to providers will also increase.

Question 52

Explain ACA subsidies for near poor and middle income. (3)

Answer 52

Make it easier for people 138-400 FPL to buy insurance BY 1) Organizing marketplace by setting up State Health Exchanges to buy into a large group policy - less expensive. 2) Subsidize insurance premium depending on income (less and less once you approach 400FPL) 3) If you work for small employer with small wages, they’ll help employer provide insurance