Policies Midterm Flashcards

Health Disparity

Differences in health status between a group and a comparison group.

Health Inequalities

Measurable differences in health status, outcomes, or access to healthcare between different population groups that can be avoidable.

Medicare

Healthcare program that provides coverage for individuals aged 65 and over.

Medicaid

Healthcare program designed to provide coverage for low-income individuals.

What is Federalism?

A system of government where power and responsibility are shared between a centralized federal government and decentralized state governments.

Agenda Setting

The process by which specific public problems earn the attention of the media, public, and government officials.

What is Pluralistic Politics?

A political system in which multiple diverse groups compete to influence government decisions and public policies.

Bismark Model

Healthcare system model that provides universal coverage, financed through employee/employer contributions and regulated by the government. Used in Germany

Beveridge Model

Healthcare system model that offers universal coverage financed through taxation and includes both public and private providers. Used in the UK

National Health Insurance Model

Universal coverage system funded through taxation with public management and private providers, used in countries like Canada.

Out of Pocket Mixed Model

Healthcare system where not everyone is covered, using a mix of group insurance, individual insurance, and out-of-pocket payments.

Filibuster

A technique used in the Senate to delay voting on a bill by holding the floor indefinitely.

Cloture

A procedure used to end a filibuster and bring a bill to a vote.

The Flexner Report

A 1910 report that examined medical education in the U.S. and led to reforms in medical training.

ALICE

Asset Limited, Income Constrained, Employed - individuals working but earning below the cost of living.

G7

Group of seven advanced nations discussing global economic stability and security, members include Canada, France, Germany, Italy, Japan, the UK, and the US.

G20

Group of the largest economies that includes all G7 nations and emerging economies, representing 85% of global output.

Big Pharma

Term used to refer to big pharmaceutical companies, often criticized for high drug prices.

Health Care Equity

Fair access, treatment quality, and resources within the healthcare system.

Public Policy Actors

Individuals or groups that influence public policy, including official actors (like lawmakers) and unofficial actors (like citizens and advocacy groups).

What is the ACA?

Affordable Care Act, (Obama Care) is a comprehensive healthcare reform law enacted in 2010 aimed at increasing health insurance coverage, reducing healthcare costs, and improving healthcare quality.

What is HR1? and what does it do?

Lowers taxes, reduces government spending, encourages work, and address what they describe as waste in programs.

Public-health concern: fewer people are projected to have Medicaid coverage, and more people are projected to be uninsured

What is DOGE?

Department Of Government Efficiency 

Established in 2025 to pursue changes aimed at reducing federal spending, improving government efficiency, and restructuring federal operations. ended on July 4, 2026

What is Social Security?

A federal program that provides retirement, disability, and survivor benefits to eligible individuals, funded through payroll taxes.

Who pays for Medicare?

The federal government, workers, employers, and the beneficiaries themselves

Part A: payroll taxes. Part B: taxes + premiums

What is OSHA?

Occupational Safety and Health Administration

A federal agency that sets and enforces workplace safety standards to protect workers from injuries, illnesses, and hazards.

NFIB vs. Sebelius (2012)?

ACA stays, Medicaid expansion becomes optional.

Supreme Court case that upheld the ACA's individual mandate as a tax but made Medicaid expansion optional for states.

What is Policy Imagery?

Refers to the core shorthand way a public policy issue is understood, discussed, and framed by the public and decision-makers.

Positive Framing: Associating a topic with progress, safety, or economic growth.

Negative Framing: Associating a topic with environmental damage, government overreach, or societal risk

Sebelius/ Burwell vs Hobby Lobby (the craft store)

Birth-control coverage + religious objections

Certain closely held for-profit corporations could claim religious protection under RFRA and object to covering some contraceptives.

King vs. Burwell 

A 2015 Supreme Court case that upheld the ACA's premium tax credits for people buying insurance through both state and federal marketplaces.

ACA subsidies + federal marketplace = YES.

California vs. Texas

A challenge to the ACA after the 2017 Tax Cuts and Jobs Act reduced the individual-mandate penalty to $0. The Supreme Court kept the ACA in place because the challengers lacked standing.

Braidwood Management Inc, vs. Becerra

The landmark case that challenged the Affordable Care Act's (ACA) free preventive care mandate, but the Supreme Court ultimately saved the mandate.

What was medical care like in preindustrial America?

Unsafe, poor sanitation, and little regulation

What was missing from preindustrial medical care?

Regulation of who could practice and how.

Why did medical schools begin developing?

To formally train physicians and create a medical profession.

What happened to laypeople's role in medicine?

Medicine became more professionalized and less layperson-driven.

What changed during Industrial America?

Medicine became more scientific and technology-driven.

What did the AMA help accomplish?

Organized physicians and protected physicians' professional interests.

What changed medical education in the late 1800s?

Medical training became more rigorous and science-based.

What year was Medicare & Medicaid established?

1965

What happened to mental health care in the 1960s?

Deinstitutionalization shifted care toward communities.

What problem can deinstitutionalization create?

Community systems may lack resources to meet people's needs.

What was workers' compensation originally designed to provide?

Cash payments for wages lost from job-related injury or disease.

What was the 1929 Baylor hospital plan?

A hospital insurance plan that became a model for Blue Cross.

Who was often left out of the health insurance market?

Elderly, disabled, unemployed, self-employed, women, and children.

What was Kerr-Mills?

A 1960 program providing medical assistance to certain low-income elderly.

How does the U.S Pay for wars?

As of WW2 it has been taxing and borrowing money which increases government debt. 

Why do people hate Big Pharma?

People often connect pharmaceutical companies with high drug prices + profits, while hospitals are more associated with actually treating and saving people.

Health inequity vs Healthcare inequity?

Health= overall outcomes. Healthcare= access, treatment, and medical resources

What are the three branches of government?

Legislative creates laws

Executive executes laws

Judicial interprets laws

What is the formal agenda?

Issues a government body has officially agreed to review or schedule

What is the decision agenda?

the narrow list of issues ready for an immediate vote or official action.

What is the issue-attention cycle?

a pattern in which public attention to an issue rises, declines, and eventually fades.

What is U.S healthcare system model?

A mix system using Medicare, Medicaid, private insurance, employer coverage, and out-of-pocket payments.

What is cost shifting?

When a healthcare provider charges one group more to make up for lower payments from another group.

What is moral hazard?

insurance coverage can make people more likely to use healthcare because they pay less directly.

What is an ACO?

Accountable Care Organization

Providers sharing responsibility and financial accountability for coordinated, quality care.

What is third- party payment?

a separate payer, such as an insurer, pays the provider for healthcare

What is Reimbursement rate?

the amount an MCO (insurance) pays a healthcare provider

What is Capitation?

A provider receives a fixed payment per enrolled patient for a set period.

What is fee-for-service?

A provider is paid separately for each service delivered.

What are political determinants of health?

Structures, relationships, resources, and power shaping policies that create social conditions.

What is quality of care?

The degree to which services increase the likelihood of desired health outcomes.

What is HMO?

Health Maintenance Organization

A managed-care plan with a smaller network, gatekeeping, and more provider control

What is PPO?

Preferred Provider Organization

A network plan allowing out-of-network care, with less provider control and no gatekeeping

Main HMO vs PPO difference?

HMO= tighter network and gatekeeping. PPO= more choice and out-of-network access

What is the Triple Aim?

Improve patient experience, improve population health, and reduce per-capita costs.

Why might an MCO choose an HMO?

greater control over care and cost can increase financial efficiency

What is concurrent utilization review?

Reviewing medical necessity before services are provided

What is retrospective utilization review?

Reviewing care after it has been provided

What is HIT?

Health Information Technology.

Technology used to electronically capture, store, manage, retrieve, and share health data.

What is Scope of Practice?

The legally defined activities a healthcare professional is allowed to preform

What is maldistribution?

An uneven distribution of healthcare providers across populations or locations

What is a deductible?

The specific dollar amount you must pay out of pocket for your medical care before your insurance company begins to pay its share.

What is a Premium?

The regular monthly payment you make to an insurance company to keep your health insurance plan active.

Why is it risky about having a high deductible?

A high deductible can be risky because you have to pay more out of your own pocket before your insurance starts paying for many covered services.

What is underinsured?

Having active health insurance, but with deductibles or out-of-pocket costs that are too high relative to income.

What is HDHP?

High Deductible Health Plan

A type of health insurance plan that features lower monthly premiums (the amount you pay to have insurance) but higher deductibles (the amount you must pay out-of-pocket for medical care before your insurance kicks in).

What is EHB connected with the ACA?

Essential Health Benefits.

These are a mandatory set of 10 broad categories of medical services that all health insurance plans sold in the individual and small-group markets must cover. Before the ACA was passed, insurance companies could sell "bare-bones" plans that completely excluded basic treatments like prescription drugs or maternity care. The EHB rule was created to ensure that all standard health insurance provides comprehensive coverage

What is reference pricing?

A payment model where an insurer sets a maximum coverage limit for a specific medical service..

Patient Impact: If you choose a provider who charges more than the reference price, you must pay the extra difference out-of-pocket.

Goal: Encourages patients to choose lower-cost providers and pressures hospitals to lower their fees.

What is bundled or episodic payments?

A single, flat-rate payment that covers all the medical services a patient receives for a specific medical condition or a single "episode of care."

What is pay for performance (P4P)?

A healthcare payment model that gives financial bonuses or penalties to doctors and hospitals based on how well they care for patients.

What are Global Budgets?

A fixed, total amount of money set in advance to cover all healthcare spending for a specific population or hospital over a set period (usually one year).

Goal: Caps healthcare spending and discourages unnecessary procedures.

Incentive: Rewards hospitals for keeping patients healthy and focusing on preventative care rather than volume.

What is Resourced-based relative value scale (RBRVS)

A payment system used by Medicare that assigns relative values to healthcare services based on the resources needed to provide them, which helps determine how much providers are paid.

What is NIH peer-reviewed process?

Experts review grant proposals, identify strengths/weaknesses, and assign preliminary scores.

What was the ACA’s primary focus?

Expanding health insurance coverage toward near universal levels

Who pays for Medicaid?

The federal government and state governments

Capitation is a healthcare payment model designed to….

shift the focus away from the volume of services and toward the value and efficiency of care

What is Consolidation?

The process of combining multiple separate entities, items, or financial accounts into a single, unified whole.

How does a bill become a law?

After it is introduced by a lawmaker, approved by committees and voted on by both the House of Representatives and the Senate, and finally signed by the President.

Obligations vs Outlays

Obligations represent a legal commitment to spend money, while outlays are the actual spending or payout of that cash.

How does cost sharing affect use of health services compared to free care?

Significantly reduces the use of healthcare services across the board compared to completely free care

How does cost sharing affect appropriateness and quality of care received?

Cost sharing drastically alters consumer behavior. It is a blunt instrument that reduces the volume of care without improving the appropriateness or technical quality of the care received.

What are the consequences of cost sharing?

Reduces overall healthcare spending but simultaneously reduces the use of both necessary and unnecessary medical care

What is RAND (Research and Development) ?

An American global non-profit research organization that develops data-driven solutions and policy analysis to help improve public policy and decision-making.

Why does RAND (Research and Development) matter in healthcare?

Reveals hospital price transparency studies. The organization provides objective analysis and independent data that policymakers use to draft laws and evaluate delivery models

What is Cost Sharing?

The portion of healthcare costs that a patient must pay out of pocket under their health insurance plan such as deductibles, copays, and coinsurance

What are the 4 main types of cost sharing?

Deductible, Copayment, Coinsurance, & Out-of-Pocket Maximum