Week 5: Health Policy/ACA/Healthcare System and Economics

Question 1

what is a policy?

Answer 1

a settled course of action to be followed by a government, buisness, or institution to obtain a desired effect

Question 2

what is a public policy?

Answer 2

influences the lives of all citizens

Question 3

what is a health policy?

Answer 3

a set of course of action to obtain a desired health outcome for an individual, group, community, or society

Question 4

can a policy be a law?

Answer 4

yes
e.g. BAL, seatbelt, care seat requirements, and smoking bans

Question 5

what are the two health systems?

Answer 5

private and public

Question 6

what is included in public health system?

Answer 6

-federal programs
-state pogram
-local programs

Question 7

what is included in private health system?

Answer 7

profit
nonprofit

Question 8

how is private health ran?

Answer 8

like a buisness. not a part of government control, economics is the centeral factor and decisions are swift and proactive

Question 9

how is public health ran?

Answer 9

power is vested in the states so policies are influenced by social and political theory

decisions are usually slow and deliberate

Question 10

what is the public health act?

Answer 10

consolidated all existing public health legislation

Question 11

what is the best way to help change policies?

Answer 11

VOTE!!

Question 12

what is advocacy?

Answer 12

the act of supporting a cause or proposal

Question 13

what is lobbying?

Answer 13

to promote or secure the passage of legislation by influencing public officials

Question 14

how does the US health outcomes compare to other countries?

Answer 14

-lower life expectancy
-higher rates of suicide
-highest chronic disease burden
-highest obesity rates
-high premature death rate
-EXPENSIVE

Question 15

what is medicare?

Answer 15

health insurance for people 65 years and older and people with disabilities

Question 16

what is medicaid?

Answer 16

health insurance for people with low income and limited resources

state based program

Question 17

what is the COBRA?

Answer 17

mandates temporary coverage of insurance even once employment ends

Question 18

what is EMTALA?

Answer 18

that emergency departments cannot turn away patients

Question 19

What is SCHIP?

Answer 19

allows children from lower income families to recieve state funded insurance

Question 20

what is the medicare modernization act?

Answer 20

provided those with medicare to receive some drug benefits

Question 21

what is the mental health parity and addiction equity act?

Answer 21

insurers must compensate comparably for addiction and mental health services as they do for physical health condition

Question 22

what is the affordable care act?

Answer 22

• Health insurance exchanges
• Medicaid expansion
• Individual mandates
• Emphasis on preventive care
• Insurer regulations

Question 23

what was the ruling of National Federation of Independent Buisness v Sebelius

Answer 23

upheld the individual mandate for health insurance BUT rules that the mandatory medicaid elegibility exapansion

Question 24

What major changes from the ACA in the employer based insurance?

Answer 24

-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

Question 25

what is the medicaid gap?

Answer 25

those who make too much to be eligible for medicaid but not eligible to purchase insurance through the state marketplaces (make 48-100% FPL)

Question 26

Who is covered with the medicaid expansion?

Answer 26

up to 133% of the FPL

Question 27

how does ACA affect buisnesses?

Answer 27

-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

Question 28

how does ACA affect women, children, and families>

Answer 28

-children can stay on insurance until 26 -max out of pocket based on family income -mammograms, pap smears, and maternity services must be covered

Question 29

what is philanthropic health care systems?

Answer 29

address health in individuals through funded activites. (e.g. AHA, planned parenthood)

Question 30

what is the first first phase of the U.S. Health system?

Answer 30

1800-1900 health concerns relating to social and public health issues. family and friends provided most of health care in home. people avoided hospitals

Question 31

what is the second phase of the U.S. healthcare system?

Answer 31

1900-1945 -focus on controlling acute infections -growth of hospitals and health department -water purity, sanitary sewage disposal, housing -new medications (insulin, sulfa)

Question 32

what is the third phase of the health system?

Answer 32

1945-1984 -shift to chronic health problems -major technical advances -birth of DNP and midwives -increase role of insurance -start of community based clinics -

Question 33

what is the fourth phase of the healthcare system?

Answer 33

1984-present -limited resources -emphasis on containing costs -more knowledgeable society -hospitals have sicker patients, shorter stays, and more intensive cares

Question 34

what is health maintenance organization (HMO)

Answer 34

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

Question 35

what is a PPO?

Answer 35

more expensive, have more options in PCP than HMO. do not referrals for specialist. payment is based on a fee for service basis

Question 36

what is a POS?

Answer 36

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

Question 37

What is medicare part A?

Answer 37

covers hospitals and facitilites some home health, some hospice, and some skilled nursing care

Question 38

what is covered in medicare part B?

Answer 38

outpatient care, home health, equipment and supplies, lab, ambulance, and preventative services ELECTIVE summplental purchase for dental and vision

Question 39

what is covered in medicare part C?

Answer 39

"Advantage Plan" which expands options, like HMO and PPO

Question 40

what is covered in medicare part D?

Answer 40

provides prescription drug coverage

Question 41

what is the accountable care organization?

Answer 41

a group of physicians and other providers that work together to manage and coordinate care for medicare fee for service beneficiaries

Question 42

what is dual eligibility?

Answer 42

when someone is eligible for medicaid and medicare

Question 43

what is tricare?

Answer 43

uniformed services, dependent, and retirees can get coverage for hospital, medical, dental, ,and prescription services

Question 44

who is covered in an indian health services?

Answer 44

must live on or near a reservation to gt some reimbursement for residents of urban areas

Question 45

who recieves social security?

Answer 45

-retired workers (most common) -disabled workers -widows and widowers -spouses -adults disabled since childhood -children