Module 5 lecture, part 6 Flashcards

1
Q

What main actions were taken for national health insurance?

A

1917, the American Association of Labor Legislation
-To expand its social agenda by advocating national health insurance
1940s
-Failed bills on national health insurance during Roosevelt presidency
-Harry Truman: 1st US President to propose national health insurance
1992, Clinton proposals
-Congress opposed with a priority in avoiding tax increases over expanding health insurance coverage

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2
Q

What prevented a national health program by blocking various attempts during the 20th century?

A

Rise of private health insurance, AMA, and related industries

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3
Q

What were the reasons for defeated national health insurance proposals?

A

Political inexpediency
Institutional dissimilarities
Ideological differences
Tax aversion

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4
Q

How did political inexpediency defeat NHI proposals?

A

No threat to US political stability, unlike Germany and England where social insurance was a way to get worker loyalty.
US was decentralized
-Insurance matters were left to local and state gov’ts
Entry into WWI
-A final political blow to NHI because of anti-German sentiments
-NHI seen as a menace inconsistent with American values

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5
Q

How did institutional dissimilarities defeat NHI proposals?

A

Voluntary sickness funds less developed in US
American hospitals mostly private: seen not consistent with national financing and payment mechanisms
Oppositions of stakeholders

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6
Q

Who were the stakeholders opposed to NHI?

A

Physicians (threat to private practice) and AMA
Insurance industry (fear of lost income)
Pharmaceutical companies (fear of gov’t as a monopoly buyer)
Retail pharmacies (fear of being replaced by gov’t established pharmacies)
American Federation of Labor (AFL) (fear of loss of influence in the workplace)

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7
Q

What are the American beliefs and values that helped defeat NHI proposals?

A

Based on the principles of market justice
Individualism
Self-determination
Distrust of gov’t
Reliance on the private sector to address social concerns

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8
Q

How did tax aversion defeat NHI proposals?

A

Middle class support needed for broad reforms
Middle class already insured
Middle class not willing to pay increased taxes to cover for others

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9
Q

What was the insurance system like before Medicare and Medicaid were created in 1965?

A

Only private insurance widely available
Only for working middle class
The poor and elderly relying on own resources or charity
Private payers charged more to offset charity: “cost shifting” or “cost subsidization”

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10
Q

What occurred with the Social Security Amendments of 1965?

A

Less opposition for programs targeted at the underprivileged
Medicare and Medicaid created

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11
Q

Characteristics of Medicare

A

Title XVIII of the Social Security Act (SSA)
-Part A: hospital and limited nursing home coverage (based on Forand’s bill, 1957)
-Part B: covers physician bills (based on Byrnes’ proposal to share the cost of premiums)
Attached to Social Security
No class distinction
Uniform national standards for eligibility and benefits
Physicians allowed to balance bill

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12
Q

Characteristics of Medicaid

A

Title XiX of Social Security Act (SSA)
Federal matching funds to the states for the indigent (based on Kerr-Mills Act, 1960)
Expanded to include all age groups, not just the elderly poor
Based on a means test developed by each state
Varying eligibility and benefits by state
Class distinction: means tested leads to stigma of public welfare for Medicaid recipients
Physicians not being able to balance bill leads to limited participation from physicians

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13
Q

What are prototypes of managed care?

A

Contract practice
Group practice
Prepaid grp plans

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14
Q

How did contract practice work?

A

Existed in the form of salary payments for physicians in remote areas (such as railroad, lumber, or mining) or a contract with independent physicians and hospitals at a flat rate per worker per month (capitation)

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15
Q

How did grp practice work?

A

Brought physicians together with business managers and technicians
-ex Mayo Clinic in MN
-Met with resistance by solo practitioners due to being seen as a threat to general practitioners and specialists in solo practices

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16
Q

How do prepaid grp plans work?

A

An enrolled pop received comprehensive services for a capitated fee

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17
Q

Examples of prepaid grp plans

A

The Hip Health Plan NY in 1947
Kaiser Permanente in the West Coast in 1942
The Labor Health Institute in St Louis, 1945

18
Q

What was one main limitation of prepaid grp plans?

A

Required sponsorship of large organizations

19
Q

Why was the HMO Act of 1973 passed? What was its aim?

A

Was passed in response to increasing HC expenditures, esp in the public sector
To establish and expand HMOs (prepaid medical plans) by providing federal funds

20
Q

It was believed that prepaid medical care would do what?

A

Simulate competition among health plans, enhance efficiency, and slow the rate of increase in HC expenditure

21
Q

Was the objective of the HMO Act of 1973 successful? Why or why not?

A

Failed to achieve its objective, mainly bc of apathy from employers

22
Q

What was the objective of the World Trade Org (WTO)’s General Agreement on Trade in Services (GATS, 1995)?

A

To remove barriers to international trade in services

23
Q

What may the WTO GATS regulate?

A

Health insurance
Hospital services
Telemedicine
Medical tx abroad

24
Q

What are three main features of the corporate era? (1900s to present)?

A

Corporatization
Information revolution
Gloablization

25
Q

To what does corporatization refer?

A

The phenomenon that HC delivery has become the domain of large orgs or corporations

26
Q

What are the two main elements of corporatization?

A

Managed care
Integrated HC organizations

27
Q

What has become the primary vehicle for insurance and delivery?

A

Managed care

28
Q

How has managed care become the primary vehicle for insurance and delivery?

A

Through consolidation of purchasing power on the demand side

29
Q

Why did integrated HC organizations form?

A

To counteract managed care’s power
It was hospital’s service expansion to other areas to recoup lost revenues from reimbursement cuts for inpt acute care hospital svcs

30
Q

What happened in the corporatization era with individual physicians?

A

They consolidated into large clinics
Formed partnerships with hospitals
Started own specialty hospitals

31
Q

What is telemedicine, and what is its purpose?

A

Integration of telecommunication systems into distant caregiving
Improve access in rural areas

32
Q

What is e-health, and what is one result of it?

A

Info and services over the Internet
Has empowered consumers

33
Q

Forms of globalization

A

Cross-border transfer of information and services
Medical tourism
Foreign direct investment in HC enterprises
Migration of health professionals

34
Q

Factors of globalization

A

Overseas operations of US corporations
Overseas demand for US providers

35
Q

What made globalization easier?

A

Corporation and information revolution

36
Q

What are some state precedents of HC reform?

A

OR Health Plan of late 1980s
MA Health Plan of 2006

37
Q

Aspects of OR Health Plan of late 1980s

A

Expansion of Medicaid with supply side rationing
Medical insurance pool to cover preexisting conditions
Employer mandate

38
Q

Aspects of MA Health Plan of 2006

A

Individual mandate
Employer mandate
Gov’t subsidies for low-income ppl
Insurance clearinghouse (Connector)

39
Q

When was the Patient Protection and Affordable Care Act passed?

A

2010

40
Q

What defined the ACA politically?

A

Partisan, no Republican support
Backroom deals within the Democratic party and interest groups representing hospital and pharmaceutical industries: American public kept in the dark about the details?

41
Q

What position did the AMA take regarding the ACA?

A

It supported the legislation

42
Q

Describe the legal challenges against the ACA?

A

The majority of ACA provisions were ruled Constitutional under the Congress’ power to tax (the individual mandate)
Can’t coerce the states to expand their existing Medicaid programs