Health Systems and Policy: US, Puerto Rico, and Global Typologies Flashcards

Vocabulary practice flashcards covering health policy concepts, historical milestones, and comparative healthcare delivery frameworks in the United States, Puerto Rico, and globally.

Flexner Report (1910)

A landmark report that exposed weak private for-profit medical schools in the U.S., closing nearly half of them and standardizing medical education around university-based science.

Marine Hospital Service (1798)

Created when Congress taxed sailors' wages to fund port hospitals, establishing the first federal healthcare role and serving as the precursor to the U.S. Public Health Service.

Hill-Burton Act (1946)

Public Law 79-725, which provided federal construction grants to expand community hospitals across the U.S. and Puerto Rico with a mandate to serve the public.

Shattuck Report (1850)

A Massachusetts report on urban sanitation that initiated early public health mortality declines before modern clinical medicine had effective treatments.

Baylor Plan (1929)

A prepaid hospital care plan created for Dallas schoolteachers, establishing the prototype for Blue Cross.

Medicare (Title XVIII)

A uniform national social insurance program enacted in 1965 providing health coverage for individuals aged 65 and older, later expanded to cover people with disabilities and ESRD.

Medicaid (Title XIX)

A joint federal-state means-tested health coverage program enacted in 1965 for low-income groups, administered and varied by state.

Diagnosis-Related Groups (DRGs)

A prospective payment system adopted by Medicare in 1983 that reimburses hospitals per case rather than per day to control healthcare costs.

Resource-Based Relative Value Scale (RBRVS)

A payment system implemented by Medicare in 1992 that restructured physician reimbursement based on resource-based relative value units.

Affordable Care Act (ACA)

A 2010 health reform that expanded Medicaid eligibility up to $138\text{\%}$ of FPL, established subsidized Marketplaces, and prohibited coverage denials for pre-existing conditions.

One Big Beautiful Bill Act (P.L. 119-21)

A July 4, 2025 federal law projecting approximately $\\text{\$}1\text{ trillion}$ in healthcare spending cuts over a decade while adding work requirements to Medicaid.

Path Dependency

The policy concept wherein early structural choices—such as employer-sponsored insurance and state-managed Medicaid—restrict and shape all future healthcare reform options.

Hospital de la Concepción el Grande

Founded in San Germán in 1524 under royal patronage, it is one of the oldest hospital institutions in the Americas.

Antianemia Commission (1899)

A commission led by Major Bailey K. Ashford that identified uncinariasis ($Necator\,americanus$) as the main cause of severe anemia among rural Puerto Ricans.

School of Tropical Medicine of Puerto Rico

An institution opened in 1926 in affiliation with Columbia University, serving as the historical nucleus of the UPR Medical Sciences Campus.

Arbona Plan (1956–1976)

A health regionalization system designed by Dr. Guillermo Arbona that organized Puerto Rico into 5 to 7 health regions with four structured levels of care: CDT, district hospital, regional hospital, and Centro Médico.

Act 72 of 1993 (La Reforma)

Puerto Rico legislation under Governor Pedro Rosselló that shifted the government from a direct provider of healthcare to a health insurance buyer by privatizing public hospitals and contracting regional MCOs.

PROMESA (P.L. 114-187)

A 2016 federal law establishing the Financial Oversight and Management Board (JSF) to oversee Puerto Rico's public budgets and fiscal plans.

Plan Vital

Puerto Rico's current Medicaid managed care program (formerly Mi Salud), managed by the Health Insurance Administration (ASES) through regional MCO contracts.

FY 2027 Medicaid Funding Cliff

The expiration of Puerto Rico's statutory $76\text{\%}$ federal Medicaid match rate (FMAP), which will drop to $55\text{\%}$ without Congressional intervention, creating an estimated \\text{\}2\text{ to }\text{\}3\text{ billion} annual budget deficit.

Act 14 of 2017 (Puerto Rico)

A statutory $4\text{\%}$ income tax incentive aimed at retaining physicians in Puerto Rico, which cost $\\text{\$}237.5\text{ million}$ in 2021 but failed to prevent workforce loss.

Three Dimensions of Health Systems

The structural classification framework consisting of Regulation (who sets access and price rules), Financing (how funds are collected), and Provision (who owns facilities and employs staff).

Beveridge Model

A national health system model financed through general taxation where the government acts as single payer and owns most facilities, offering free care at the point of service (e.g., UK NHS).

Bismarck Model

A social health insurance model financed through joint employee-employer contributions to non-profit sickness funds with private service provision and strict price regulation (e.g., Germany).

National Health Insurance (NHI) Model

A hybrid model that uses single-payer government financing alongside private healthcare providers (e.g., Canada, Taiwan).

Out-of-Pocket Model

A system typical of low-income areas where healthcare is purchased individually at the point of delivery without financial risk pooling.

Socialized Health Insurance (SHI)

A classification where government regulates non-profit private insurers financed by payroll taxes to reimburse private providers.

Mirror, Mirror 2024

A comparative analysis by the Commonwealth Fund of 10 high-income health systems across 70 indicators, ranking Australia 1st and the U.S. 10th overall.

EBAIS (Costa Rica)

Comprehensive Primary Healthcare Teams ($Equipos\,B\acute{a}sicos\,de\,Atenci\acute{o}n\,Integral\,en\,Salud$) that assign every resident to a local care team, serving as the key driver of Costa Rica's high efficiency.

Healthcare Segmentation (Latin America)

A structural pattern dividing healthcare access into social security for formal workers, ministry programs for the poor, and private systems for the wealthy.