last three lectures Flashcards
first state that required employers to provide insurane for workers
- Hawaii Prepaid Health Care Act passes requiring employers to cover any employee working more than 20 hours/week, later expanded to State Health Insurance Program
who is eligible for healthy SF coverage
run by SF DPH
living on a combined family income at or below 400% of the Federal Poverty Level.
A San Francisco resident who can provide proof of San Francisco residency*;
Uninsured for at least 90 days**;
Not eligible for public insurance programs such as Medi-Cal, Medicare, or financial assistance to purchase insurance through Covered California;
Age 18orover
Some Healthy San Francisco Participants pay a fee for their health coverage. The Healthy San Francisco Participant Fee is based on a “sliding scale
individual mandate of obamacare
everyone needed insurance and subsidies provided to those that could not afford
how does medicare expansion cut costs
Reforms to the Medicare payment system are meant to promote greater efficiency in the healthcare delivery system by restructuring Medicare reimbursements from fee-for-service to bundled payments
4 commonly cites reasons we see increased spending per capita in US
administrative costs -BIGGEST DIFFERENCE
price (costs of doctor, procedure, drugs)
use of high technology
Health care outcomes same or worse
what current trend have we seen with premiums
Over the prior 10 years, insurance premiums had
risen 131%.
Four Basic Modes of Health Care Financing:
Out-of-pocket payment
Individual private insurance
Employment based private insurance
Government financing
free market
let individuals buy health insurance / care, subsidize the poor. Often called “consumer driven” but with issues of moral hazard.
what % of cancers are thought to be caused by environmental triggers
Approximately 80 – 90% of all cancers may be caused by environmental and lifestyle triggers1
6 major disparities in the US healthcare system
Infant Mortality
- Cancer Screening and Management
- Cardiovascular Disease
- Diabetes
- HIV Infection/AIDS
- Immunizations
3 layers of racism
institutionalized
personally mediated
internalized
New infections resulting from changes or evolution of existing organisms.
emerging
what is re-emerging disease
Answer: Cholera, Dengue fever, Diphtheria: Meningococcal meningitis, Yellow fever
Epidemiology looks at what?
Examines RISK FACTORS or EXPOSURE
that lead to DISEASE or OUTCOMES
the number or proportion of cases or events or conditions in a given population.
prevalence
Incidence
the frequency with which an event, such as a new case of illness, occurs in a population over a period of time
measure of association which quantifies the relationship between an exposure and health outcome
Odds Ratio
different than relative risk which looks at exposure
Bradford-hill criteria
temporal strength dose-required relationship consistency plausability consideration of alternative experiment specificity coherence
Free market - why is moral hazard an issue
consumer driven
Free market Free Patients who have low-deductible, low co-payment insurance will demand any and all pharmaceuticals and other treatments that promise any benefit at all, net of the risks and side effects of the treatment, without regard to cost. This is a standard “moral hazard” problem.
market
how does improved mixed system work
Improved mixed system – regulate private insurance, expand public insurance (PPACA). “Managed competition”
key provisions of patient Protection and Affordable Care Act
Private insurance regulation - fairer, plainer
Insurance exchanges - individuals / small business
Public expansion for poor (Medicaid, CHIP)
Medicare - close gaps, control costs
Individual mandate
Subsidies for poor / near-poor to purchase insurance
Payment reforms and quality initiatives
Association Health Plans
all for negotiating power with small business
…can exempt people with pre-existing conditions.
