HSAD Quiz 1

Great Depression

many people could not afford healthcare, causing hospitals + physicians to lose income

Baylor University Hospital

started early hospital insurance plans

1937

there were 26 plans covering over 600k members, and the American Hospital Association (AHA) began approving plans

After WWII

the federal government encouraged employer-sponsored private insurance through favorable wage-control and tax treatment

1965

medicare and medicaid were established

Blue Cross

grew because hospitals needed a reliable way to receive payments when patients are poor

Iron Triangle

quality, cost, access = hard to balance

Hard to balance

improving access can increase costs and reducing costs can affect access/quality

NIH

supports medical research

SSA

federal aid for public health and welfare

Health Professions Educational Assistance Act

funding for healthcare professional schools

Medicare and Medicaid

expanded government healthcare financing

Regional Medical Programs

addressed heart disease, cancer, and stroke

Comprehensive Health Planning Act

coordinated regional healthcare planning

HMO act

supported development of HMOs

Balanced Budget Act

focused on reducing healthcare costs

HMO

• health maintenance org

• prepaid, fixed-fee model

• intended to control healthcare costs

• emphasizes promoting health

PPO

• preferred provider org

• organized provider networks

• serves private insurers and self-insured firms

• became a dominant insurance arrangement

• covered 52% of covered employees in 2022

Fee-for-service

providers receive payment for services delivered

Diagnosis-related groups (DRGS)

hospitals receive a predetermined payment based on a patient’s diagnosis

• introduced through medicare’s prospective payment system

• hospitals face financial risk when costs exceed DRG payment limits

• intended to encourage cost control

Resource-based relative value scales

designed to make physician payments more equitable across services, specialties, and locations

American Medical Association (AMA)

represents physician interests; historically opposed government-provided insurance

Insurance companies

influence premiums, policies, and healthcare reform

Pharmaceutical industry

lobbies on drug pricing and prescription drug coverage

Business and labor

influence employee healthcare benefits and workplace safety

Consumers

advocate for patient interests and healthcare access

Affordable Care Act (ACA)

• providing new consumer protections

• improving quality and lowering costs

• increasing access to affordable care

• holding insurance companies accountable

Federalism

a system in which power is divided between the federal government and state governments

Federal government in healthcare

medicare coverage, subsidized insurance, national healthcare policy

State and local government in healthcare

medicaid options, professional licensing, emergency planning

Healthcare institutions

health info tech, charitable care, organizational improvements

Healthcare decisions

not made by the federal gov alone. diff levels of gov and healthcare orgs share responsibilities

Health policy

government actions intended to address a public health issue, problem, or concern

• can take the form of laws, regulations, codes, decisions, and actions

Three parts of policymaking

1. Problem — what needs to be fixed?

2. Stakeholders — who is affected/influential?

3. Policy — what action is decided?

*politics also influences the process, and policies can change over time

Three categories of public policy

• Social policy

• Economic policy

• Foreign policy

How a policy becomes law STEP 1

Identify a problem

How a policy becomes law STEP 2

Draft the policy

How a policy becomes law STEP 3

Legislative vote

How a policy becomes law STEP 4

Implement the policy

How a policy becomes law STEP 5

Evaluate effectiveness

Regulatory development and enforcement

creating and enforcing rules

health resource allocation

distributing money, staff, and resources

information production and dissemination

collecting and sharing health info

policy advocacy and agenda setting

promoting issues that need government attention

HRSA

support for healthcare access and services

SAMHSA

mental health and substance use services

IHS

healthcare for eligible american indian and alaska native populations

ATSDR

health risks associated with hazardous substances

AHRQ

healthcare quality and safety research

systems thinking

understanding how different parts of healthcare and governmentns are connected and influence one another

national healthcare expenditures

total amount spent on healthcare in the US

• funded by both public and private sources

  • healthcare financing affects cost, quality, and access

  • healthcare spending that grows faster than GDP is considered unsustainable

GDP — gross domestic product

total monetary value of goods and services produced within a country over a certain period

insurance

protects individuals and organizations against the risk of significant finanical loss

risk pooling

combining individual risks across a group

moral hazard

when having insurance encourages greater use of healthcare because the individual is protected from some of the costs

copayment

fixed amount you pay for a service

coinsurance

% of a serivce’s cost you pay

HMO (managed care plans)

combines insurance and healthcare delivery

PPO

uses a network of preferred providers, with out-of-network flexibility

POS

hybrid of HMO and PPO

HDHP

lower monthly premiums but higher deductibles

capitation

fixed prepaid amount for healthcare services

withholds

part of provider payment is retained under a risk-sharing arrangement

managed car backlash

opposition to restrictive provider choices and referral policies during 1990s

medicare

• for older people and certain younger individuals

• federal program

• includes parts a,b,c,d

medicaid

• serves broke people

• joint federal-state program

• states administer programs under fed guidelines

• fed and stat governments share funding

medigap

supplemental private insurance that helps cover out-of-pocket costs under original medicare

FMAP

determines federal matching funds for state medicaid spending