Notes 4

Question 1

Other costs v. total costs since 1987?

Answer 1

Spending on mental illness and substance abuse is declining, gap widening between those and total health care costs

Question 2

Who usually operates mental illness care? Origins?

Answer 2

Usually a state-operated thing….used to be long term residential centers away from urban centers with few effective treatments

Question 3

What changed to long term residential centers?

Answer 3

Rx’s were effective in controlling mental illness starting 1950s - presented as long term alternative to mentally ill institutions/residential centers. Also, quality and cost measures led to closure.

Question 4

When MCARE/MCAID was passed, did it include mental coverage?

Answer 4

NOPE. MCARE/MCAID passage excluded coverage for mental illness, specifically for hospitals that were institutes for mental disorders. This was a huge incentive for states to close down mental hospitals.

Question 5

Community Mental Health Act?

Answer 5

promised discharge of pts so they could be sent home.

Question 6

Who would tend to have serious mental illness?

Answer 6

Younger, female, poor people with MCAID/CHIP insurance.

Question 7

Treatment for ANY v. serious mental illness?

Answer 7

ANY = more likely to not receive any care. Serious - more likely to get meds or some other treatment.

Question 8

What areas in US would be more likely to face a shortage of mental health professionals?

Answer 8

Rest, South,…probably rural areas

Question 9

Recent trends in psych institutions v. meds?

Answer 9

DECLINING psych institutions, huge growth in med use

Question 10

When did mental health meds start up?

Answer 10

…since meds have become more effective, stigma associated with mental health care is decreased (instead of covering LTC) so insurance will cover

Question 11

Number of mental beds since 1986?

Answer 11

Decreasing

Question 12

What’s parity, and what improved it?

Answer 12

Mental Health Parity and addiction equity act of 2008 (another one in 1996) - eliminated practice of unequal health treatment, and Improves access to much needed mental health and substance use disorder treatment services through more equitable coverage.

Question 13

ACA mental provisions?

Answer 13

2014 - MCAID expansion to cover more shit including meds, for BOTH MENTAL HEALTH AND ADDICTION

Question 14

Addiction - public health issue?

Answer 14

Yep, major cause of mortality…arises in adolescents, peaks, and either you get over it or you continue for a long time.

Question 15

3 reasons smoking declined?

Answer 15

public education campaigns, taxes, and restrictions on marketing/ads

Question 16

Problem with sending addicts to jail?

Answer 16

Disease marked by compulsion to use a substance while knowing that it’s bad for you…its’ mental, but we’ve criminalized it wrongly

Question 17

Middle ground for criminalization?

Answer 17

Drug court is away to combine public health and criminal justice. Drug court graduates are 40% less likely to repeat offense.

Question 18

2 perceived barriers (on behalf of docs) to palliative care implementation?

Answer 18

Pts aren’t adequately informed, don’t ask…pts are reluctant to accept care cuz it means they prob won’t recover…insurance doesn’t adequately reimburse

Question 19

When are docs trained about palliative care?

Answer 19

In continuing education (NOT MED SCHOOL OR RESIDENCY, although younger docs are being more exposed)

Question 20

Community rating?

Answer 20

Health insurance provides mechanism to distribute health care more in accordance with human need rather than ability to pay. This is done by redistributing funds from the healthy to sick.

Question 21

2 ways community rating is achieved?

Answer 21

1) WITHIN groups, people who become ill receive benefits in excess of their premiums, while healthy people can’t take advantage 2) BETWEEN groups, people who use health care less help pay for sick people who use more health care than their premiums can buy

Question 22

How redistributive is experience rating?

Answer 22

A lot less redistributive than community rating…just like community WITHIN groups there is redistributing based on need, but BETWEEN groups there more healthy people don’t subsidize high risk groups

Question 23

2 points of view regarding experience rating?

Answer 23

From elderly/chronic illness perspective, experience rating is DISCRIMINATORY. Healthy people might have another viewpoint…why should they voluntarily transfer their wealth to sicker people through insurance subsidy. This is why community rating CAN’T SURVIVE in a market driven competitive private insurance system.

Question 24

Insurance companies were originally made to solve the problem of out-of-pocket expenses, but what 2 problems were created?

Answer 24

1) People no longer had to pay out of pocket, so they started using more health care unnecessarily 2) Since providers controlled insurance, and they don’t have to charge pts anymore, they can raise prices. Both = RISING COSTS

Question 25

2 groups who received little benefit from employment-based private health insurance?

Answer 25

Poor (usually unemployed or low salary with no insurance) and elderly (needed health care most and were crapped on by the disappearance of community rating)