Module 18 - Health Systems and Policy Flashcards
T/F: Healthcare is not the most responsible for keeping a population healthy
T
T/F: Upstream determinants matter most
T;
**UPSTREAM DETERMINANTS MATTER MOST
- Thinking about social-ecolocial model (upstream are further out on the the social ecological model)
- Legislation
- Working and living conditions
- Socioeconomic status (employment, opportunity, protections, conditions, educational attainment, & overall income) & how it paints a picture of inequity
- Structural systems of oppression (separate and integrated in our radical systems)
T/F: Out of pocket is highest in lower income countries
T
primary Care
outpatient general practice
secondary care
specialists (oncology, rheumatology, etc)
tertiary care
advanced, specialized, hospital-based care
Evaluating outcomes
Health
- population measures
- clinical measures
Quality
- evidence-based, safe, effective
Access & Equity
- access issues / disparities?
Finance
- Fair, efficient?
System Responsiveness
Universal Health Coverage (UHC)
all people have access to the full range of quality health services they need, when and where they need them, without financial hardship
Medicare
social insurance for elderly and permanently disabled;
federally administered (same package for everyone), single payer, etc.
- Closest to UHC that we have
- Everyone is automatically covered at 65; mandates that everyone is covered at a certain age
Medicare does NOT cover…
- glasses
- hearing aids
- most dental
- long term care
Medicaid
(pre-ACA):
- pregnant women
- children
- disabled
- some elders
Medicaid coverage
- coverage varies per state
- eligibility based on household income % of the federal poverty level and category (child, pregnant, frail elder)
Health insurance can be provided in the following ways…
- Employer Based (ESI) - private
- non-group plan (individual) - private
- medicare - public
- medicaid - public
- uninsured
Monthly premium
pay this amount each month to your insurance company so that you have insurance
Deductible
how much you have to spend for your covered health services before insurance pays anything
Copayments and coinsurance
payments you make to your health care provider each time you get care
copayment = set fee
coinsurance = %
Medicaid: Funding
federal government (taxpayers in all states) pays for at least 1/2 the costs
taxpayers in that state pay for the rest
T/F: ACA reduced the proportion of underinsured folks reduced from 18-10%
T
Policy is about ___
redistribution
Why does policy matter?
- can shift individual behaviors (stick)
- casts a wider net & can benefit all exposed to a particular environment
