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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

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