US Healthcare System & Policy: Key Concepts, ACA, WHO, and Nursing Roles

What is the primary focus of the Patient Protection and Affordable Care Act (ACA) of 2010?

To address high rates of uninsured individuals due to unaffordability and preexisting condition exclusions.

What are the key concepts of the US healthcare system?

Market-driven, multi-payer, heavily private, supports over 18 million healthcare workers, and incurs massive costs (17.8% of GDP).

What are the major provisions of the ACA regarding insurance coverage?

Requires minimal essential coverage or a federal tax penalty, establishes insurance marketplaces, and mandates coverage of essential benefits.

What groups are most at risk of lacking health insurance in the US?

Young adults, working uninsured, persons of Mexican origin, and illegal immigrants.

What is the role of the World Health Organization (WHO) in global health?

To provide guidance in promoting world health through standards, programming, and collaboration.

2019 WHO Goals

Address health amidnst the climate debate, healthcare inequality, preparedness for epidemics, expand access to meds, stop infectious disease, food safety, tobacco use, worker safety, water sanitation, hygiene in health facilities, educate healthcare workers, gain public trust.

What health indicators are used to compare the US with other nations?

Average life expectancy and infant mortality rates.

How does the US's infant mortality rate compare to other countries?

Still trails behind other developed countries. Discrepencies related to race/ethnicity.

What is the role of nurses in health policy?

Nurses should stay informed about healthcare policy issues, join professional organizations, serve on committees, advocate for nursing issues, and educate others.

What are some examples of delivery systems in US healthcare?

Ambulatory care, independent practice, managed care organizations, and hospital-based practices.

Ambulatory care

Outpatients. Includes urgent care centers, telehealth, outpatient centers, community centers, VA

Independent Practice

Hospital based practice. Important safety net for vulnerable populations.

Concierge and Hospitalists

Retainer medicine. Membership fee for enhanced health care, personalized and holistic, older patients, higher household income.

What is the purpose of Health Maintenance Organizations (HMOs)?

To control costs through a capitation payment method where providers receive a fixed payment per enrollee.

Independent Practice Associations

Physician organizations which care for HMO members in private office.

Acocuntable Care Organizations (ACOs)

Enabled by ACA ...where voluntary groups of providers (doctors, hospitals, etc.) come together to coordinate care for a patient population. Structure similar to HMO. Focus is cost containment.

Preferred Provider Organization (PPO)

Group of healthcare providers that provide services to a specific group, often at a reduced rate.

Point of Service Plans (POS)

Additional fee for providers outside of network. This increases consumer choice.

High Deductible Health Insurance Plans (HDHPs)

A health insurance plan with lower premiums and higher deductibles than a traditional health plan.

Medicare

Covers elderly individuals and those with disabilities.

Medicaid

Covers low income individuals and families. 1/5 Americans.

Tricare

For uniformed service members, retirees, and eligible family.

What is the significance of the 2019 elimination of the ACA mandate?

It increased the number of uninsured Americans.

What is Medicaid and who does it cover?

A program that covers low-income individuals and families, funded by federal and state funds.

What is Medicare and who is eligible for it?

A program that covers elderly individuals and persons with disabilities, funded through mandatory payroll deductions.

What are Accountable Care Organizations (ACOs)?

Groups of providers that coordinate care for a patient population, enabled by the ACA.

What are the financial implications of high deductible health insurance plans (HDHPs)?

They have high annual out-of-pocket deductions but lower monthly premiums, suitable for healthy individuals.

What is the role of local health departments in the US healthcare system?

To provide direct services to the public.

What are some health disparities in the US?

Disparities persist due to age, education, language, location, gender orientation, and ethnicity.

What is the impact of immigration on healthcare access in the US?

Illegal immigrants are often excluded from Medicaid/CHIP and may avoid seeking care due to fear of deportation.

What are the main goals of the WHO for 2019?

To elevate health in climate debate, reduce healthcare inequality, expand access to medications, and improve water sanitation.

What was the average life expectancy in the US in 1960 and 2016?

1960: 69.8 years; 2016: 78.5 years.

What is the significance of the ACA's focus on vulnerable populations?

It aims to improve affordability, accessibility, and financing of healthcare for those most at risk.

What is the role of Advanced Practice Nurses in the healthcare system?

They serve as primary care providers and are involved in a multidisciplinary collaborative approach.

What are some challenges faced by the US healthcare system compared to other nations?

Higher costs, disparities in health outcomes, and a significant number of uninsured individuals.

What is the impact of chronic illness trends in the US?

Concerns include rising rates of obesity, sedentary lifestyles, and an increase in drug poisoning deaths.