First Test Flashcards
GENERAL vs. SPECIALIST physician’s median income.
General median incomes are lower than specialist. $180,000 vs. $450,000. Specialist do spend a few more years in school, but both graduate with loans $200,000+
Where was the scientific model of medical innovation innovated. When was it imported to the U.S.?
Started in Europe and spread to the U.S. in the early 20th century (1910). AMA was founded by a group of doctors wanting to create a stable and reliable medical education. New curriculum (Flexner Report) required medical schools to: be part of a university, 4 yrs. of training, and first 2 yrs. to concentrate on basic laboratory science.
What was the result of the AMA’s Flexner Report on medical school education?
Increased quality of doctors and their pay due to amount of doctors being limited by the new standards of med school.
What is unusual about the profit margin of American pharmaceutical industries?
AMA changed the quality of physicians prescribing drugs. Drugs approved by the AMA were viewed more favorably. This created a mutually dependent relationship between drug manufacturers and the AMA. Drug manufacturers created their own association (PhRMA). Due to laws providing patent protection for new (expensive) drugs. Profit margin was $85 billion last year and expected to rise $10-35 billion w/ ACA.
Why is 1965 a landmark year in healthcare reform?
Medicare and Medicaid was introduced involving and amendment to the SSA. There was a concern that the financial security of senior citizens at risk when receiving serious treatment. Originally planned to have them go to hospitals when needed and the cost will be covered by the fed. gov’t (universal health care). Medicaid introduced for poor people.
How high was the payroll tax for Medicare likely to rise within 30 years.
70% for each worker if the cost for each beneficiary remains the same (unlikely). Beneficiary cost is expected to increase as medical care cost increase. Beneficiary coverage expected to go from 3.5 to 2.
What extent can doctors charge more if they don’t accept Medicare assignments?
Half of doctors don’t accept since Medicare fees are 2/3 of typical fees. When patients visit doctors that are not covered by Medicare they will have to pay out of pocket upfront and be reimbursed 80% of the cost. Doctors charge 115% so patients pay 35% vs. 20%.
Medicare fraud
Medicare doles out $600 billion annually and $272 billion goes to criminals. Rewards are higher, work is safer, and lighter penalties. The amount of claims (4.5 million daily) makes it easier for fraud to slip through. There are no checks for this large market. Healthcare professional are also included.
Title XXI of SSA. What was scandalous about the underspending.
Covering uninsured children. Congress enacted State Children Health Insurance Program (S-CHIP) as an incentive for states to create a program to covered uninsured children w/ majority of the cost paid by federal funds. Program should last 3 years. If funds are not spent it will be sent back. Half of the money went back because congress did not want those who are eligible for Medicaid to be shifted to S-CHIP.
What is the ACA?
Health reform law signed in March 2010 intended to: extend publicly funded health insurance coverage to millions of uninsured adults whose income fall near or before the federal poverty line (fpl). Also out into place reforms to expand coverage, hold insurance companies accountable, lower health cost, more choice and enhance quality for all. Citizens can be taxed if not covered by health insurance ($95 per adult, $47.50 per child).
How is Medicaid not effective?
“Half the states don’t award Medicaid to people below the poverty line.S-CHIP extends health insurance coverage to children and families above Medicaid income threshold.”–Dr. Long
Before the ACA, what was the most recent major reform of healthcare policy?
Congress passed the Social Security Act of 1965, establishing Medicare and Medicaid for the elderly and poor.
What was the ACA’s public option proposal?
Insurance options would be organized and administered by the federal government. Proposed by a Democrat, but Republican stated it will cause unfair competition.
What was the ACA’s single payer system proposal?
The federal government would be primarily responsible for financing the healthcare system. Republicans believed we should build on strength of private companies instead.
Briefly distinguish between Medicare and Medicaid.
Medicare is for individuals 65 yrs. old and over or disabled.
Medicaid is for individuals and families with low income 133% under the fpl w/ ACA.
