Health Policy and Law Midterm

piece of legislation for universal right to healthcare- emergency sevices

emtala

Levels to Judical System courts

Court Level	Definition	Main Responsibility
US District Trial courts 94	Courts where cases are first heard. Civil and Criminal	Examine evidence, hear witnesses, and determine facts.
Court of Appeals Appellate courts 12 regions	Courts that review decisions made by lower courts.	Determine whether legal errors occurred during the trial.
Supreme Court	The highest court in the judicial system.	Makes final decisions on significant legal questions and constitutional issues.

5th and 14th Ammendment

Protect fundamental liberties

9th Ammendment

certain right in the Constitution do not mean other rights do not exist

!4th Ammendment

Due process and equal protection

10 Ammendment

reserves powers not delegated to federal government

How third party reimbursement works lock and key

A payment arrangement in which an entity other than the patient or healthcare provider pays some or all of the cost of healthcare services.

Who are the three parties?

1. Patient: Receives healthcare.

2. Provider: Delivers healthcare.

3. Third-party payer: Pays for some or all of the services.

Examples of third-party payers include private insurance companies, Medicare, and Medicaid.

Copayments

A fixed amount a patient pays for a covered healthcare service.

$25 per office visit.

Deductibles

The amount a patient must pay for covered healthcare services before their insurance begins paying its share for services subject to the deductible.

First $1,000 of applicable expenses.

coinsurance

The percentage of covered healthcare costs that a patient pays after meeting the applicable deductible.

20% of a covered bill.

Typical Amount for Copayment

$15-30

core public health functions

assessment, policy development, and assurance

These functions help public health organizations identify health problems, develop solutions, and evaluate whether those solutions work.

Policy development

has to fix that problem

Assurance

is that our policy is doing what it's intended to do.

Assessment

Tells us what is the problem?

The Three Core Functions of Public Health Example

1. Assessment

Public health officials discover that many people in a community are being injured in car accidents because they are not wearing seatbelts.

2. Policy Development

Lawmakers develop or strengthen seatbelt laws to reduce injuries and deaths.

3. Assurance

Public health officials evaluate seatbelt use and crash-related injuries to determine whether seatbelt policies are effective.

Constitution

An enforceable written body of law

ex. US Constitution

Statute

Formal written laws enacted by a legislative body

ex. State healthcare licensing law

Regulation

Rules, orders, or administrative laws created by executive or administrative agencies under authority granted by legislation.

ex. Rules governing hospital safety

Key Barriers to access of healthcare

Barrier	Definition
Financial	Inability to afford healthcare costs.
Geographic	Healthcare services are too far away.
Transportation	Difficulty traveling to healthcare appointments.
Insurance	Lack of insurance or inadequate coverage.
Provider availability	Too few healthcare professionals or facilities.
Cultural	Differences in cultural beliefs or healthcare practices may create obstacles.
Language	Difficulty communicating with healthcare professionals.
Health literacy	Difficulty understanding health information or navigating the healthcare system.
Disability and accessibility	Physical, sensory, or communication barriers.
Discrimination	Unfair treatment that limits access to appropriate care.
Time and work obligations	Scheduling conflicts or inability to take time off.

Three system of insurance

Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Exclusive Provider Organizations (EPOs)

how are these funded versus how are they delivered

They can either be funded privateately or funded publicly. They' either be delivered privately or delivered publicly.

The three different cultural systems are in Germany, Canada, and Great Britain.

1. Canada (National Health Insurance / Single-Payer Model)

• How it is funded: Financed primarily through provincial and national general tax revenues.

• How insurance works: The provincial government acts as the single public payer for core medical and hospital care. Patients show a provincial health card and are not billed for covered services.

2. Germany (Social Health Insurance )

• How it is funded: Financed via income-based contributions split jointly between employees and employers into non-profit sickness funds.

• How insurance works: Over 90 competing non-profit sickness funds provide statutory core benefits. High earners can choose to opt out into private health insurance.

3. Great Britain (National Health Service)

• How it is funded: Financed directly through national general taxation.

• How insurance works: There is no traditional commercial health insurance system; the state directly organizes and covers medical care. Care at the point of service is free

Police powers

The authority of state governments to enact and enforce laws to protect public health, safety, welfare, and morals, subject to constitutional limits.

Public Health Agencies

Government organizations responsible for protecting and improving the health of populations.

Examples include:

• State health departments.

• Local health departments.

• The Centers for Disease Control and Prevention (CDC).

Social Determinants of Health

Conditions in the environments where people are born, live, learn, work, play, worship, and age that influence health outcomes.

Examples:

• Education.

• Income.

• Housing.

• Employment.

• Social support.

• Access to healthcare.

• Neighborhood safety.

Hurley v. Eddingfield

A physician refused to treat a patient who later died. The case addressed whether the physician could be held liable for refusing to provide treatment when there was no established physician-patient relationship or other legal obligation requiring the physician to treat the patient.

-no-duty-to-treat principle.

Dobbs v. Jackson

• In 2018, Mississippi enacted the Gestational Age Act, which prohibited abortions after 15 weeks of pregnancy except in cases of medical emergency or severe fetal abnormality. Jackson Women’s Health Organization sued state health officer Thomas Dobbs, arguing that pre-viability abortion bans violated established constitutional precedent; the ruling concluded that the U.S. Constitution does not grant a right to an abortion.

-The ruling removed federal constitutional protections for abortion and returned the authority to regulate or prohibit abortion back to individual state legislatures and the people

Buck v. Bell

The case concerned a Virginia law authorizing the involuntary sterilization of certain people classified by the state as having intellectual disabilities.

-use of law to justify eugenics and violations of individual bodily autonomy.

King v. Burwell

The Affordable Care Act created health insurance marketplaces and provided financial assistance to eligible individuals purchasing insurance. The dispute concerned whether subsidies were available to qualifying people purchasing coverage through federally operated marketplaces, rather than only through marketplaces established by individual states.

-concerns the interpretation of the Affordable Care Act and the availability of health insurance subsidies.

Die with Dignity

End-of-life decisions and medical aid in dying. Death with Dignity Acts are laws in certain jurisdictions that permit eligible, terminally ill adults to request medical aid in dying under specified legal safeguards.

-Death with Dignity laws raise questions about patient autonomy, end-of-life care, medical ethics, and legal safeguards.

Health Disparities

Differences in health outcomes or health status between populations.

These differences may be associated with factors such as income, geographic location, race or ethnicity, disability, or access to healthcare.

What percent of Americans receive employee-sponsored insurance?

55%

Difference between utility and scarcity

utility is how much you are willing to give up

Garrett enjoys Swiss cake rolls and gets high satisfaction from eating one. Therefore, the professor has high utility for Swiss cake rolls.

scarcity available resources are limited relative to people's wants and needs.

In healthcare, scarcity can involve: Limited hospital beds

Difference between price and value

price:monetary amount a buyer must pay to obtain the product.

value: The worth or importance of a good or service to an individual or society.

Example of Economic Priciples

• Utility: Your professor really enjoys Swiss cake rolls.

• Price: The store charges $6.69 per box.

• Value: The professor may believe the enjoyment is worth $6.69.

• Scarcity: Limited availability could affect the market price, depending on demand and other market conditions.

Single Seller controls the market

Monopoly

Entitlement Program and Block Grant Difference

In an entitlement program, if you are eligible, you get the benefits. Medicare

A block grant program is when the money runs out, and no one gets it anymore. Pell Grant

How many states account for 1/3 of medicaid spending?

5

Determinants of health

Individual characteristics and behaviors, environments, Economic, Biological and genetic, social, Healthcare-related