Exam 1 Flashcards
Administrative Law
The body of law produced by executive (i.e., administrative) agencies of federal, state, and local
governments.
Capitation
A method of payment for health services in which
a fixed amount is paid for each person served without regard to the actual number or nature of services provided.
Centers for Disease Control and Prevention
The federal agency within the Department of Health and Human Services charged with disease revention, education, and public health activities.
Copayments
Refers to a form of beneficiary cost-sharing for
covered health insurance benefits and services, expressed as a flat dollar payment (e.g., $5.00 for a prescription drug).
Deductible
The amount patients must pay out of their own
pocket before their health insurance policy begins contributing to the cost of their care
Department of Health and Human Services
A federal agency that administers federal health and welfare programs and activities.
Department of Labor (DOL)
A federal agency responsible for administration and enforcement of ERISA, a federal law that sets requirements for employer-provided health benefits
that are not offered through state-licensed health insurance plans.
Diagnostic Related Group (DRG)
A system used to classify patients (particularly under Medicare) for the purpose of reimbursing hospitals. Hospitals are paid a fixed fee for
each case in a given category, regardless of the actual costs of providing care.
Entitlement Programs
Refers to a guarantee of access to benefits or services based on established rights or by legislation (e.g., the Medicaid program).
Epidemiology
The study of patterns of health and illness and
associated factors at the population level.
Executive Order
A presidential directive, with the authority of a law, that directs and governs actions by executive Officials
Federalism
Refers to a system of government in which sover-
eignty is constitutionally divided between a central governing authority and constituent political units (e.g., states), and in which the power to govern is shared between the national and state governments.
Federally Qualified Health Center (FQHC)
A community health center that either receives funding under Section 440 of the Public Health Service Act, or a center that has been certified as meeting the same criteria.
Police Powers
is the capacity of the states to regulate behavior and enforce order within their territory for the betterment of the health, safety, morals, and general welfare of their inhabitants.[1] Under the Tenth Amendment to the United States Constitution, the powers prohibited from or not delegated to the Federal Government are reserved to the states respectively, or to the people. This implies that the states do not possess all possible powers, since some of these are reserved to the people.
Stare Decisis
A Latin term that refers to the legal principle
that prior case law decisions should be accorded great deference and should not be frequently overturned.
Interest Groups
Interest groups are any organization of people with policy goals who work within the political process to promote such goals. Interest groups attempt to influence policy in multiple ways: Lobbying government, Engaging in election activities, Educating various public’s, Mobilizing various public’s. Many interest groups in society are those focused on advancing their members’ economic interests. Some have a large membership base, while others represent only a few members.
Role of States in implementing health policy
Key decisions made on state level
Variation among states in how policymaking process is structured
State/local health bureaucracy:
State level agencies (ex: Medicaid, public health)
Local public health agencies
Legal doctrine of federal supremacy
federal laws—the Constitution, statutes, and
treaties are the “supreme” law of the land, and thus preempt state laws that conflict with them.
Presidential Authority
Sets the agenda Budget proposals Persuasion Sign/veto bills Executive Orders
Roles of the House and Senate, including how many members and year terms for each
House: Initiates all revenue bills (Art. I, sec. 7)
Initiates (and passes or defeats) articles of impeachment (Art. I, sec. 2), 435 members with two-year terms, More hierarchically organized (more centralized, more formal, stronger leadership), Power distributed less evenly, Members are highly specialize, Emphasizes tax and revenue policy, More committees and subcommittees
Senate: Gives “advice and consent” to treaties (Art. II, sec. 2) and to major presidential appointments (Art. II, sec. 2), Tries impeached officials (Art. I, sec. 3),
100 members with six-year terms, Less hierarchically organized (less centralized, less formal, weaker leadership), Power distributed more evenly, Members are generalists, Emphasizes foreign policy, Fewer committees and subcommittees
Economic interests of private, for-profit companies versus the community.
Policies and laws do not always support the best interests of public health. Policies at times favor the economic interests of private, for-profit company interests over the community. This is a reality because one focus of policy and law concerning public health is finding a balance between public regulation of private individuals and corporations, and their ability to exercise rights that allow them the function free of overly intrusive government intervention. Take for example, the debate on trans-fat elimination. Although this is deemed a favorable policy to promote health, the food industry will need to alter their process, which is expensive, and can be seen as the government controlling their profits. The outcome of a policy to ban trans-fat may not come to fruition if the food industry rallies their constituents in their favor.
Three common characteristics of the uninsured.
Poor, low education, non-native, racial/ethnic minority, location, age
Four examples of the way being uninsured impacts an individual’s health status.
When someone is uninsured they are less likely to get preventive treatment from health care professionals that can lead to bigger problems that could have been avoided with regular doctor visits. The uninsured are also less likely to complete follow up treatment recommendations and more likely to forgo the recommended care due to concerns about being able to afford the treatment.
more likely to delay care. more likely to be hospitalized with preventable conditions
How much does the U.S. spend on health care services and how is the Affordable Care Act (ACA) projected to impact spending growth?
$2.5 trillion on health care services, representing 17.6% of GDP
puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.
Mandatory and discretionary spending
Mandatory spending - Spending that the Government must spend. Discretionary spending - Spending category through which governments can spend through an appropriations act.
Compare the US and one other country’s health care system in terms of payers, financing, universality, and role of private insurance.
Publically financed, privately delivered national health care system (Canada)
Publically financed and delivered national health systems (Britain)
Socialized insurance system with mandatory contributions and private delivery (Germany
Role of Congress in the policymaking process
Congress is the major policy making body of the federal government. Congress creates public policy through legislation to address specific problems and to set funding amounts for governmental programs. The members of Congress can also play a role in policy implementation, including making suggestions in appropriations bills to outline how agencies should actualize policies. Legislative policymakers also has authority over all new and amended regulations Once a bill is drafted, one or more Members of Congress introduces it as legislation, becoming its sponsor(s). At this point, a bill or resolution is numbered (H.R. in the House of Representatives and S. in the Senate) and referred to a committee based on different rules of procedure.
Three specific roles played by the judicial branch of government
Enforcing Legal Rights.
Two main functions of the legal system are to establish legal rights and to create institutions to enforce those rights. The primary enforcers of individual legal rights, and those best in position to create remedies for their violation, are the courts.
Reviewing the Actions of the Political Branches. An important piece of the separation of powers puzzle is the doctrine of judicial review. Judicial review refers to the power of the courts to declare laws unconstitutional and to determine whether the actions of the legislative and executive branches of government are lawful. The theory behind judicial review is that as the branch of government most independent of the political process, courts can pass judgment on the actions of the political branches free of partisanship.
Maintaining Stability in the Law.
Courts are expected to maintain a measure of stability, continuity, and predictability in the law. This expectation derives from the idea that those subject to the law should not have to contend with continuous swings in the direction law takes. In theory, the relatively non-political judicial branch of government is in the best position to bring this expectation to fruition.
