Health Policy & Economics

Question 1

The majority of healthcare spending goes to…

Answer 1

Treatment of preventableconditions such as cardiac disease, cancer, lung diseases, STDs, and vaccines.

Question 2

4 levels of health care in the US

Answer 2

local, state, national, and international
Each level generally classified as public or private

Question 3

Public sector health services

Answer 3

Local: vary depending on needs, size, and resources of the community
State: vary in structure and how core functions carried out; most pivotal role in health policy formation
National: public health service; eight functional branches: CDC, FDA, NIH, SAMSHA, HRSA, AHRQ, Indian Health Service, and ATDSR

Question 4

Private sector health services

Answer 4

Proprietary health services: privately owned and managed
* For-profit
* Not-for-profit

Question 5

Private sector health services functions

Answer 5

• Detecting unserved needs or exploring better methods for meeting needs already addressed
• Piloting or subsidizing projects
• Promoting public knowledge
• Promoting health legislation
• Assisting official agencies with innovative programs not otherwise possible
• Evaluating official programs; assuming public advocacy role
• Planning and coordinating to promote collaboration among voluntary services and between voluntary and official agencies
• Developing well-balanced community health programs for more relevant and comprehensive services

Question 6

International Health Organizations

Answer 6

World Health Organization

Pan American Health Organization

UNICEF-United Nations International Children’s Emergency Fund

USAID leads international development and humanitarian efforts to save lives, reduce poverty, strengthen democratic governance and help people progress beyond assistance.

UNESCO- United Nations Educational, Scientific and cultural Organization

Question 7

Core Public Health Functions

Answer 7

• Assessment
• Policy development
• Assurance
  All occur at local, state, federal levels

Question 8

Core Functions at the local level

Answer 8

Local government health agencies should fulfill these core functions as follows:
* Monitor local health needs and the resources for addressing them
* Develop policy and provide leadership in advocating equitable distribution of resources and services, both public and private
* Evaluate availability, accessibility, and quality of health services for all members of the community
* Keep the community informed about how to access public health services

Question 9

Core Functions at the state level

Answer 9

General functions of state health departments include (Erwin & Brownson, 2017)
* Statewide health planning
* Intergovernmental and other agency relations
* Intrastate agency relations
* Certain statewide policy determinations
* Standards setting
* Health regulatory functions

Question 10

Core Functions at the federal level

Answer 10

At the federal level, public health responsibilities include
* Assuring the capacity of all levels of government to provide essential public health services
* Acting when health threats span many states, regions, or the whole country
* Acting where the solution may be beyond the jurisdiction of individual states
* Acting to assist states when they do not have the expertise or resources to mount an effective response in a public health emergency (e.g., natural disaster, bioterrorism, emerging disease, etc.)
* Facilitating the formulation of public health goals in collaboration with state and local governments and other relevant stakeholders (e.g.,Healthy People 2020)
* Acting transparently and accountably for public health investments
* Disseminating innovation and best practices from state and local public health (TFAH, 2006, p. 7)

Question 11

Trends and Issues Influencing Health Care Economics

Answer 11

High cost of health in America
Cost-control measures
Access to health services
* Uninsured
* Underinsured
Medical bankruptcies
Managed care

In 2018, the United States spent about$3.6 trillionon healthcare, which averages to about$11,000per person.

Question 12

Where does the money go?

Answer 12

About 75% of health care spending goes toward preventable conditions such as cardiovascular disease, diabetes, cancer, lung diseases, injuries, STDs, and vaccine preventable diseases, yet <5% of health care spending goes into prevention and public health(Mays, 2013).

Question 13

Health Care Financing

Answer 13

Third-party payments
Private insurance companies (trend toward consumer-driven health plans and health savings accounts (HMO, PPO,POS)
Independent or self-insured health plans
Government health programs
* Medicare, Medicaid, Federal Employees Health Benefits Plan, CHAMPUS
* SCHIP
* Other government programs

Question 14

Affordable Care Act (2010)

Answer 14

The law has 3 primary goals:

Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of thefederal poverty level (FPL).

Expand the Medicaid programto cover all adults with income below 138% of the FPL. (Not all states have expanded their Medicaid programs.)

Support innovative medical care delivery methods designed to lower the costs of health care generally.

Question 15

Medicare

Answer 15

known as Title XVIIIof the Social Security Act Amendments of 1965, has provided mandatory federal health insurance since July 1, 1966,for adults aged 65 years and older who have paid into the Social Security system (CMS, 2015a). It also covers certain people with disabilities (regardless of age).

Question 16

Medicaid

Answer 16

nown as Title XIXof the Social Security Amendments Act of 1965, provides medical assistance for children, pregnant women, parents with dependent children, seniors, and people with severe disabilities. Medicaid covers 37% all children and 77% of children living below poverty level.It covers 20% of all Medicare beneficiaries and 64% of enrollees living in nursing homes.However, Medicaid only covers 35% of adults living below poverty level.

Question 17

Medicare components

Answer 17

Part A of Medicare, is the hospital insurance program,
Part B of Medicare, the supplementary and voluntary medical insurance program, primarily covers physician services but also covers home health care for beneficiaries not covered under Part A
Part C Medicare plans, also called Medicare Advantage, are private plans generously subsidized by the federal government (Cubanski et al., 2015). Part C plans are not supplemental to Part A and Part B—they take the place of Part A and Part B
Forty-five percent of Medicare beneficiaries have supplemental coverage through a private company or employer retiree health insurance plans—known asMedigapcoverage—added to Medicare Part A and PartB
Part D, is the prescription benefit plan.
Financing of Medicare is through general tax revenues (41%), payroll taxes (38%), premiums from beneficiaries (13%), and other sources.

Question 18

Medicaid components

Answer 18

The largest portion of Medicaid spending goes toward people with disabilities (42%) and older adults (21%). This group is only 24% of Medicaid enrollees. Nearly 10 million people are eligible for both Medicaid and Medicare, 14% of Medicaid enrollees. This small group uses 40% of all Medicaid spending.
Medicaid is jointly funded between federal and state governments to assist the states in providing adequate medical care to eligible persons (Paradise et al., 2015)

Question 19

Health Care Rationing Cause

Answer 19

Limited resources
Need to establish eligibility for government health care programs
At risk groups use inequitable amount of limited services

Question 20

Health care rationing effect

Answer 20

Restrict people’s choices
Deny access to beneficial services
Exclude enrollees at greatest risk

Question 21

Health Care Reform Possibilities

Answer 21

Universal coverage and single-payer system
Pros: universal coverage; emphasis on prevention; control of costs; increased access; incentives for efficiency; administrative simplicity; combination of private/public; no tie to employment

Cons: removal of competition model, which ensures a free market, individualism, and the right to choose

Question 22

Effects of Health Economics on Community Health Practice

Answer 22

• Disincentives for efficient use of
  resources
• Incentives for illness
  care
• Conflicts with public
  health issues