Health Care Policy

Question 1

What is health policy?

Answer 1

The planning, development, and implementation of interventions designed to maintain and improve the health of a group of individuals.

Question 2

Which factors considered positive to primary care physicians? Which factors are considered negative?

Answer 2

Positive

• Increased use of health information technology

Negative

• Increased use of metrics to assess provider performance
• Programs that include financial penalties for unnecessary hospital admissions or readmissions

Question 3

Insurance complexity and restrictions create concerns for patients and doctors. How do these complexities affect patients and physicians, respectively?

Answer 3

Patients

• Insurance did not cover as expected/spent a lot of time on paperwork
  
  • Adults spent a lot of time on paperwork or disputes over medical bills and/ or insurance denied payment or did not pay as much as expected in the past year

Physicians

• Insurance coverage restrictions pose major time concern
  
  • Amount of time doctor or staff spend getting patients needed medications/treatments because of coverage restrictions is a major problem

Question 4

What are the components of the heath care system?

Answer 4

• Delivery
• Payment
• Financing
• Insurance

Question 5

What is the purpose of insurance?

Answer 5

To protect against catastophic risk

Question 6

Health Care Transaction

Answer 6

Question 7

The Flow of Funds in U.S Health Care

Answer 7

Question 8

Where does the nation’s health dollar come from?

Answer 8

• Health insurance- 73%
  
  • Private health insurancde- 33%
  • Medicare- 20%
  • Medicaid-16%
  • VA, DOD, and CHIP- 4%
• Out of pocket- 11%
• Other third-party payers and programs- 8%
• Investment-5%
• Public health activities- 3%

Question 9

Where does the nation’s health dollar go?

Answer 9

• Hospital care- 32%
• Physician and clinical services- 20%
• Other spending- 20%
• Prescription drugs- 10%
• Government administration and net cost of health insurance- 8%
• Other health, residential and personal care- 5%
• Nursing care facilities and continuing care retirement communities- 5%

Question 10

Medicare represents _____ % of the federal budget.

Answer 10

13

Question 11

What does each part of medicare cover?

Answer 11

A: Hospital and skilled nursing care

B: Outpatient, physician visits when medically necessary

C:“Medicare Advantage” plans, approved by Medicare but run by private companies. Provides A, B, and D benefits

D: Drug plan. Voluntary and not automatic

NOTE: Rising health care costs and the increasing aging population presents a situation for concern for medicare.

Question 12

True or False. Both Medicare and Medicaid are funded equally by the state and federal govement.

Answer 12

False.

*Medicare is federally- funded only and medicaid is funded by both state and federal govement.

Question 13

Who qualifies for medicare?

Answer 13

• >65 years old
• Disabled
• In need of hemodialysis
• Eligible for social security

Question 14

Who qualifies for medicaid?

Answer 14

• Poor
• Children
• Parents of dependent children
• Pregnant women
• Disabled

Question 15

Who is eligible for bothe medicaid and medicare?

Answer 15

Chronically ill, long-term care

Question 16

How are services used?

Answer 16

Question 17

Rethinking the Organization of Delivery Care

Answer 17

Question 18

Public policy

Answer 18

Policy that is established by the federal, state, and local levels of government

Question 19

Private policy

Answer 19

Policy that is established by private organizations

Example: MCOs and JCAHO

Question 20

What are the five main forms of health policies?

Answer 20

• Laws
• Rules/Regulations
  
  • Guide law implementation
• Operational decisions (protocols/procedures)
• Judicial decisions
• Macro policies
  
  • FDA regulation of pharmaceuticals

Question 21

What are teh mechanisms of health policies?

Answer 21

Allocative policies

• Subsidies from Centers from Medicare and Medicaid services

Regulatory policies

• Social regulations
  
  • Smoking, immunication
• Quality controls on the provision of health services
  
  • Pharmaceutical regulation by FDA, P4P
• Market-entry decisions
  
  • Certificates of need
• Rate or price-setting controls on health service providers
  
  • Sustainable growth rate (SGR) for Medicare
• Market-preserving controls
  
  • Antitrust

Question 22

Lobbyists

Answer 22

A group of persons working on behalf of or strongly supporting a cause, such as an item of legislation

Question 23

What are the goals of the Medicare Access and CHIP Reauthorization ACT (MARCA)?

Answer 23

• Repeals the Sustainable Growth Rate formula
• Changes the way that Medicare rewards clinicians for value over volume
• Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
• Gives bonus payments for participation in eligible alternative payment models (APMs)