HSCI 523 Flashcards
Describe Jeffersonianism.
Emphasized states’ rights.
Against a powerful national government.
Weak national government.
Majority of authority should be in the legislature.
Welfare & healthcare are not part of the government’s role/responsibility.
After the revolution and emancipation from Great Britain, what has the most significant political debate been about?
How much responsibility the federal government should have regarding healthcare & welfare.
Very differing political ideologies control healthcare.
Jeffersonianism refers to…?
Democratic-Republicans/Our current Republicans
Which historical view describes a weak national government?
Jeffersonianism
Which historical view places an emphasis on states’ rights?
Jeffersonianism
Which historical view believes healthcare is not part of the federal government’s role?
Jeffersonianism
Which historical view takes more of a farming approach?
Jeffersonianism
Which historical view believes in a weak executive branch?
Jeffersonianism
Hamiltonianism refers to…?
Federalists.
Democrats of today.
Describe Hamiltonianism.
Hamilton believed that the U.S. had the resources to become a superpower & the only way to achieve that was to make one powerful national government with one president.
Federal government should take care of everything for citizens (including welfare & healthcare)
Which historical view believes in a national/federal/central government?
Hamiltonianism
Which historical view believes in one powerful president?
Hamiltonianism
Which historical view believes that the government is responsible for healthcare?
Hamiltonianism
Describe James Madison’s view.
Divided power of checks and balances.
Was for a big national government as long as it was checked by the other branches.
Which historical view wanted checks and balances?
Madison’s view.
Which historical view wanted a big national government as long as it was checked by other branches?
Madison’s view.
What year was the Flexner Report?
1910.
What did Flexner’s Report result in?
Modern Medical School Education
What did Flexner’s Report lead to?
Blue Cross and then Blue Shield
Describe Blue Cross’s origins.
First health insurance in the U.S.
Justin Kimball created a pre-paid hospital plan with Baylor University & DUSD.
50 cent premium & up to 21 days of hospitalization free.
Describe Blue Shield’s origins.
After provider request, copied BX’s model for professional physician services.
Separate until the 70s when they merged as Blue Cross Blue Shield.
What year was Blue Cross created?
1929
What year was Blue Shield created?
1939
What was the Social Security Act passed?
1935
What did the Roosevelt Revolution Era comprise of?
Stock market and economic depression that led to SSA ‘35 & New Deal
What was enacted during the Roosevelt Era?
Congress enacted the SSA with its “New Deal Social Welfare System
What is SSA the foundation of?
Of all health & welfare policies.
Medicare & Medicaid are amendments to SSA.
Why did FDR establish the Office of Economic Stabilization?
FDR established The Office of Economic Stabilization as a way to control inflation by freezing wages.
What year was the IRS Rule in?
1943
What did the IRS Rule of 43 cause?
Employer contributions to group health plans (ESHI) became exempt from taxation due to the IRS ruling.
Foundation of the U.S. healthcare system
What year did the Hill-Burton Act pass?
1946
What was the purpose of the Hill-Burton Act?
To rebuild hospital stock to help the underserved community after the Great Depression.
Supported for hospitals to expand their facilities through federal funding.
Caused a hospital boom.
In exchange for federal funding, what did the Hill-Burton act require?
Charity care (to provide free services to the poor and indigenous)
What caused a hospital boom in the 50s?
Hill-Burton Act
Briefly describe Medicare during the first era.
‘65-‘94
Bipartisan popular program.
Earned right.
Generated a $100 billion surplus in Part A’s trust fund
Briefly describe Medicare during the second era.
‘94-‘97
Debate over how to save Part A’s trust fund from bankruptcy (considered raising taxes, cutting reimbursement, emphasizing managed care)
BBA ‘97
What health plans came as a result of BBA ‘97?
Medicare Advantage & SCHIP
What is BBA ‘97?
Bipartisan agreement that Medicare was the spending criminal and main source of deficit.
Medicare Managed care (part C) was created and let private HMO’s run their own programs.
What is SCHIP?
Provided health insurance coverage to low-income children who do not qualify for Medicaid.
Briefly describe Medicare during the third era.
‘98-‘06
Part A’s surplus grew.
2003, Congress enacted Part D.
MMA brought about MA.
Briefly describe Medicare during the fourth era.
‘07- present
As baby boomers began to join, enrollment grew rapidly and surplus shrank again.
57 million enrolled today.
Briefly describe Medicaid during the first era.
‘65-‘86
Welfare based program for low-income individuals on the discretion of states.
Briefly describe Medicaid during the second era.
‘86-‘92
Federal mandates to expand eligibility, benefits packages, and reimbursement.
Rising enrollment and costs.
Growing tension between states and federal government
(State efforts to leverage federal dollars)
Briefly describe Medicaid during the third era.
‘93-‘99
‘97 CHIP block grant
For low-income children who do not qualify for Medicaid.
% of uninsured Americans declines.
Briefly describe Medicaid during the fourth era.
‘00-‘08
During recession, Bush focuses on constraining the cost of Medicaid.
Briefly describe Medicaid during the fifth era.
‘09- present
Obama signs MACRA ‘15.
75 million enrolled today.
What is MACRA ‘15?
Medicare Access & CHIP Reauthorization Act.
Medicaid funding for states.
Includes Medicaid Expansion as part of ACA
(Supreme court then made the expansion mandate into an option)
What are the main components of the HMO Act of ‘73?
Kaiser
Managed Care 1.0
Managed Care 2.0
Managed Care 3.0
Why did Nixon want to copy Kaiser’s model?
To fix skyrocketing healthcare expenditures due to Medicare/Medicare.
Briefly describe the history of Kaiser.
Henry Kaiser created on-site clinics.
Dr. Garfield approached Kaiser with an offer to put a clinic on urban construction sites & wanted BX style payments.
The clinic later became Kaiser hospital and then Kaiser health plan.
Garfield then hired doctors and formed a medical group.
What does Managed Care 1.0 include?
Capitation PMPM
Practice Guideline
Gatekeeper
What is Practice Guideline?
To standardize treatment to streamline practice and cost.
To try to solve the problem of small area variation.
(Remember from cost conundrum, hospitals only a few miles apart had a large difference in expenditures)
What is Gatekeeper?
Have to always go through a PCP
Tried to transform our unmanaged care to managed care.
What does Managed Care 2.0 include?
Rigid Utilization
DRG
Backlash
Why did Reagan get rid of the HMO Act in ‘81?
Didn’t like 2.0 because it encouraged the establishment of more not for profit HMO’s.
Not for profits didn’t need to pay property tax or federal income taxes, so there were huge incentives for not for profit HMO’s to remain not for profit HMO’s.
Reagan got rid of the HMO Act in 1981 and made not for profit HMO’s into for profits.
Caused their primary interest to be profit driven to make money and to use rigid utilization to cut costs.
What is Rigid Utilization?
Drive-through delivery
Pre-certification
Pre-authorization
Refusal to cover certain procedures/name brand drugs
Must call before you prescribe a service to get approval/micromanaging
What is DRG ‘83?
Before DRG, hospitals would hold patients for as long as possible to provide a lot of procedures to generate revenue, but then DRG caused this to go away (changed to only getting a fixed dollar amount for a diagnosis).
During change from retrospective (FFS) to prospective (DRG), small hospitals couldn’t survive so either closed or merger/consolidations took place.
What is the backlash in Managed Care 2.0?
Because of everything involved in 2.0, backlash took place with PPO’s gaining market share/popularity.
