SPEA-H 124 : EXAM 1
63 Cards in this Set
Front | Back |
---|---|
health care policy usually reflects...
|
public opinion
|
problems of healthcare:system complexity
|
vast array of players and payers
|
problems of healthcare:contradictions in objectives
|
ineffectiveness; inefficiency(overuse and duplication of services, i.e. rural communities)
|
problems of healthcare: size and complexity
|
limited access, inconsistent quality, high costs
|
reform efforts: 1960s
|
increased access for low income populations and older Americans
|
reform efforts: 1970s-1980s
|
controls to slow cost growth
|
reform efforts: 1990s
|
more cost controls and quality improvements; market influence; privately owned managed care organizations
|
reform efforts: 2010 and beyond
|
cost, quality, and access; patient protection and affordable care act
|
primary market goal
|
providers: earn more
insurers and patients: spend less
|
Old healthcare system
|
confidential provider/patient contract, not subject to outside review; treatments and outcomes opaque to consumers- no accessible information
|
new healthcare system
|
increasing scrutiny by government, private insurers, employers, public advocacy groups, and industry watchdogs
doctor is bound by insurers rules, not the patient relationship
|
why public cynicism
|
results from widespread exposure to inadequacies of the health care system
|
the pathways to better healthcare do not ________....even in those instances in which healthcare is important too many americans__________.
|
generally depend on better health care; do not receive it
|
rural health services
|
rural systems often incomplete: service shortages; small populations means health care providers don't want to locate there-not economically viable
|
aging population means...
|
major gaps in delivery system appropriateness for care of older, culturally diverse Americans; financial gaps in medicare and medicaid payment for older adult basic needs
|
increased longevity, technological advances place________
|
new demands on system
|
first level of prevention
|
period during which the individual is at risk for the disease but is not yet affected
|
primary prevention
|
measures designed to promote health and specific protections
|
secondary prevention
|
involves early detection and prompt treatment to achieve early cure or slow progression, prevent complications, and limit disability
Most preventive health care is currently focused on this level
|
tertiary prevention
|
consists of rehabilitation and maximizing remaining functional capacity when disease has occurred and left residual damage; represents the most costly, labor intensive aspect of medical care and depends heavily on effective teamwork by representatives of a number of healthcare disciplines
|
natural history of diseases illustrates 2 important aspects of Health Care system
|
1. the focus of health care has been directed at curative and rehabilitative side of the disease continuum
2. the value in planning community services
|
rural community shifts
|
shift from impatient to outpatient care
|
balanced budget act of 1997
|
included a rural hospital flexibility program that replaced the essential access community hospital with a critical access hospital model
~increased the number of allowed occupied impatient beds and maximum length of stay before required discharge or transfer
|
paradox of technology advances
|
tech grew in sophistication and increasing number of people were deprived of its benefits
|
healthcare up until 1940s
|
industry dominated by physicians; patient/MD relationship sacred and confidential; mostly personal payments
|
shift from personal to insurance payments
|
dramatic alteration in physician patient relationship; distanced patients awareness of costs; created "business" of medicine
|
great depression era
|
birth of blue cross; hospitals began experimenting with insurance plans
|
Baylor University hospital plan
|
-for public school teachers- guaranteed 21 day hospital care for $0.50 per month payment
-started the blue cross model
AMA: opposed to the idea of private health insurance or government involvement
|
1930s AMA
|
aggressive protest against government involvement in providing health insurance for everybody
|
social security act of 1935
|
-most significant U.S. social initiative passed by any congress
-federal aid to states for public health, welfare, maternal/child health, crippled children
-direct gov't payments to retired persons
|
Post WWII healthcare
|
-government gave a huge boost to the private insurance industry
-federal subsidies for hospital construction, research, and professional education
-effect was to enable employees to take wage increases in the form of health insurance benefits rather than cash
|
why did Post WWII HI system pump increasing proportion of national income into health care
|
because insurance companies simply raised their premiums rather than exerting pressure on physicians and hospitals to contain costs
|
Post WWII price and wage controls
|
employers not permitted to raise wages
-benefits were exempted from federal taxation
-rise of employer-sponsored health insurance
|
kennedy-Johnson era
|
-1960-1968
-creative federalism
-1965: title 18- medicare, title 19- medicaid
|
health professions education assistance act of 1963
|
provided direct federal aid to medical professional schools and their students
|
Nixon-Ford era
|
-1968-1976
-New Federalism
-decentralized, shifted support from public health, social programs
-removed state restrictions on HMOs
-Req. many employers to offer HMO if they offered other insurance
-cost containment and controls
|
comprehensive health planning act: 1966
|
to promote comprehensive planning for rational systems of health care personnel and facilities in designated regions
|
national health planning and resources development act of 1974
|
established a new organization: health systems agency (HSA)
-spurred state certificate of need (CON) laws
|
HMO act of 1973
|
supported the development of HMOs through grants for federal demonstration projects
|
Health Maintenance Organization (HMO)
|
Organization responsible for financing and delivery of comprehensive health services to an enrolled population for a fixed fee
-insurance programs that provided health care to a defined population for a fixed price
|
did HMO act of 1973 control costs?
|
ya but raised many access and quality issues
|
result of medicare and medicaid
|
skyrocketed costs! (intended to improve access)
|
Hill-Burton Act of 1946 to increase hospital capacity...
|
resulted in overcapacity...then increased costs
|
1981-1989 healthcare
|
reductions in social program support; government changes the way it pays providers for medicare patients, away from fee-for-service
|
prospective payment system (1980s)
|
Reagan administration; a new way for medicare to reimburse hospitals for providing care to medicare patients
|
Reagan administration
|
significant reduction in government expenditures for social programs occurred
|
technological advances bring problems
|
ability to extend life raises questions about the quality of life and right to die
|
biomedical advances: early 1900s
|
antibiotics-for infectious diseases
|
dramatic advances of 1950s and 1960s
|
birth control pills; polio vaccines; heart-lung machines; CT scanners
|
increased use of technology has contributed to higher health care costs: T/F
|
true
|
Office of Technology assessment
|
intended to help officials sort out complex scientific information without particular policies or actions
|
explosion of scientific knowledge leads to...
|
-increased physician specialization and incomes
|
ncreased specialization leads to...
|
shortage of primary care physicians among rural and inner-city populations grew
|
AMA
|
established in 1847 to improve medical education; history of opposition to government controls; advocacy for physician autonomy
|
single most important impetus for healthcare reform
|
rising health care costs and insurance premiums
|
health insurance lobbies have been unsuccessful in thwarting new, tougher regulations on insurers in the affordable care act: T/F
|
true
|
American Public Health Association
|
focus on health promotion and disease prevention
|
health insurance portability and accountability act (1996)
|
intended to address the problem of the growing number of uninsured
-permits people to continue insurance coverage after a loss or change of employment
|
how many presently uninsured
|
45 million
|
aging of America
|
social and family changes limit opportunities for informal care-giving; high costs of institutional care- offers little to fill gaps
|
1990: healthy people 2000
|
national plan to reduce preventable deaths, disabilities, and diseases; goals out of reach
|
ACA: affordable care act
|
-mandate that everyone get health insurance(or pay the penalty)
-subsidized insurance for the poor
-new incentives for primary care and prevention
-prohibits denials for per-existing conditions
-coverage for dependents to age 26
-new payment methods
|
ACA 4 major goals
|
-providing new consumer protections
-improving quality and lowering costs
-increasing access to affordable care
-holding insurance companies accountabl
|