Exam 1

Question 1

Administrative Law

Answer 1

The body of law produced by executive (i.e., administrative) agencies of federal, state, and local
governments.

Question 2

Capitation

Answer 2

A method of payment for health services in which

a fixed amount is paid for each person served without regard to the actual number or nature of services provided.

Question 3

Centers for Disease Control and Prevention

Answer 3

The federal agency within the Department of Health and Human Services charged with disease revention, education, and public health activities.

Question 4

Copayments

Answer 4

Refers to a form of beneficiary cost-sharing for
covered health insurance benefits and services, expressed as a flat dollar payment (e.g., $5.00 for a prescription drug).

Question 5

Deductible

Answer 5

The amount patients must pay out of their own

pocket before their health insurance policy begins contributing to the cost of their care

Question 6

Department of Health and Human Services

Answer 6

A federal agency that administers federal health and welfare programs and activities.

Question 7

Department of Labor (DOL)

Answer 7

A federal agency responsible for administration and enforcement of ERISA, a federal law that sets requirements for employer-provided health benefits
that are not offered through state-licensed health insurance plans.

Question 8

Diagnostic Related Group (DRG)

Answer 8

A system used to classify patients (particularly under Medicare) for the purpose of reimbursing hospitals. Hospitals are paid a fixed fee for
each case in a given category, regardless of the actual costs of providing care.

Question 9

Entitlement Programs

Answer 9

Refers to a guarantee of access to benefits or services based on established rights or by legislation (e.g., the Medicaid program).

Question 10

Epidemiology

Answer 10

The study of patterns of health and illness and

associated factors at the population level.

Question 11

Executive Order

Answer 11

A presidential directive, with the authority of a law, that directs and governs actions by executive Officials

Question 12

Federalism

Answer 12

Refers to a system of government in which sover-
eignty is constitutionally divided between a central governing authority and constituent political units (e.g., states), and in which the power to govern is shared between the national and state governments.

Question 13

Federally Qualified Health Center (FQHC)

Answer 13

A community health center that either receives funding under Section 440 of the Public Health Service Act, or a center that has been certified as meeting the same criteria.

Question 14

Police Powers

Answer 14

is the capacity of the states to regulate behavior and enforce order within their territory for the betterment of the health, safety, morals, and general welfare of their inhabitants.[1] Under the Tenth Amendment to the United States Constitution, the powers prohibited from or not delegated to the Federal Government are reserved to the states respectively, or to the people. This implies that the states do not possess all possible powers, since some of these are reserved to the people.

Question 15

Stare Decisis

Answer 15

A Latin term that refers to the legal principle

that prior case law decisions should be accorded great deference and should not be frequently overturned.

Question 16

Interest Groups

Answer 16

Interest groups are any organization of people with policy goals who work within the political process to promote such goals. Interest groups attempt to influence policy in multiple ways: Lobbying government, Engaging in election activities, Educating various public’s, Mobilizing various public’s. Many interest groups in society are those focused on advancing their members’ economic interests. Some have a large membership base, while others represent only a few members.

Question 17

Role of States in implementing health policy

Answer 17

Key decisions made on state level
Variation among states in how policymaking process is structured

State/local health bureaucracy:
State level agencies (ex: Medicaid, public health)
Local public health agencies

Question 18

Legal doctrine of federal supremacy

Answer 18

federal laws—the Constitution, statutes, and

treaties are the “supreme” law of the land, and thus preempt state laws that conflict with them.

Question 19

Presidential Authority

Answer 19

Sets the agenda
Budget proposals
Persuasion
Sign/veto bills
Executive Orders

Question 20

Roles of the House and Senate, including how many members and year terms for each

Answer 20

House: Initiates all revenue bills (Art. I, sec. 7)
Initiates (and passes or defeats) articles of impeachment (Art. I, sec. 2), 435 members with two-year terms, More hierarchically organized (more centralized, more formal, stronger leadership), Power distributed less evenly, Members are highly specialize, Emphasizes tax and revenue policy, More committees and subcommittees
Senate: Gives “advice and consent” to treaties (Art. II, sec. 2) and to major presidential appointments (Art. II, sec. 2), Tries impeached officials (Art. I, sec. 3),
100 members with six-year terms, Less hierarchically organized (less centralized, less formal, weaker leadership), Power distributed more evenly, Members are generalists, Emphasizes foreign policy, Fewer committees and subcommittees

Question 21

Economic interests of private, for-profit companies versus the community.

Answer 21

Policies and laws do not always support the best interests of public health. Policies at times favor the economic interests of private, for-profit company interests over the community. This is a reality because one focus of policy and law concerning public health is finding a balance between public regulation of private individuals and corporations, and their ability to exercise rights that allow them the function free of overly intrusive government intervention. Take for example, the debate on trans-fat elimination. Although this is deemed a favorable policy to promote health, the food industry will need to alter their process, which is expensive, and can be seen as the government controlling their profits. The outcome of a policy to ban trans-fat may not come to fruition if the food industry rallies their constituents in their favor.

Question 22

Three common characteristics of the uninsured.

Answer 22

Poor, low education, non-native, racial/ethnic minority, location, age

Question 23

Four examples of the way being uninsured impacts an individual’s health status.

Answer 23

When someone is uninsured they are less likely to get preventive treatment from health care professionals that can lead to bigger problems that could have been avoided with regular doctor visits. The uninsured are also less likely to complete follow up treatment recommendations and more likely to forgo the recommended care due to concerns about being able to afford the treatment.
more likely to delay care. more likely to be hospitalized with preventable conditions

Question 24

How much does the U.S. spend on health care services and how is the Affordable Care Act (ACA) projected to impact spending growth?

Answer 24

$2.5 trillion on health care services, representing 17.6% of GDP

puts our budget and economy on a more stable path by reducing the deficit by more than $100 billion over the next ten years – and more than $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Question 25

Mandatory and discretionary spending

Answer 25

Mandatory spending - Spending that the Government must spend. Discretionary spending - Spending category through which governments can spend through an appropriations act.

Question 26

Compare the US and one other country’s health care system in terms of payers, financing, universality, and role of private insurance.

Answer 26

Publically financed, privately delivered national health care system (Canada)
Publically financed and delivered national health systems (Britain)
Socialized insurance system with mandatory contributions and private delivery (Germany

Question 27

Role of Congress in the policymaking process

Answer 27

Congress is the major policy making body of the federal government. Congress creates public policy through legislation to address specific problems and to set funding amounts for governmental programs. The members of Congress can also play a role in policy implementation, including making suggestions in appropriations bills to outline how agencies should actualize policies. Legislative policymakers also has authority over all new and amended regulations Once a bill is drafted, one or more Members of Congress introduces it as legislation, becoming its sponsor(s). At this point, a bill or resolution is numbered (H.R. in the House of Representatives and S. in the Senate) and referred to a committee based on different rules of procedure.

Question 28

Three specific roles played by the judicial branch of government

Answer 28

Enforcing Legal Rights.
Two main functions of the legal system are to establish legal rights and to create institutions to enforce those rights. The primary enforcers of individual legal rights, and those best in position to create remedies for their violation, are the courts.

Reviewing the Actions of the Political Branches. An important piece of the separation of powers puzzle is the doctrine of judicial review. Judicial review refers to the power of the courts to declare laws unconstitutional and to determine whether the actions of the legislative and executive branches of government are lawful. The theory behind judicial review is that as the branch of government most independent of the political process, courts can pass judgment on the actions of the political branches free of partisanship.

Maintaining Stability in the Law.
Courts are expected to maintain a measure of stability, continuity, and predictability in the law. This expectation derives from the idea that those subject to the law should not have to contend with continuous swings in the direction law takes. In theory, the relatively non-political judicial branch of government is in the best position to bring this expectation to fruition.