Foundations of Healthcare Systems Exam #2

Perfect Market

A theoretical market where many buyers and sellers exist, products are interchangeable, and there is transparency with easy entry.

Healthcare Market Reality

A market that is highly regulated with asymmetrical information, where patients often lack knowledge about their best options and insurance coverage influences pricing.

Waste in Healthcare

Resources spent in healthcare that do not lead to improved quality of care, including failures in care delivery, coordination, overtreatment, administrative complexity, and pricing failures.

Policy Window

A moment when the problem (crisis), solution (policy), and political will converge, allowing for policy action.

Interest Groups

Organizations that seek to influence policy and political outcomes, competing for resources and power within the healthcare system.

The Three-Legged Stool (Gruber Model)

The framework of the Affordable Care Act consisting of mandates, marketplace subsidies, and insurance reforms, essential for the system's stability.

Medicaid Expansion

A key provision of the ACA that increased coverage eligibility to nearly all individuals under 138% of the federal poverty level, although some states opted out.

Marketplace Subsidies

Financial assistance provided to individuals to help lower the cost of purchasing health insurance through the ACA marketplaces.

Insurance Reforms in ACA

Changes that prevent discrimination based on pre-existing conditions, eliminate lifetime/annual caps, and require essential health benefits.

Trump Era Healthcare Politics

An attempt to repeal parts of the ACA while maintaining popular provisions like protections for pre-existing conditions.

Biden Era Healthcare Politics

Initiatives that expanded access and subsidies under the ACA, including the American Rescue Plan and the Inflation Reduction Act.