Complete Public Health Exam 1

What political party is most responsible for health care reform?

Democratic party - ACA, Medicare/Medicaid, and Inflation Reduction Act

Social Security Act

1935 - FDR creates old-age pensions and maternal-child health grants. Health insurance dropped under AMA opposition

Social Security Amendments

1965 - Create Medicare and Medicaid

HMO Act

1973 - Nixon promotes Health Maintenance Organizations (HMOs) to control costs.

EMTALA

1986 - Hospitals must screen and stabilize emergency patients regardless of ability to pay

CHIP

1997 - Children’s Health Insurance Program, created by the Balanced Budget Act (Clinton/Democrats), for children of families who make too much for Medicaid and too little for health insurance

Patient Protection and Affordable Care Act

2010 - Expanded access to health insurance, lower costs, and enhance consumer protections

Citizens United v FEC

2010 - Protects independent political spending by corporations as free speech - major challenge to the ACA

Tax Cuts and Jobs Act

2017 - Removes induvidual penalty. Is a big challenge to the ACA

Health Policy

Created to expand access, reduce costs, and improve quality

Policy

Any formal or informal agreement about how an institution governing body, or community will address shared problem. Processes to achieve an end. Violations.

Law

System of rules a country, state, or community recognizes and enforces through penalties or sanctions. Actual rules. Passed by legislative body, enforceable penalty.

Law or policy? City ordinance requiring cyclists under 18 to wear helmets, with a $25 fine

LAW - passed by legislative body, enforceable penalty.

Law or policy? Police department “de-escalation first” use-of-force guidelines

POLICY - internal; violations bring discipline, not criminal charges

Law or policy? EMTALA requires hospitals to screen and stabilize emergency patients regardless of ability to pay

LAW - passed by Congress

Law or policy? State statute requires hospitals to report communicable diseases within 24 hours

LAW - enforced by state

U.S Health Policy focuses more on ___________ than actual health

Organization and financing of medical goods and services

In the U.S Health Care System, there are extremes of ____ and ______

Excess (waste, superficiality, etc) and deprivation (short-term survival, limit of opportunities, etc)

What are the holy trinity of Health Policy and Management?

Access, Cost, and Quality

What is the goal of the holy trinity of health policy and management?

Increase access, reduce costs, and improve quality

Access refers to the ability to….?

Obtain personal health services that are needed, affordable, convenient, and acceptable and effective.

Cost at the macro level (national) refers to the…?

Proportion of the total healthcare expenditures that make up the gross domestic product.

Cost at the micro level (induvidual) refers to the….?

Costs that people incur to pay for health insurance and receive health care goods and services

Quality refers to the degree to which…?

Health care services for individuals and populations increase the likelihood of desired outcomes.

What is the definition of Health?

“ A state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity.”

What is the definition of Health Care?

A system to help people improve if they become ill

What is the definition of Health Care Delivery System?

The arrangement of providers, facilities, and resources that delivers medical care to people/populations

What is the definition of Health Care System?

All activities aimed at promoting, restoring, and maintaining health (not just medical services)

What keeps the health care system from reform?

Erosion of trust in medical care and government, and medical care is privately organized but publicly financed

The Right (Neoliberals) opinion of the welfare state

Hurts economy, too many taxes and regulations that minimize growth, less interest to invest and work.

The Left (Progressive/Pro-Labor) opinion of the welfare state

Not transformative enough and instead stabilizes social control, inefficient b/c its bureaucratic, doesn’t eliminate income inequality.

Market Justice view of healthcare basic

Healthcare as an economic commodity distributed by ability to pay

Social Justice view of healthcare basic

Healthcare as a basic human right distributed by individual need

Implications of Social Justice view of healthcare

Collective responsibility, community wellbeing supersedes the individual

Implications of Market Justice view of healthcare

Individual responsibility, purchasing power, limited obligation to collective good, private solutions

Is Social or Market Justice more prevalent in the U.S?

They both collide, but primarily market justice

Why is healthcare not a clean free market?

Information asymmetry (patients cant judge quality or necessity), Inelastic demand (people don’t “shop” for emergency care), Third-party payment (insurance), Public goods/externalities (benefits beyond the buyer)

What approach to health most aligns with Market Justice?

Biomedical

What approach to health most aligns with Social Justice?

Public Health and Social Epidemiology

What is a right?

Legal, Social, or ethical principles of freedom or entitlement.

What is a commodity?

valuable things that can be bought and sold

What is supply?

The quantity of a commodity avaliable

What is demand?

The buyer’s desire to pay for the service or commodity

What is a free market?

Price, quantity, and quality are set by supply and demand between private buyers and sellers, with minimal government intervention.m

Almost everywhere else in the world, health care is treated as a human right; in the U.S., health is a ____ _____

Private choice

Biomedical approach to health

Physical wellbeing, individual, technology

Public Health approach to health

Physical, mental, and social wellbeing, population (primarily), community and individual, prevention

Social Epidemiology approach to health

Biomedical and correlation to social outcomes, all levels of focus, community and environmental conditions

Social Construction of Health and Illness approach to health

Subjective sense of physical, emotional, and mental wellbeing (does not include illness and disease), between larger institutions and people’s lives, health understanding and stigmatization.

Definition of Health

Construct of physical, emotional, mental, and spiritual wellbeing.

Definition of illness

Subjective understanding and embodied feelings of health

Disease definition

Physical or mental malady determined by an objective medical evaluation

What are the three levels of prevention?

Primary, Secondary, and Tertiary

What is the primary level of prevention?

Policies, environment, social action

What is the secondary level of prevention?

Early detection and screening to contain disease

What is the tertiary level of prevention?

Reduction of complications and disability through treatment

What are the 5 determinant of population health?

Social characteristics, total ecology, genes and biology, health behaviors, and medical care

Genes/biology and health behaviors only account for __% of population determinants

25%

Father of social epidemiology

Leonard Syme

Three social epidemiological approaches

Psychosocial, Political economy of health, and Ecosocial

Psychosocial epidemiological approach

Physiological response to social stress/human interaction. Doesn’t include biology

Political economy of health epidemiological approach

Who benefits from social arrangements and health policies and how they shape a person’s resources and risks. Doesn’t include biology

Ecosocial epidemiological approach

Multiple levels of interaction between individual (bio/psycho/social) and the physical/social environment. Includes biology

Why hasn’t the risk factor approach been successful?

Hard to identify, too difficult for people to change behaviors, too individual, only focused on stats

Social constructionism

Assumes everything is created through meanings and experiences that are shaped by cultural and social systems

Is biomedicine socially constructed?

Yes, as a form of regulation, and is not absent of social and political contexts.

Social Construction approach to health

Medical knowledge about illness and disease are bound to perception and culture

Social Epidemiology vs. Social Construction similarities

Assess environmental conditions and social determinants

Social Epidemiology vs. Social Construction differences

Epidemiology = social stratification to explain health disparities

Construction = Social phenomenon to explain health disparities

Social Epidemiology vs. Social Construction limitations

Epidemiology = Focused on biomedical outcomes, needs to identify which environmental factors shape health

Construction = Too many definitions of health to develop general treatments, not as focused on wellbeing, no biology

Steps to developing health policy

Bill (proposed and negotiated), Proposition(voted on), Executive order (signed and publised), Supreme Court and other judicial decisions

Why has National Health insurance failed in the U.S?

Decentralized government, denouncing “socialized medicine”, aversion to higher taxes, AMA historically opposing it, Competing interests.

What is a census?

informs allocative policies: counts of persons living in poverty determine federal money to states for Medicaid, etc

Decennial Census

Every 10 years - entire population

American Community Survey

Annually - representative sample

Economic Census

Every 5 years - businesses

What is lobbying

Legal policy advocacy to directly influence legislators

Revolving door

Members of government taking jobs with lobbying firms and industries they used to oversee

Who directly makes decisions about health policy?

elected and appointed officials

Who indirectly makes decisions about health policy?

electorate and health industry donors

3 key players in healthcare system

Patients, providers, and payers

What does health insurance do?

Protects our financial assets against health-related catastrophe - WWII wage freeze

Who do public programs serve?

Medicare: elderly, disabled

Medicaid: Low-income

CHIP: Children of low-income families who earn too much for Medicaid

Subsidy

Money paid by government to support an undertaking of public interest and keep to price of service low.

4 functioning parts of health care delivery system

Financing (government/employer), Insurance, Delivery, Payment

Managed Care delivery systems do…?

Insurance, delivery, and payments

4 Major events leading to ACA

1. Growth of managed care and managed competition since 1970s

2. Failure of Clinton’s health Security Act, CHIP, and Medicare Modernization Act

3. Significant healthcare reform in Mass 2006

4. Obama’s Democratic majority in House and Senate - Obama’s Deal

What is the ACA?

Health care reform law passed to make health insurance more available, affordable, and accessible

How has the ACA changed?

1. 26 yrolds on parents plan

2. Consumer protections

3. Delivery reform

4. Women’s health services cannot be a higher premium

Where does the ACA stand in 2026?

Marketplace enrollment fell 12%

1.5M removed improper enrollments

Big Beautiful Bill introduced new eligibility checks every 6 months

Less full-time employees

Critiques of the ACA - Left

Marketplace instability, insurance gaps persist, leaves out single-payer option, focuses on economic viability

Critiques of the ACA - Right

Taxing wealthy, government expansion of public programs, private insurance regulation, “undeserving” populations receive medicaid, Subsidy costs and improver marketplace enrollment

Challenges to the ACA 2010

Cultural, Legislative, Executive, and SCOTUS

Medicaid expansion covers adults up to..?

138%

Premium tax credits help people by market plans and are limited to..?

400%

The ACA envisioned most people gaining ___ coverage

Private

Why did more people end up using Medicaid instead of private coverage?

Tax Cuts and Jobs Act, Subsidies were limited four plan tiers, cutting of full-time employees