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

1
Q

what is a policy?

A

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

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2
Q

what is a public policy?

A

influences the lives of all citizens

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3
Q

what is a health policy?

A

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

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4
Q

can a policy be a law?

A

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

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5
Q

what are the two health systems?

A

private and public

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6
Q

what is included in public health system?

A

-federal programs
-state pogram
-local programs

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7
Q

what is included in private health system?

A

profit
nonprofit

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8
Q

how is private health ran?

A

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

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9
Q

how is public health ran?

A

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

decisions are usually slow and deliberate

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10
Q

what is the public health act?

A

consolidated all existing public health legislation

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11
Q

what is the best way to help change policies?

A

VOTE!!

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12
Q

what is advocacy?

A

the act of supporting a cause or proposal

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13
Q

what is lobbying?

A

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

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14
Q

how does the US health outcomes compare to other countries?

A

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

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15
Q

what is medicare?

A

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

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16
Q

what is medicaid?

A

health insurance for people with low income and limited resources

state based program

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17
Q

what is the COBRA?

A

mandates temporary coverage of insurance even once employment ends

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18
Q

what is EMTALA?

A

that emergency departments cannot turn away patients

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19
Q

What is SCHIP?

A

allows children from lower income families to recieve state funded insurance

20
Q

what is the medicare modernization act?

A

provided those with medicare to receive some drug benefits

21
Q

what is the mental health parity and addiction equity act?

A

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

22
Q

what is the affordable care act?

A
  • Health insurance exchanges
  • Medicaid expansion
  • Individual mandates
  • Emphasis on preventive care
  • Insurer regulations
23
Q

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

A

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

24
Q

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

A

-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

25
Q

what is the medicaid gap?

A

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

26
Q

Who is covered with the medicaid expansion?

A

up to 133% of the FPL

27
Q

how does ACA affect buisnesses?

A

-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

28
Q

how does ACA affect women, children, and families>

A

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

29
Q

what is philanthropic health care systems?

A

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

30
Q

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

A

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

31
Q

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

A

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

32
Q

what is the third phase of the health system?

A

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

33
Q

what is the fourth phase of the healthcare system?

A

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

34
Q

what is health maintenance organization (HMO)

A

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

35
Q

what is a PPO?

A

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

36
Q

what is a POS?

A

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

37
Q

What is medicare part A?

A

covers hospitals and facitilites

some home health, some hospice, and some skilled nursing care

38
Q

what is covered in medicare part B?

A

outpatient care, home health, equipment and supplies, lab, ambulance, and preventative services

ELECTIVE summplental purchase for dental and vision

39
Q

what is covered in medicare part C?

A

“Advantage Plan” which expands options, like HMO and PPO

40
Q

what is covered in medicare part D?

A

provides prescription drug coverage

41
Q

what is the accountable care organization?

A

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

42
Q

what is dual eligibility?

A

when someone is eligible for medicaid and medicare

43
Q

what is tricare?

A

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

44
Q

who is covered in an indian health services?

A

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

45
Q

who recieves social security?

A

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

46
Q
A