intro to ph 2

How does U.S. healthcare spending compare to other developed nations?

The U.S. spends more per person on healthcare (12,555) than any other developed nation, almost double the comparable country average (6,729).

Despite high spending, what are some poor health outcomes in the U.S.?

The U.S. has:

• Higher maternal mortality rates
• Lower life expectancy
• More preventable deaths

What are reasons for the U.S.'s poor healthcare performance?

• Fee-for-service system: Encourages more procedures over better outcomes.
• Administrative costs: Complex billing and insurance systems.
• Lack of price transparency: Patients don’t know costs upfront.
• Limited access: About 10% of adults are uninsured, delaying care.
• High drug prices: No government regulation and high pharmaceutical markups.

When were Medicare and Medicaid founded?

Both Medicare and Medicaid were founded in 1965.

How does U.S. healthcare spending compare to other developed nations?

The U.S. spends more per person on healthcare (12,555) than any other developed nation, almost double the comparable country average (6,729).

Despite high spending, what are some poor health outcomes in the U.S.?

The U.S. has:

• Higher maternal mortality rates
• Lower life expectancy
• More preventable deaths

What are reasons for the U.S.'s poor healthcare performance?

• Fee-for-service system: Encourages more procedures over better outcomes.
• Administrative costs: Complex billing and insurance systems.
• Lack of price transparency: Patients don’t know costs upfront.
• Limited access: About 10% of adults are uninsured, delaying care.
• High drug prices: No government regulation and high pharmaceutical markups (e.g., EpiPens cost 600 in the U.S. vs. 80–98 abroad).

When were Medicare and Medicaid founded?

Both Medicare and Medicaid were founded in 1965.

Who administers Medicare?

Medicare is administered by the federal government.

Who administers Medicaid?

Medicaid is administered by joint federal and state governments.

Who is covered by Medicare?

Medicare covers people 65+ and individuals with disabilities.

Who is covered by Medicaid?

Medicaid covers low-income individuals and families.

What is the funding source for Medicare?

Medicare is funded by federal payroll taxes and premiums.

What is the funding source for Medicaid?

Medicaid is funded by federal and state funds.

What is the coverage focus of Medicare?

Medicare covers hospital care, outpatient care, and prescription drugs (Parts A, B, C, D).

What is the coverage focus of Medicaid?

Medicaid provides comprehensive medical coverage, often including long-term care.

What is the income requirement for Medicare?

There is no income requirement for Medicare.

What is the income requirement for Medicaid?

Medicaid eligibility is based on income.

What is the difference between medical care and public health?

• Medical care focuses on individual patients and treatment of illness.
• Public health focuses on population health and prevention of disease.

What is the role of public health in the provision of medical care?

• Ensures equitable access to healthcare.
• Works to eliminate health disparities.
• Provides preventive services (e.g., vaccinations, health screenings).
• Acts as a provider of last resort, especially for uninsured or underserved populations through community health centers (over 1,400 in the U.S.).
• Supports policies like Medicare and Medicaid.

When was the Affordable Care Act (ACA) passed and what were its primary goals?

The ACA was passed in 2010 and aimed to expand access to health insurance, regulate the insurance industry, and improve healthcare quality.

What are some key insurance company regulations introduced by the ACA?

The ACA introduced:

• No lifetime limits on health coverage.
• No policy cancellations when medical costs rise.
• The Medical Loss Ratio (MLR) rule, requiring insurers to spend a minimum percentage of premiums on actual medical care.
• No denial of coverage for pre-existing conditions.

How did the ACA impact dependent coverage?

Young adults could stay on their parents’ insurance until age 26.

What was the ACA's provision regarding preventive services?

Many preventive services (vaccinations, screenings, wellness visits) became free of charge for insured patients.

How did the ACA improve Medicare?

It closed the “donut hole” in Medicare Part D, which lowered prescription drug costs for seniors.

How did the ACA expand Medicaid eligibility?

It allowed states to expand Medicaid eligibility to individuals earning up to 138\% of the federal poverty level, with the federal government initially covering 100\% of costs.

What were 'Insurance Exchanges' under the ACA?

Marketplaces created for comparing and purchasing insurance plans, with federal subsidies available for lower-income individuals.

What was the 'Individual Mandate' of the ACA, and what happened to it?

It required all individuals to have health insurance or pay a penalty to keep premiums stable, but it was repealed in 2017.

How did the ACA impact the uninsured rate?

The uninsured rate dropped dramatically, from 16.8\% in 2008 to 10.2\% in 2017, with the strongest gains in Medicaid expansion states.

What does it mean to ration healthcare?

Rationing healthcare means deciding how limited medical resources are allocated when demand exceeds supply.

How is healthcare commonly rationed in the U.S.?

In the U.S., rationing is often implicit, determined by a person's ability to pay, rather than an official policy.

What are some examples of healthcare rationing in the U.S.?

Examples include:

• Limited organ transplants.
• High costs for end-of-life care (25\% of Medicare spending occurs in the last year of life).
• Financial barriers forcing Americans to avoid or delay care due to cost.

What is an advance directive?

An advance directive is a written legal statement specifying a person’s medical treatment preferences if they become unable to communicate or make decisions.

What is the purpose of an advance directive?

Its purpose is to ensure a person’s wishes are honored regarding life support or comfort care, reduce emotional burden on family, and encourage autonomy.

What are the common types of advance directives?

The common types are:

1. Living Will: Specifies desired medical treatments.
2. Durable Power of Attorney for Healthcare: Appoints someone to make medical decisions on the person’s behalf.