Chapter 21: Exam 2 Flashcards
Authoritative decisions made in government, agencies, or organizations that are intended to direct or influence the actions, behaviors, or decisions of others.
Policy
Influencing others (policies) to adopt a specific course of action (policy) to solve a societal problem. Begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem. Is accomplished by building relationship with the appropriate policy makers- the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome.)
Advocacy
refers to policies specifically intended to direct or influence actions, behaviors, or decisions that influence the health of populations. Policies that are specifically intended to direct or influence actions, behaviors, or decisions that influence the health of populations. Can affect culture by changing knowledge, attitudes, and behaviors of individuals and groups.
Public Health Policy
The U.S. economic culture supports an open market. Attempts to intervene in the market system to promote quality, supply, and equity/fairness. Universal health coverage: when all individuals and communities receive essential health services without financial hardship. The World Health Or
Health in all policies
Health policy is an explicit part of professional life for public health nurses (PHN’s).
-Advocating for
-Identifying
-Interpreting
-Implementing public health laws, regulations, and policies
Actions to take with policy
What is the policy process?
-Assessment of health status: social data, needs, and resources.
-Goals and objectives: input from stakeholders
-Explicit evaluation criteria for policy planning:
likelihood of achieving policy goals and objectives or demonstrated achievement of them. Limits to use: estimate involve uncertain projection of future events.
effectiveness
the achievement of program goals or benefits in relation to the cost. Least cost for a given benefit or the largest benefit for a given cost. Limits to use: measuring all cost and benefits is not always possible. Policy decision making reflects political choices as much as efficiency.
efficiency
fairness or justice in the distribution of the policy’s cost, benefits, and risk across population subgroups. Limits to use: difficulty in finding techniques to measure equity; disagreement over whether equity means a fair process or equal outcome.
equity
How do you be politically active?
Assuming leadership positions in the healthcare system or contacting elected officials about legislation affecting the industry. Nurses can obtain formal training in policies, become involved in city councils and committees, or even run for local office.
“the study of decisions—the incentives that lead to them, and the consequences from them— as they relate to production, distribution, and consumption of goods and services when resources are limited and have alternative uses.” The CDC then applies this to the process for conducting cost-benefit analysis as it applies to preventive strategies.
Economics
examines the financing of public health from the governmental perspective with a focus on the delivery and funding of public health goods and services. Public health economist are concerned with the cost analysis, economic evaluation, modeling, and the analysis of health-care regulation on the cost, burden, health, effectiveness, and efficiency of health programs.
Public health economics
What are the types of health insurance?
-Preferred provider organization (PPO) plan (MOST IMPORTANT)
-Health maintenance organization (HMO) plan (MOST IMPORTANT)
-Point of service (POS) plan
-Exclusive provider organization (EPO)
-Health savings account (HSA)-qualified plan
-Indemnity plans
Health maintenance organization is a type of health insurance that usually limits coverage to care from doctors who work for or contract with HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.
HMO’s
Preferred provider organization is a type of health insurance that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network.
PPO’s
How are HMO’s and PPO’s alike?
They both consist of a network. Networks are one way to lower health care cost — network providers agree to give discounts in exchange for access to a health plan’s members.
How are HMO’s and PPO’s different?
Unlike HMO, a PPO offers you the freedom to receive care from any healthcare provider— in or out of your network. With HMO plan, you must stay within your network of providers to receive coverage. Under a PPO plan, patients still have a network of providers, but they aren’t restricted to seeing just this physicians. You have the freedom to visit any health care provider you wish when under a PPO plan. A PPO plan can be a better choice compared with an HMO if you need flexibility in which health care providers you see. More flexibility to use providers both in-network and out-of-network. You can usually visit specialist without a referral, including out-of-network specialists. HMO plans typically have a lower monthly premium. The main differences between PPO and HMO are the size of the health care provider network.
are rights granted to citizens and certain non-citizens by federal law. Are either financed from Federal trust funds or paid out of the general revenues. Those paid out of the general revenues are income redistribution programs intended to address problems such as illness and poverty.
Entitlement programs
What do entitlement programs include?
Medicaid, Medicare, Social Security, Unemployment, and Welfare Programs.
What type of client would entitlement programs qualify for?
Low income Americans qualify for benefits, and the determination of this is called “means-testing.” Qualification for most welfare programs is at or below the poverty threshold. For some programs, is is at a multiple of the threshold, such as 130%.
The state of Tennessee’s Medicaid program. It provides healthcare to mostly low-income pregnant women, parents or caretakers of a minor child, children and individuals who are elderly or have a disability. To get medicaid, you must see the income and resource limits. You can apply anytime needed for TennCare.
TennCare
The federal health insurance program for people who are 65+. Certain younger people with disabilities, people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, called ESRD)
Medicare
Women, Infants, and Children Program is the special supplemental nutrition program for women, infants, and children. It gives federal funds intended to be used to buy foods or pay for healthcare referrals and nutritional education for low-income women who are pregnant, postpartum, or breastfeeding, as well as nutritionally at-risk infants and children up to age 5.
WIC
Children Health Insurance Program is an insurance program that provided low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not snout to by private insurance. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program.
CHIP
