4 Principles of Bioethics/ US Healthcare Insurance

Question 1

Autonomy

Answer 1

• Focuses on respect and human dignity
• Individuals have the right and freedom to make decisions for themselves that fulfill their life plans, decisions should be made without coercion or influence
• Example: A patient leaves against medical advice.

Question 2

Non-maleficence

Answer 2

• “Do no harm”, act according to standard of care, practice guidelines and policy
• Seek to produce the least harm possible
• Example: patient with a communicable disease requires quarantine

Question 3

Beneficence

Answer 3

Do good”, obligation to perform actions that maintain or enhance the dignity of others
* Actions should not place unnecessary or undue burdens on the healthcare provider
* Example: Health professionals staying up to date on the latest practice guidelines.\
Do good for others, and do good for ourselves
Being a good samaritan
Systems level → advocate for upstream policies

Question 4

Justice

Answer 4

• Everyone has equal opportunities, elimination of discrimination in biological studies and healthcare
  o Example: Everyone has access to basic health care
• Social
  o Create fair and equal society where each person matters, individual rights are recognized and protected and decisions are made honestly and fairly
  o Examples: Two major issues: Intersocial treatment (ageism) or unequal government regulation (public school segregation and integration)
  o Two types of social justice issues:
   Intersocial treatment: ageism against co-workers
   unequal government regulation: public school segregation and integration
• Distributive
  o Fair distribution of benefits and burdens in society where a minimum level of goods and services should be available to members
  o Example: welfare rights- right to receive certain social goods including access to food, housing, education, police and fire protection
• Restorative
  o Emphasis placed on repairing the harm caused by criminal behavior via cooperative process with meeting between stakeholders (perpetrator and victims) to make amends for harm and reintegrate parties back into communities
  o It is the responsibility of the government to maintain order and for the community to build peace
  o Emphasis placed on repairing the harm caused by criminal behavior & criminal justice systems
  o Cooperative process with a meeting between the stakeholders (perpetrator and victims)
  o Make amends for the harm
  o Reintegration of the parties back into the communities
  o It is the responsibility of the government to maintain order and for the community to build peace
  o Example: Mediation between the school bully, and student who was bullied.

Question 5

Federal Entities Responsible for Public Health Services

Answer 5

Global level- World Health Organization

Question 6

Federal Level: US Department of Health and Human Services

Answer 6

• Administration for Children and Families (ACF)
• Agency for Healthcare Research and Quality (AHRQ)
• Center for Disease Control and Prevention (CDC)
  o Prevention and Control of:
   Communicable and Non communicable Diseases
   Injuries and Disabilities
   Workplace Hazards
   Environmental Health Threats
  o Research
  o National surveillance
  o Web resources (CDC Wonder, FASTSTATS)
• Center for Medicaid and Medicare services (CMS)
• Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Services (IHS)
• National Institute of Health (NIH)
• Substance Abuse and Mental Health Services Administration (SAMHSA)

Question 7

Eligibility for Affordable Care Act (ACA)

Answer 7

• An attempt at universal healthcare in US fully implemented in 2014 which funded public health measures
  Mandatory funds for early childhood home visitations, national diabetes prevention program, loan repayment programs to increase public health workforce and nurse managed clinics/ school based health centers
• ACA expansion of eligibility
  Coverage of children, in some states adults, to at least 133% of the federal poverty level
  States determine eligibility by income and family size
• Net income vs. gross income
  To qualify for premium subsidies, < 400% FPL Estimated income must be at least 138% in most states to use the Marketplace
• The insurance marketplace online site

Question 8

Medicare

Answer 8

• Federally funded insurance program for people aged 65 and over and for those who qualify for social security due to disability

you can be over 65 and receive both Medicare and Medicaid

Question 9

Medicare

Part A

Answer 9

(only a primary physical at time of starting insurance program) hospital and physician services with limited services

Question 10

Medicare

Part B

Answer 10

Physician and nursing services, preventative care (vaccines, preventative labs, x-rays) premium (based on income) must be paid for yearly visits after starting plan

Question 11

Part C

Answer 11

Medigap or Medicare Advantage Plans- private insurance

Question 12

Part D

Answer 12

Medicare Advantage Prescription Drug plan- must join a private insurance plan

Question 13

Medicaid

Answer 13

• Supported by federal and state funds but state regulated/ mandated (snowbirds → depends on where you pay your taxes where you get primary medicaid from) provides insurance for low-income individuals of ALL ages
• Income level is based on GROSS annual income as well as the number of people in your household!!!!
• Includes children’s health insurance program (CHIP)
  Effective since 1997 which covers children who do not meet the eligibility for medicaid and children who do qualify for for medicaid can enroll in CHIP (separate from Medicaid but in some states can operate as an extension)

Question 14

**Uninsured **

Answer 14

• The working poor are most likely to be uninsured
  o These individuals don’t make enough and don’t have employers that provide them with insurance plans

Most uninsured are full-time workers