HSA3111 Exam 1

hiiiii jungkook ily

4 Components of healthcare system

Government, insurers, patients and providers

Single Payer Model

One source of coverage

Multi Payer Model

Multiple sources of coverage

Source of Coverage

Government, Private (insurance Companies)

Social Security Act

1965 created medicare and medicaid

Iron Triangle

Cost/money, access, quality

Belveridge

Single payer system where the government pays, funded through taxes, and the government handles delivery of care

National Health Insurance

Single payer system, where the government pays, funded through taxes, privatized care delivery

Bismarck

Multi-payer system, private pay, funded by taxes, and privatized care

US system

employer insurance, self-pay insurance, senior (Medicare),l low ses (medicaid), military/veterans

Mandatory budget

Government spending on programs required by permanent law. social security, medicare, medicaid

Discretionary budget

Government spending that congress and president approve through annual appropriation acts

Access (5 As)

Availability, affordability, accessibility, accommodation, acceptability

Triple Aim Triangle

Improve health, lower costs, better care

Policy

Guideline that may or may not have legal force

Mandate

originates from executive branch

Regulatory domains

Federal, State, Private

Children’s Healthcare Insurance Program

Also known as amendment 21 to the SSA. Effective 1998.

CHIP Less than age 1 requirement

less than 200% of FPL

CHIP 1-18 requirement

133% you can only qualify for this in florida if you have kids/dependents

Alternatives to chip

Ages 1-4 medikids 133-200, 5-18 florida health kids 133-200 pay a small monthly fee

Affordable Care Act

2010. Includes medicaid expansion, and the marketplace

Big Beautiful Bill

2025. Includes the reduction in and changes to medicaid, changes to the marketplace, and health savings accounts.

Medicaid changes (OB3)

Money laundering reduction, work requirements, and eligibility verification.

Marketplace changes (OB3)

Income and eligibility verification, no payment caps for income misreported

Health Savings Account changes (OB3)

Medicare part A contributions, Use for fitness/exercise, and x2 contributions if less than 75k.

Population Health

Health outcomes of a group of individuals, including the distribution of such outcomes in a group.

Health outcome

Actual state of health of a population

Indicators

Measures used to track and access outcomes

Factors that determine population health

Policy, drivers (patterns of health, iv), outcomes (dv)

Drivers

Genetics (pre disposition) ie cancer, Social determinants of health, individual behaviors (smoking, diet)

Social determinants of health

Socio-economic status, education, food insecurity, pollution, household composition

Health outcomes

Indicators of status: life expectancy, infant mortality, diabetes, hypertension, obesity, asthma. Indicators of access, chip, adult health insurance, unmet needs due to cost

Health disparity

A preventable, difference in health outcomes that negatively affects certain people/groups.

Historical developments that have shaped the system

• In historical order (no need to remember historical dates)

• Home based informal care with almshouses for the poor

• American Medical Association forms

  • professionalized medicine

• Flexner Report

  • determine standards to teach people medicine

• Great Depression/Blue cross is formed

  • Beginning of hospital care insurance

• Social Security Act is created

  • Foundation for healthcare programs, maternal and children’s health

• Blue Shield is created (WWII)

  • Physician services coverage model

• Employer based insurance cemented by tax advantage

• Medicare and Medicaid (1965)

• HMO Act

  • Provide federal support for hmos to attempt to control cost of core

• EMTALA

  • emergency care required regardless of ability to pay

• HIPAA

  • privacy standards and insurance reforms

• CHIP

• Affordable Care Act

• OB3
  
  
  

US Healthcare system basics

loosely connected components

system metrics

cost, access, quality

Stakeholders in US health

Suppliers (pharmaceutical industry), Consumers/patients, Government, Providers, and Insurance/payers

Four Key Factors

Who pays, How many pays, Funding, Care delivery

Most people get their insurance through

employer

Cost

Federal Gov (31) Medicaid, Medicare, ACA, VA

Consumers (28) Out of pocket, premium shares, copays, deductibles

Private Businesses (18) Contributions for workers

States (16) Medicaid, Health benefits for public workers

Other private (7): Philanthropy, private workers compensation

Cost Government Agencies

CMS: Total expenditure, GDP, Per capita

Department of Labor, Household spending

Kaiser Foundation, Premiums and deductibles

5 As of Access

Availability, Affordability, Accessibility, Accommodation, Acceptability

Donabedian/Quality

Structure, Process, Outcome

Hedis

Effectiveness, Access, Experience, Utilization and Resource Use

Steeep

Safe, Timely, Effective, Efficient, Equitable, Patient-Centered

Law

Legally binding work

Executive

Enforce laws

Senate

100 senators, 6 year terms, majority/minority leaders, appoint

House

435, 2 years, speaker, appropriation bills (generate revenue/spend money)

Path of a bill

1. Bill is sponsored and sent to house committee

2. Bill is voted on on house floor

3. Sent to senate committee

4. Senate floor and vote

5. Reviewed by joint committee

6. Discuss and amend

7. Bill goes back to H/S for final vote

8. President signs/vetoes

9. Bill is law

EHealth

A set of technologies applied with the help of the internet, in which healthcare services are provided to improve quality of life and facilitate healthcare delivery

mHealth

Medical and public health practice supported by mobile applications, such as phones, patient monitoring devices, and other wireless devices

Healthcare Information Technology HIT

The processing, storage, and exchange of health information in an electronic environment

Government Role in Technology

Hipaa, HiTech: Health Information Technology for Economic and Clinical Health Act: strong measures of security for electronic, hipaa easier to follow

Technology benefits

Efficiency, enhanced communication, advanced diagnosis, personalized treatment, patient empowerment, cost savings

Technology types

Game (VR), Cyber security, genetics, remote monitoring, telemedicine, wearable technology, blockchain, AI, cloud, robotic surgery

Block chain advantages

Secure, Transparent, Immutable, Efficient

Algorithm

A process or set of rules to be followed in calculations of other problem-solving operations, especially by a computer

Deep Learning Algorithim

Image and speech recognition (chatgpt)

NLP

Compute and generate language (siri)

Computer vision

Recognize objects/faces (X-rays)

Reinforcement of learning ☆

Training and decision making

Healthcare (medical treatments)

Genetics in shaping the future

Assess risk level, diagnose, and target treatments