Module 2 lecture, part 2 Flashcards

1
Q

What are some major themes in the current US healthcare system?

A

Cost control
Reducing national deficits and balancing federal budget
Preserving the quality of care
Universal coverage

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2
Q

What are the projections?

A

Deficits of nurses, dentists
Surpluses of physician specialists, pharmacists
Consolidation of fragmented allied health professions
Increased needs of public health approaches with focus on pops, information-driven planning, collaborative responses, and broad definition of health and health services

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3
Q

In what direction should we go?

A

Rational understanding of health services that includes health promotion and health protection strategies
Comprehensive basic benefit packages for all Americans
Benefit packages should have financing from the same source

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4
Q

What is the role of federalism and PH?

A

The Constitution
-Promote and provide for the general welfare
-Regulate international affairs and interstate commerce
“Health” is not found in the US Constitution
Federal gov’t involved in health matters through the states
Initial duties limited to preventing the importation of epidemics and assisting states and localities with episodic communicable dz

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5
Q

Describe the shifts in relative roles of gov’ts

A

Major roles of local gov’ts before 1875
States’ extensive involvement after 1875
Expanded federal gov’t’s role since the Great Depression (Social Security, Medicare, Medicaid)
New Federalism during the 1980s: decreased federal influence
Expansion of the federal gov’t’s role in the 21st century in response to new PH threats

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6
Q

What are the purposes of PH laws?

A

Protect and promote health
Ensure rights of individuals in the process

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7
Q

Is there one repository for the entire body of PH law?

A

No

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8
Q

What are the different forms of PH law?

A

Constitutionally based
-Where powers, duties, and limitations of federal law are established (and state in state constitutions)
Legislatively based
-Includes all of the acts and statutes enacted by Congress and state and local legislative bodies
Administrative law
-Promulgated within the executive branch of gov’t
Judicially based
-aka common law
-includes tradition, legal custom, and previous decisions
-Important for laws which have not been codified by various bodies

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9
Q

Which type of law contains the most frequently encountered legal interactions for health professionals and consumers?

A

Administrative law

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10
Q

How does administrative law have extensive impacts on daily life?

A

Immunizations required to enter school
Identifying sexual contacts for some STIs
Requirements for septic fields
Licensing health professionals

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11
Q

What are some other components of administrative law?

A

Developing and enforcing rules and regulations
No separation of powers in administrative law
Control points for the rule making process and final administrative decisions
-Reviewed and checked by committees and courts

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12
Q

On what basis do administrative agencies develop and enforce rules and regulations?

A

Enacted statutes

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13
Q

Why is no separation of powers justified in administrative law?

A

Administrative agencies often operate in a narrow and discrete area that requires a high level of technical expertise

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14
Q

What are the major levels of governmental public health?

A

National: federal health agencies such as DHHS and its components
Tribal: Indian Health Service
State: state health agencies such as HDs and human service agencies
Local: local PH agencies, often called local health departments

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15
Q

What range of activities do federal health agencies address?

A

Include, but not limited to:
-Research
-Training
-Primary care
-Health protection

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16
Q

What are the key public health service agencies?

A

Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
Centers for Dz Control and Prevention (CDC)
National Institutes of Health (NIH)
Food and Drug Administration (FDA)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Agency for Toxic Substance and Dz Registry (ATSDR)
Agency for Healthcare Research and Quality (AHRQ)

17
Q

What are some characteristics of state health agencies?

A

Health roles and duties often scattered among dozens of agencies
Many different configurations for state health agency: free-standing unit or within a larger multipurpose health and human services agency
Variability in state health agencies’ responsibilities

18
Q

What is the financial burden of state health agencies on state?

A

~30% of total state budgets spent on health purposes

19
Q

What are characteristics of local health departments?

A

Where rubber meets road
Often relate to ten or more state and federal agencies for funding and direction

20
Q

Who has the primary statutory PH authority on the state level?

A

The director of the state HD, state board of health, or multipurpose superagency; or the governor

21
Q

Basic arrangements for local HDs

A

Decentralized
Centralized
Mixed

22
Q

Decentralized local HD arrangement

A

Formed and managed by local gov’t; may also report to state health agency

23
Q

Centralized local HD arrangement

A

Directly operated by the state

24
Q

From where do local HDs get their funding?

A

Local funds (26%)
The state (37%: 17% originally from federal funds)
Direct federal funds (2%)
Medicare and Medicaid reimbursements (15%)
Fees (12%)
Other sources (8%)

25
Q

How do counties contribute to the local HD?

A

The most common form of subdividing states
Carry out various PH responsibilities delegated or assigned by states

26
Q

How do cities contribute to the local HD?

A

Generally not established as agents of the state
Can choose to have an HD
May rely on the state or their county for PH services

27
Q

What are the forces shaping governmental PH activities in the US?

A

Nature and perceived importance of threats
Relationships among levels of gov’t

28
Q

Trends in intergovernmental relationships

A

After 1915, fed gov’t becoming more active
The Great Depression in the 1930s: fed gov’t has more direct role
Medicare and Medicaid titles of the Social Security Act after 1965
New Federalism in 1980s: more state-centered
Expansion of the federal gov’t’s role in the 21st century to respond to new PH threats and the HC crisis

29
Q

What are the system inputs?

A

Workforce
Information
Organization and relationships
Facilities
Funding

30
Q

What are the processes?

A

Assess
Develop policy
Assure

31
Q

What are the outputs?

A

Programs and services consistent with mandates and community priorities

32
Q

What are the outcomes?

A

Improved organizational performance
Improved program performance leads to improved outcomes