Lecture 2/Chapter 3

Question 1

US health care

Answer 1

• shaped by anthro-cultural values and social, political, and economic antecedents
• evolution of medical science and technology
• reform has taken center stage in American politics
• tracing the transformations in medical practice

Question 2

medical services: preindustrial era: colonial times

Answer 2

• colonial times in America
• medicine lagged behind other countries
• treatment attitudes emphasized natural history and common sense
• strong domestic character
• community based*
• personal interactions with pts.
• doctors are not well respected yet
• bartering/trading

Question 3

medical services: preindustrial era: 5 factors making medical profession an insignificant trade

Answer 3

• 1. medical practice was in disarray -> no organization
• 2. medical procedures were primitive -> no license or credibility
• 3. institutional core was missing:
• almshouse and pesthouse- isolating sick people so healthy people dont get sick
• mental asylum
• dreaded hospital- hospital was a place to go and die
  4. demand was unstable -> fee for service -> no standardization
• 5. medical education was substandard

Question 4

medical services: postindustrial era: physicians

Answer 4

• delivered scientifically and technically advanced services to insured patients
• became an organized medical profession -> med school
• certifications and licenses
• gained power, prestige, and financial success
• health care took its current shape during this period
• need for healthy workforce for health care factories

Question 5

7 factors in professional sovereignty growth

Answer 5

• medical services: postindustrial era
• 1. urbanization
• 2. science and technology
• 3. institutionalization- hospitals
• 4. dependency- gatekeeping, referrals
• 5. autonomy and organization
• 6. licensing- met a standard -> qualified
• level of public safety and competence increases
• 7. educational reform

Question 6

medical services: postindustrial era

Answer 6

• specialization in medicine -> gatekeeping -> managing costs, primary doctor referrals, dependency
• reform of mental health care
• development of public health
• health services for veterans
• birth of worker’s compensation
• creation of Medicare and Medicaid
• regulatory role of public health agencies

Question 7

rise of private health insurance

Answer 7

• medical services: postindustrial era
• technological, social, and economic factors
• early blanket insurance policies
• economic necessity and the Baylor plan
• successful private enterprise
• self interest of physicians -> guarantees pay for their service
• combined hospital and physician coverage
• employment based health insurance
• health people pay a small amount each month to benefit the sick
• profitable -> big business
• premiums are adjusted based on health, age

Question 8

failure of national health care initiatives during the 1990s

Answer 8

• medical services: postindustrial era
• political inexpediency
• institutional dissimilarities
• ideological differences- illness vs. wellness
• tax aversion

Question 9

medical care in the corporate era

Answer 9

• early developments
• HMO act of 1973
• corporatization of health care delivery

Question 10

HMO act of 1973

Answer 10

• federal funding for the growth of HMOs under the belief that prepaid medical care (instead of fee-for-service) would stimulate competition among health plans, increase efficiency, and control rising health expenditures
• Employers with 25 or more employees have to offer an HMO alternative
• Was not taken seriously by employers until 1980 when their own health insurance started to grow rapidly
• cooperate era

Question 11

corporatization of health care delivery

Answer 11

• managed care organizations (MCOs)
• managed care gave you options on where you can go
• more choices based on what you pay
• managed access
• basically indistinguishable from large insurance corporations
• 100,000s people to treat

Question 12

globalization of health care

Answer 12

• corporate era
• 4 modes of economic interrelationships
• telemedicine
• medical tourism- things not approved by the FDA -> travel to get procedure done
• foreign direct investment in health services
• health professionals move to other countries
• 3 aspects:
• 1. US corporations expanded overseas
• 2. medical care by US providers in demand overseas
• 3. global health discipline

Question 13

era of health care reform

Answer 13

• age of managed care
• increasing access to resources, health care, treatment -> until the point you cant anymore! -> managed care
• controlling cost, access, quality
• affordable care act

Question 14

patchy legacy of the ACA (2010)

Answer 14

• partially reduced number of uninsured American’s
• Medicaid accounted for roughly 60%
• 40% attributed to income based federal subsidies
• required residents to have minimum coverage or pay penalty tax -> penalties were less than the actual health insurance -> fail
• many americans did not benefit
• prospects for new reforms

Question 15

summary

Answer 15

• need for health insurance recognized the great depression
• US insurance began as a private endeavor
• creation of medicare and medicaid
• ACA passed without seeking consensus among americans
• provisions helped low income americans obtain insurance
• put greater financial burdens on the middle class
• insurance began as private until medicare/medicaid 1965

Question 16

medicare/mediaid

Answer 16

• very important to health care income

- half the income of a health care institution

Question 17

medicaid

Answer 17

• need based
• cant afford to have insurance
• state by state
• state directly determines the benefits
• federal state gives money to medicaid to fund it

Question 18

lobbying

Answer 18

influence legislative on a state level

Question 19

four main eras in the US health care evolution

Answer 19

• preindustrial- consumer sovereignty
• postindustrial- professional dominance -> urbanized
• between the business leaders and providers
• corporatization- corporate dominance -> networks and systems
• between insurance companies and providers
• health care reform- government dominance

Question 20

6 factors in passing the affordable care act

Answer 20

• 1. democratic party held presidency and majorities in congress
• 2. control of the executive and legislative branches
• 3. closed door deliberations
• 4. benefits were overstated
• 5. backing of major industry representatives
• 6. Obama tied reform proposals to economic growth
• market place -> insurance rates -> failure

Question 21

specialization in medicine

Answer 21

• postindustrial
• a hallmark in American Medicine
• 58-:52 specialist to generalist ratio
• specialized fields in allied health professions
• unlike Britain, the structure of medicine in the US did not develop around a nucleus of primary care, but…
• the gatekeeping model can be seen in HMOs
• initial contact with general practitioner required for a referral to a specialist
• in the US -> specialist > general
• in other countries -> general > specialist
• restricts access
• gatekeeping
• managing costs

Question 22

Baylor Plan

Answer 22

• specific hospital in Texas
• the teachers in the school need to be healthy to teach the kids
• each teacher will pay $3 a month to the hospital and all healthcare will be free
• this is what blue cross blue shield is based upon

Question 23

groundbreaking medical discoveries

Answer 23

• 1846- anesthesia
• 1847- aseptic technique- identifying microbes
• 1860- sterilization techniques
• 1865- antiseptic surgery
• -1895- x-ray imaging*
• 1929- penicillin

Question 24

development of public health

Answer 24

• public health in the US developed in response to deadly outbreaks of communicable diseases
• separate from private practice of medicine
• due to physicians skepticism of controlling private medical practice
• private practices focus on the individual (not community)
• smallpox
• public health = community
• controlling deadly disease

Question 25

creation of medicare and medicaid

Answer 25

- increase access to health care immensely - before 1965, only private insurance was widely available - politicians believed there would be loss opposition for programs targeted at the underprivileged - only the working middle class had private insurance - the poor and elderly had to rely on own resources or charity - private payers charged more to offset charity (cost shifting) - social security amendments, 1965 created medicare and medicaid - made it a separate fund so people dont have to sacrifice their needs over health care - *costly for the system! -> payroll deductions to fund this - as elderly population increases more and more funds are being taken

Question 26

medicaid*****

Answer 26

- additional health insurance for people that didnt pay into the funds bc they didnt work - need based - no balance billing - money came from federal government and given to the states - increase access to health care - title XIX of SSA - federal matching funds to the states (based on kerr-kills act) - for the indigent - class distinction - stigma of public welfare - eligibility and benefits vary from state to state

Question 27

medicare****

Answer 27

- title XVIII of the social security act (SSA) - hospital and limited nursing home coverage (based on forand's bill) - covers physician bills - no class distinction - balance billing - Part A of Medicare- finance hospital insurance partial nursing home coverage for the elderly - Part B of Medicare- proposal to cover physician’s bills through government subsidized insurance

Question 28

the creation of medicare and medicaid has had the greatest impact on:

Answer 28

- access | - not cost and quality

Question 29

is the distribution of primary care vs specialty care physicians in the US healthcare delivery system well suited for implementation of the ACA

Answer 29

- no - ACA focuses on getting most care to most people - we need more primary care to do this - solutions- gatekeeps, influence students to go towards general care

Question 30

primary care vs specialty care

Answer 30

-US leans towards specialty care slightly