Week 5: Health Policy/ACA/Healthcare System and Economics Flashcards
what is a policy?
a settled course of action to be followed by a government, buisness, or institution to obtain a desired effect
what is a public policy?
influences the lives of all citizens
what is a health policy?
a set of course of action to obtain a desired health outcome for an individual, group, community, or society
can a policy be a law?
yes
e.g. BAL, seatbelt, care seat requirements, and smoking bans
what are the two health systems?
private and public
what is included in public health system?
-federal programs
-state pogram
-local programs
what is included in private health system?
profit
nonprofit
how is private health ran?
like a buisness. not a part of government control, economics is the centeral factor and decisions are swift and proactive
how is public health ran?
power is vested in the states so policies are influenced by social and political theory
decisions are usually slow and deliberate
what is the public health act?
consolidated all existing public health legislation
what is the best way to help change policies?
VOTE!!
what is advocacy?
the act of supporting a cause or proposal
what is lobbying?
to promote or secure the passage of legislation by influencing public officials
how does the US health outcomes compare to other countries?
-lower life expectancy
-higher rates of suicide
-highest chronic disease burden
-highest obesity rates
-high premature death rate
-EXPENSIVE
what is medicare?
health insurance for people 65 years and older and people with disabilities
what is medicaid?
health insurance for people with low income and limited resources
state based program
what is the COBRA?
mandates temporary coverage of insurance even once employment ends
what is EMTALA?
that emergency departments cannot turn away patients
What is SCHIP?
allows children from lower income families to recieve state funded insurance
what is the medicare modernization act?
provided those with medicare to receive some drug benefits
what is the mental health parity and addiction equity act?
insurers must compensate comparably for addiction and mental health services as they do for physical health condition
what is the affordable care act?
- Health insurance exchanges
- Medicaid expansion
- Individual mandates
- Emphasis on preventive care
- Insurer regulations
what was the ruling of National Federation of Independent Buisness v Sebelius
upheld the individual mandate for health insurance BUT rules that the mandatory medicaid elegibility exapansion
What major changes from the ACA in the employer based insurance?
-created SHOP marketplaces to help small buisness
-employer shared responsibility payment (>50 employees)
-90 day maximum wait period
-benefits and coverage disclosure laws
-incentives for worksite wellness programs
what is the medicaid gap?
those who make too much to be eligible for medicaid but not eligible to purchase insurance through the state marketplaces (make 48-100% FPL)
Who is covered with the medicaid expansion?
up to 133% of the FPL
how does ACA affect buisnesses?
-encourages employers to provide insurance
-created SHOP marketplaces
-employer shared responsibility
-90 day maximum wiat
-benefits and coverage disclosure laws
-incentives for worksite wellness
-small buisnesses tax credit to provide employees coverage
how does ACA affect women, children, and families>
-children can stay on insurance until 26
-max out of pocket based on family income
-mammograms, pap smears, and maternity services must be covered
what is philanthropic health care systems?
address health in individuals through funded activites. (e.g. AHA, planned parenthood)
what is the first first phase of the U.S. Health system?
1800-1900
health concerns relating to social and public health issues.
family and friends provided most of health care in home.
people avoided hospitals
what is the second phase of the U.S. healthcare system?
1900-1945
-focus on controlling acute infections
-growth of hospitals and health department
-water purity, sanitary sewage disposal, housing
-new medications (insulin, sulfa)
what is the third phase of the health system?
1945-1984
-shift to chronic health problems
-major technical advances
-birth of DNP and midwives
-increase role of insurance
-start of community based clinics
-
what is the fourth phase of the healthcare system?
1984-present
-limited resources
-emphasis on containing costs
-more knowledgeable society
-hospitals have sicker patients, shorter stays, and more intensive cares
what is health maintenance organization (HMO)
a prepaid health plan wihth fixed monthly payment and copays that are low. must see those within the network of the HMO. must see a PCP to go to a specialist
what is a PPO?
more expensive, have more options in PCP than HMO. do not referrals for specialist. payment is based on a fee for service basis
what is a POS?
contains elements of both PPO and HMO.
-requires co pay
-requires referral to specialist
-services can be used out side of network but may be more expensive
What is medicare part A?
covers hospitals and facitilites
some home health, some hospice, and some skilled nursing care
what is covered in medicare part B?
outpatient care, home health, equipment and supplies, lab, ambulance, and preventative services
ELECTIVE summplental purchase for dental and vision
what is covered in medicare part C?
“Advantage Plan” which expands options, like HMO and PPO
what is covered in medicare part D?
provides prescription drug coverage
what is the accountable care organization?
a group of physicians and other providers that work together to manage and coordinate care for medicare fee for service beneficiaries
what is dual eligibility?
when someone is eligible for medicaid and medicare
what is tricare?
uniformed services, dependent, and retirees can get coverage for hospital, medical, dental, ,and prescription services
who is covered in an indian health services?
must live on or near a reservation to gt some reimbursement for residents of urban areas
who recieves social security?
-retired workers (most common)
-disabled workers
-widows and widowers
-spouses
-adults disabled since childhood
-children
