ph 162 quiz #3

What does the text mean by "special populations?" Be familiar with the definition of the term, other similar terms that are often used interchangeably, and examples of groups that the authors categorize as "special populations."

-They are more vulnerable than the general population and experience greater barriers in access to care, financing of care, and racial or cultural acceptance.
-Groups: These population groups consist of racial and ethnic minorities, uninsured children, women, persons living in rural areas, homeless individuals and families, mentally ill individuals, chronically ill and disabled individuals, and persons
with human immunodeficiency virus (HIV}/acquired immunodeficiency syndrome (AIDS)
-similar terms: Various terms are used to describe these populations, such as "underserved populations;' "medically underserved;' "medically disadvantaged;' "underprivileged;' and "American under classes:"

Be familiar with the "vulnerability framework" discussed by the text, in particular what they mean by "predisposing characteristics," "enabling characteristics," and "need characteristics." Be prepared to recognize examples of these and to distinguish between them.

-According to the framework, vulnerability is determined by a convergence of (1) predisposing, (2) enabling, and (3) need characteristics at both the individual and ecological (contextual) levels. Not only do these predisposing, enabling, and need characteristics converge and determine individuals' access to health care, but they also ultimately influence individuals' risk of contracting illness or, for those already sick, recovering from illness
-predisposing: include biological factors that may influence the likelihood an individual needs a health service, social structure that may influence how an individual can cope with health problems, and health beliefs that may influence an individual's perception of their need for a health service
ex. Racial/ethnic characteristics, Gender and age (women and children), Geographic location (rural health)
-enabling: include family characteristics such as income, insurance coverage, access to services (transportation and distance to care), and community characteristics such as availability of resources and region of the country
ex. Insurance status (uninsured), Homelessness
-need: account for the subjects' health beliefs or psychosocial factors when measuring access to health care services.
ex. Mental health, Chronic illness/disability, HIV/AIDS

Be familiar with the authors' framing of racism in health care, and how it manifests itself.

-Racism in health care does not typically surface in a blatant, overt way, but rather tends to take the form of racial micro-aggressions or underrepresentation of people of color in the health care workforce
-Racism also surfaces in the significant variations in the way providers approach non-minority and minority patients. Recent studies have found evidence of poorer-quality care and physician dismissal or downplaying of condition severity in minority patients. Historic underrepresentation of certain racial groups in health care also reflects the institutionalized racism present within this sector.

Be familiar with policy tools. Be able to recognize and distinguish between, allocative policies, distributive policies, redistributive policies.

-allocative policies: They involve the direct provision of income, services, or goods to certain groups of individuals or institutions. Allocative tools in the health care arena may be either distributive or redistributive.
-distributive policies: spread benefits throughout society. Typical distributive policies include funding of medical research through the National Institutes of Health (NIH) , the development of medical personnel, construction of facilities, and initiation of new institutions
-redistributive policies: designed to benefit only certain groups of people by taking money from one group and using it for the benefit of another. This system often creates visible beneficiaries and payers.

What does it mean for government to be a "subsidiary" to the private sector?

In the United States, health care has not been seen as a right of citizenship or as a primary responsibility of government. Instead, the private sector has played a dominant role in developing the U.S. health care landscape.

What does it mean for policies to be fragmented? Be able to recognize examples.

Federal, state, and local governments pursue their own policies, with little coordination of purpose or programs occurring. The subsidiary role of the government and the attendant mixture of private and public approaches to the delivery of health care have also resulted in a complex and fragmented pattern of health care financing in which (1) the employed are predominantly covered by private insurance (2) the elderly are insured through Medicare; ( 3) the poor are covered by Medicaid; and (4) special population groups-for example, veterans, American Indians, members of the armed forces, Congress, and employees of the executive branch-have coverage provided directly by the federal government.

What does it mean for policies to be incremental and piecemeal? Be able to recognize examples.

The incremental and piecemeal health policies observed in the United States have resulted from numerous compromises made to accommodate a variety of competing interests . An example is the broadening of the Medicaid program since its introduction in 1965. The Medicare program was also expanded incrementally.

Be able to recognize examples of interest groups in the health policy arena.

federal/state governments, employers, consumers, insurers, practitioners, provider organizations, technology producers, American Medical Association, American Association of Retired Persons, American Hospital Association, American Health Care Association, Pharmaceutical Research and Manufacturers of America

What are the future considerations for domestic health policy discussed in the text?

-The Rural Action Plan: 1. Build a sustainable health and human services model for rural communities by empowering rural providers to transform service delivery on a broad scale
2. Leverage technology and innovation to deliver quality care and services to rural communities more efficiently and cost-effectively. 3. Focus on preventing disease and mortality by developing rural-specific efforts to improve health outcomes
4. Increase rural access to care by eliminating regulatory burdens that limit the availability of needed clinical professionals. Expansion of Medicare's telehealth benefit to permit rural health clinics and federally qualified health centers to provide telehealth services, as well as an expansion of telehealth access to the Indian Health Service and tribal facilities
-Health insurance expansion: Under the Biden administration, an updated version of ACA is likely to be proposed with the goal of further expanding health insurance coverage. By expanding ACA premium subsidies, the Biden plan is likely to lower the cost of marketplace coverage for enrollees, including the uninsured and others currently priced out of the marketplace

Be familiar with the 8 forces of future change and be prepared to recognize and distinguish between examples.

(1) social and demographic, (2) political, (3) economic, (4) technological,(5) informational, (6) ecological, (7) global, and (8) anthrocultural. These forces often interact in complex ways, and these inter actions are not always simple to interpret.

social and demographic

Shifts in the demographic composition of the population, cultural factors, and lifestyles affect not only the need for health care, but also the means by which those needs will be met. The elderly, vulnerable populations, and people with certain high-cost health conditions all present varied needs.

political

The history of health care in the United States and in other countries is replete with examples of major changes brought about through political will, depending on which party has the legislative majority. These attributes can be observed in a predominantly propagandist media, divisive rhetoric and actions from both private and public entities, high-level political corruption, and a political machinery that pushes forward predominantly a one-sided agenda.

economic

Economic growth, employment, house hold incomes, and the national debt are major forces that will determine the availability of health care services, their cost, and their affordability.

technological

Americans strongly favor ongoing innovation, greater availability, and wider use of new technology. One recent example of this preference is the passage of the 21st Century Cures Act of 2016, which is aimed at advancing medical innovation and ensuring quick access to new treatments.

informational

Information technology (IT ) has numerous applications in health care delivery. IT has also become an indispensable tool for managing today's health care organizations. Ex. smart cards to prevent forgery and identity theft

ecological

New diseases, natural disasters, and bioterrorism have major implications for public health, and potentially even global consequences. Ex. are influenza, coronavirus, West nile virus

global

examples are generic drugs and medical equipment are being manufactured in Asian countries for export to Europe, Canada, and the United States, medical tourism, cross-border telemedicine, universal healthcare as a global trend

anthro-cultural

In a society that is becoming more culturally diverse and politically factious, however, a significantly higher proportion of Americans now say that the federal government has a responsibility to make sure that all Americans have health insurance-63 % held this opinion in 2020

Be familiar with the three options for future health care reform from the section "health reform in transition." Be able to recognize different examples of policies that they discussed in this section.

-Medicare for All: create a single-payer system-a national health care program in which the financing and insurance functions are taken over by the federal government, a system labeled as "socialized medicine"
-Public Option: The American College of Physicians (ACP) has put forward a policy proposal to achieve universal coverage through either a single-payer system or a public-financed coverage option
-Status Quo (do nothing): neither repeal and replacement of the ACA nor Medicare for all is realistic. In between these two extremes lies the reality that a large segment of the population is currently satisfied with their employer based health insurance

Define and recognize examples of "patient activation."

refers to a patient's skills, confidence, ability, and motivation to become actively engaged in his or her own health care. Ex. changing one's diet, engaging in physical activity, and having regular checkups

Be prepared for questions asking about the system-wide implications of challenges for the nursing profession, challenges for primary care physicians, and challenges for geriatric care.

-challenges for the nursing profession: Nurses should practice to the full extent of their education and training; Nurses should obtain higher levels of education and training to adequately address the needs of a patient population with complex needs; Achieving cultural diversity in the nursing workforce remains a challenge; Collaboration will require all members of a team to work together to their full potential on behalf of patients; Effective workforce planning and policy making require better data and improved information systems
-challenges for primary care physicians: Four Pillars for Primary Care Physician Workforce Development --> pipeline, process of medical education, practice transformation, payment reform; Experts point to imbalances in work loads, time allocations, expectations of both organizations and patients, and payments (realign and rebalance demands)
-challenges for geriatric care: Despite the clear need for more geriatric care practitioners, this field has not attracted health care professionals in sufficient numbers. The Geriatrics Academic Career Award Program was created to support the career development of junior faculty in geriatrics at accredited schools in various medical and other health-related disciplines. Second, the Geriatrics Workforce Enhancement Program is designed to educate and train primary care workforce in integrated geriatrics and primary care models.