Module 18 - Health Systems and Policy

Question 1

T/F: Healthcare is not the most responsible for keeping a population healthy

Answer 1

T

Question 2

T/F: Upstream determinants matter most

Answer 2

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)

Question 3

T/F: Out of pocket is highest in lower income countries

Answer 3

T

Question 4

primary Care

Answer 4

outpatient general practice

Question 5

secondary care

Answer 5

specialists (oncology, rheumatology, etc)

Question 6

tertiary care

Answer 6

advanced, specialized, hospital-based care

Question 7

Evaluating outcomes

Answer 7

Health
- population measures
- clinical measures

Quality
- evidence-based, safe, effective

Access & Equity
- access issues / disparities?

Finance
- Fair, efficient?

System Responsiveness

Question 8

Universal Health Coverage (UHC)

Answer 8

all people have access to the full range of quality health services they need, when and where they need them, without financial hardship

Question 9

Medicare

Answer 9

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

Question 10

Medicare does NOT cover…

Answer 10

• glasses
• hearing aids
• most dental
• long term care

Question 11

Medicaid

Answer 11

(pre-ACA):
- pregnant women
- children
- disabled
- some elders

Question 12

Medicaid coverage

Answer 12

• coverage varies per state
• eligibility based on household income % of the federal poverty level and category (child, pregnant, frail elder)

Question 13

Health insurance can be provided in the following ways…

Answer 13

1. Employer Based (ESI) - private
2. non-group plan (individual) - private
3. medicare - public
4. medicaid - public
5. uninsured

Question 14

Monthly premium

Answer 14

pay this amount each month to your insurance company so that you have insurance

Question 15

Deductible

Answer 15

how much you have to spend for your covered health services before insurance pays anything

Question 16

Copayments and coinsurance

Answer 16

payments you make to your health care provider each time you get care

copayment = set fee
coinsurance = %

Question 17

Medicaid: Funding

Answer 17

federal government (taxpayers in all states) pays for at least 1/2 the costs

taxpayers in that state pay for the rest

Question 18

T/F: ACA reduced the proportion of underinsured folks reduced from 18-10%

Answer 18

T

Question 19

Policy is about ___

Answer 19

redistribution

Question 20

Why does policy matter?

Answer 20

• can shift individual behaviors (stick)
• casts a wider net & can benefit all exposed to a particular environment