Chapters 1-3 Flashcards
What are the two major healthcare reform initiatives have played out in the US political landscape in the last two decades?
Health Security Act (Clintons)
Patient protection and ACA
What was the hallmark of the Health Security Act?
Universal coverage mandate, required employers to contribute to a pool of funds intended to cover the costs of insurance premiums for their workers, with caps on total employer costs and subsidies for small businesses
The Obama plan (ACA) focuses on what?
Reforming private health insurance market, extending insurance coverage to the uninsured, providing better coverage or those with preexisting conditions, improving prescription drug coverage in medicare and extending the life of the medicare trust fund accounts
How will ACA be financed?
Through taxes, like a 40% tax on cadillac insurance policies
These kind of policies offer the richest benefits
Cadillac insurance policies
How much of our GDP goes towards healthcare spending?
17.9%
This refers to the value of all goods and services produced within a country for a given period, a key indicator of the country’s economic activity and financial well being.
Gross domestic product
According to the WHO where does the US rank in healthcare systems in comparison to other countries?
36th out of 191countries
This is not merely the absence of disease or infirmity but a state of complete physical, mental, and social well being.
The WHO definition of health
Because of the WHOs definition of health many countries build the case that poverty, lack of education, discrimination, and other social, cultural and political conditions found around the world are essentially ____ ____ ____.
Public health issues
This is also a result of personal characteristics and choices
Health
This is the anticipated number of years of life remaining?
Life expectancy
This is the number of deaths in a given population within a specified period
Mortality
This is the incidence or prevalence of diseases in a given population within a specified period
Morbidity
This is a physical or mental condition that limits an individuals ability to perform functions generally characterized as normal
Disability
_____ ____ typically denotes a government sponsored program that attempts to make health insurance available to the uninsured
Healthcare reform
What is the key objective for the ACA?
To provide most if not all americans with health insurance coverage
What is the most common measure of health?
Life expectancy
This combines mortality and morbidity index that reflects years of life free of disability and symptoms of illness
Quality-adjusted life years
What are the major categories of mental health measures:
Mental conditions Behaviors Perceptions Satisfaction Services received
What is the most commonly used measure of relative social well-being?
SES (socioeconomic status)
What does SES consider?
Education level, income, occupation
The frequency of social activities a person undertakes within a specified period
Social contacts
This interpersonal relationships with social contacts and the extent to which the individual can rely on them for support
Social resources
This is the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in the principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventative treatment of disease
Public health
APHA?
American public health association
The practice of public health leads to ____ and ___ benefits for society
Direct and indirect
These are factors that influence one’s health status. Typically they include one’s socioeconomic status, environment, behaviors, heredity, and access to medical care
Determinants of health
Who proposed the theory of Force Field and well-being paradigm of health?
Blum 1974
The force field/well-being paradigms of health suggests four major influences on health:
Environment (the most important)
Lifestyle
Heredity
Medical care (has the least impact on health and well being)
Dahlgren and Whitehead 2006, model divides factors that influence health into two categories:
Fixed factors
Modifiable factors
These items are unchangeable such as age, sex, and genetic make up
Fixed factors
These are individual lifestyle choices, social networks and community conditions, the environment in which one lives and works, access to important goods and services such as education, sanitation, food, and health care
Modifiable factors
Ansari and colleagues proposed a public health model of the determinants of healthcare in which these factors are categorized into four major groups:
Social determinants
Healthcare system attributes
Disease inducing behaviors
Health outcomes
What are the three theories of disease causality are:
Germ theory
Lifestyle theory
Environmental theory
This theory holds that every disease has a specific cause which should be identifiable
Germ theory 19th century
This is the study of the factors controlling the presence or absence of a disease
Epidemiology
This theory tries to isolate specific behaviors (smoking, exercise) as causes of a disease and identifies solutions on the basis of changing these behaviors.
Lifestyle theory
This theory considers the general health and well being of individuals more so than disease. Best understood by analyzing the larger context of the community
Environmental theory
What are the conceptual frameworks of health determinants?
Environment, health status, medical care, and individual characteristic
Rates of psychological stress, homicide, suicide, and other behavioral health indicators can be attributed in part to:
Crowding, isolation, and other social environmental factors
The level of behavioral risk factors exhibited by a population is related to:
Socioeconomic status
Behavioral risk factors are divided into three categories:
Leisure activity risks
Consumption risks
Employment participation and occupational risks
What behavioral risk factor does one have the least amount of control over?
Employment and occupational factors
What are the major components of SES?
Income
Education
Occupational status
Most items that we buy or sell are defined as? Goods and services whose worth can be captured as a monetary value, that serve a specific purpose and that can be exchanged with other similar products
Commodities
Medical care differs from traditional commodities in four ways:
Care is derived
Presence of agency relationship
Pricing varies according to who pays the fees
Medical care service provision is influenced by the environment by which it takes place
The demand for medical care is ____ it stems from the demand for a more fundamental commodity–health itself
Derived
______ ____ the consumer or the patient in healthcare delegates some authority to make decisions and perform actions on his behalf to an expert agent (physician or healthcare provider)
Agency relationship
This is a decision made by an authority about an action, either one to be taken or one to be prohibited to promote or limit the occurrence of a particular circumstance in a population
Policy
Decision making that affects the general population or significant segments of the general population is meant to improve the conditions of genera welfare of the population or sub populations under is jurisdiction
Public policy
This is what affects the private organization only, is meant to improve the conditions and general welfare of the employees of that organization
Private policy
Policy that pertains to or influences the attainment of health: legislation over individuals, organizations, or the society whose goal is to improve health for the population or sub populations
Health policy
This is part of health policy but with a focus on healthcare, specifically it is related to the financing, delivery and governance of health services for the populations or sub populations within a jurisdiction
Healthcare policy
What are two major types of health policies?
Regulatory
Allocative
What is the predominant goal of health policy?
Improve population health
What are the goals of healthcare policy?
Provide equitable and efficient access to and quality of needed healthcare services
These policies are regulations or rules that impose restrictions and are intended to control the behavior of a target group by monitoring the group and imposing sanctions if it fails to comply
Regulatory policies
These health policies involve the direct provision of income, services, or goods to a certain group of individuals or institutions and can distributive or redistributive
Allocative health policies
Regulations that provide benefits or services to a targeted population or us population typically, entitlements
Distributive policy
These are deliberate efforts that alter the distribution of benefits by taking money or property from one group and giving it to another
Redistributive policy
Conceptual framework for the health policy determinants:
Nature of the problem
Sociocultural norms that influence the perception of the problem
Health policy
Political system which policy is formulated
This indicates the reach of the problem
Magnitude
This denotes the extent to which the problem is urgent
Severity
Entities or individuals who hav e a direct or indirect role in the development of policy are considered?
Stakeholders
These tests are conducted during the policy development process to ensure there is adequate funds available and to verify that the benefits outweigh the costs
Financial feasibility
These studies examine how the policy can be translated into programs and carried out under an existing or a new infrastructure
Administrative feasibility
This is a type of stakeholder, a collective of individuals or entities that hold a common set of preferences on a particular health issue and often seek to influence policy making or public opinion
Interest group
Name the major stakeholders in health care policy?
Consumers and patients Healthcare providers Healthcare organizations Payers and insurers Regulators Medical device and pharmaceutical manufacturers Educational and research institutions Business and corporations
Who are the intended beneficiaries of health policy?
Consumers and patients
These are activities that seek to influence an individual or organization with decision making authority
Lobbying
MCO
Managed care organizations
Those who work from outside the government to introduce and implement innovative ideas into public sector practice, are instrumental in bringing new ideas and fundamentally changing the usual way of practice
Policy entrepreneurs
Policy making takes place where?
Federal, state, and local levels of government as well as in the private sector
What policy has the most profound impact on care delivery?
Federal health policy
What branch of government is referred to as the US congress and is composed of two chambers:
Legislative branch: house of representatives and the senate
What’s the most active of the three branches of government in policy making by way of the statutes or laws it enacts?
Congress
An individual responsible for making or enacting laws
Legislator
Legislators operate by three powers that derive its influence in health policy making:
Power to use any reasonable means not directly prohibited by the constitution to carry out the will of the people
The power to tax
The power to spend
This is law made by government to achieve a particular objective
Legislation
This is the capacity to enforce legislation on behalf of the government as granted by the US constitution
Statutory authority
The president, and the department heads referred to as cabinet members within his or her administration comprise the what branch of government? And they craft legislation
Executive
What are the three major stages of policy making?
Policy formulation
Policy implementation
Policy modification
There are two main components of the policy formulation stage:
Agenda setting
Legislative development
This refers to the selection of a health problem as a policy target. It also refers to the ability to influence the priorities of issues for policy consideration
Agenda setting
The stand taken regarding a particular issue, policy position often influences the focus and orientation of legislation
Policy position
To protect against future acts of terrorism President Bush signed into law the what act of 2002?
Homeland security act
When is the likelihood of policy action the greatest?
When public opinion is high and the degree of conflict or dispute is low
Who documented evidence that poorly trained lab techs were misreading pap smear tests leading to false diagnosis of cervical cancer or no diagnosis with the cancer was present?
Walt Bogdanich 1987
What did the report of Bogdanich lead to?
Prompted congress to pass the clinical laboratory improvement amendments in 1988, prescribing minimum standards of training, testing, and workloads for lab techs
The presiding officer of the US house of representatives typically chosen from the majority party of the house
Speaker of the House
Senate leader elected by the party that holds majority in the senate. He or she serves as the chief senate spokesperson for the party and s responsible for scheduling the legislative and executive business of the senate
Senate majority leader
What happens when bill introduced in Congress?
Bill assigned to a congressional committee
Committee approval the. Bill is scheduled for congressional consideration
Bill is passed in congress
Bill is presented to president
President signs into law or vetoes
An action undertaken by Congress to postpone consideration of the legislation
Tabling legislation
Change or addition to a current law or piece of legislation
Amendment
The president has three options in acting on legislation
Sign it, which then becomes law
Veto the legislation and it dies without 2/3 majority of congress to overturn
Pocket veto-does nothing and auto becomes law after 21 days if congress is in session
A public access source that publishes presidential and federal agency documents, a daily publication of the US federal government
Federal register
This is the process by which implementation agencies set detailed rules and regulations for the application of laws
Rule making
The ability to obtain a policy objective depends on the presence of a host of requirements:
Logic of the potential solution is sound
Structure is in place
Program activities are designed to reflect the policy intent and logic model
Program activities are carried out effectively and efficiently
Unintended outcomes will not jeopardize the continuation of the program
External factors will not jeopardize the impact of the program
What is an example of uncontrolled determinants?
Prevalence of diabetes and obesity
This refers to revisions to the rules or regulations pertaining to a piece of original legislation to enhance its benefits to the target population, reduce its negative consequences, refine its policy objectives, or address other issues related to the policy
Policy modification
When does policy modification take place?
After policy has been implemented and could occur during agenda setting
Activities to review, monitor, or supervise the process of formulating, implementing, and modifying public policy
Oversight
The largest component of the executive office, implements and enforces the commitments and priorities of the president and assists executive departments and agencies across the federal government
Office of management and budget
The authority to interpret and apply the law
Jurisdiction
Why would policy modification occur?
Change in the logic model Consequence of implementation Policy analysis and evaluation Resource constraints Changing goals Interest group involvement Oversight
This is a landmark policy that established the social security program for the elderly, since its enactment a. Number of health related modifications have been made
1935 social security act
Examples of fragmented healthcare programs:funding of health insurance
Employed (covered by their employers)
The elderly (social security and medicare)
The poor ( covered by medicaid)
Special population groups, military and indians (covered by federal government)
There are two new types of interest groups have emerged in the health policy making paradigm:
Corporate america and healthcare consumers
PhRMA
Pharmaceutical research and manufacturers of america
Provision in the health insurance portability and accountability act and affordable care act that aims to reduce administrative costs through the adoption of electronic transactions and standardization of operating rules
Administrative simplification
What state enacted landmark legislation to provide health insurance coverage to nearly all state residents?
Massachusetts 2006
What’s the name of Massachusetts health insurance program?
Commonwealth care health insurance program
A type of democratic government in which the head of state is not a monarch; governmental activities and affairs are open to all interested citizens
Republican
Are states required to adhere to a three branch system?
No
Officials in the executive branch of state government. Examples include the governor, who is chief executive of a state or territory, and the attorney general who serves as the main legal advisor to the state government and has the executive responsibility for law enforcement
State executives
This consists of a House of Representatives and is known in some states as the assembly or house of delegates and a senate chamber
State legislature
When are state’s supreme court rulings not binding?
If they do not adhere to the constitution of the united states
How many readings does a bill go through at the state level before being voted on by elected officials?
3
This term refers to processes carried out in the democratic, representative tradition. It is not the same as the one spelled with a capital D, which often refers to the political party in the united states
Democratic
Local governments usually fall into one of two levels:
County or municipality, and in alaska counties are called borough and parishes in Louisiana
What did the oregon health authority do in 2009?
Created an insurance exchange
What is Sustinet?
Created by Connecticut in 2009, a public health care plan to provide coverage for 98% of Connecticut residents by 2014, initially vetoed but the veto overrides by 67%
What is Sustinets focus?
On preventative care and management of chronic illnesses
What’s the most common level of regulation for health?
Tobacco products and smoking in public
This corporation conducts research and analysis to improve and inform policy making in the areas of health, education, and national security.
RAND
What are RAND’s public health focus areas?
Obesity, post traumatic stress disorder, and complementary and alternative medicine
HDHPs
High deductible health plans
This conducts research and public policy work to address the challenges facing the united states and global community?
The pew charitable trusts
The pew trusts support health research in four policy areas:
Consumer product safety
Emerging science
Food and health
Medical safety
3 major goals of the Kids safe and healthful foods project:
Ensure that nutrition standards estab by the USDA for foods and beverages available in schools based on scientific evidence
Make sure schools have sufficient resources to properly train cafeteria employees and keep equipment in good working order
Help USDA estab and enforce stringent food safety policies for use in schools
An informal term to the corporations based on operating in the united states;they are not under direct governmental control
Corporate america
Who is the largest owner of retail oproperty in the world and spends the most money of any bran on marketing?
McDonalds
What’s the seventh largest cash crop in the united states?
Tobacco
What is the most heavily taxed consumer product in the US when measured by the percentage of the retail price?
Tobacco
What’s the most preventable cause of mortality and morbidity according to the american lung association?
Smoking cigarettes
Health policy making is characterized by several factors in the no federal sectors:
- Constraints imposed by broader policy landscape
- Relationship between politics and policy
- the level of public health funding
- The ways in which private sector shapes policy direction
- Policy entrepreneurship at the grassroots level
- Lack of integration and coordination among policymaking groups in creating policy initiatives
_______ at the state and local levels is limited by broader federal policy
Policymaking
Our healthcare system is functionally fragmented wth little standardization, resulting in?
Duplication of certain services and inadequacy of others
The ____ sector shapes policy direction more than state and local governments go
Private
Public innovator who from outside the formal positions of government, introduces, translates, and implements new ideas into public practice
Policy entrepreneurs
______-______ project stress participation and empowerment; deeply involving community members leads to acceptance of the initiative and helps promote sustainability of the intervention
Community-based
