PUBH 400 Quiz 2

National healthcare reform (ACA)- what were the affordable care act changes

***Government Shutdown: Republican proposed budget will cut Medicaid by $1 TRILLION → 338 hospitals at risk of closing. ACA premiums have skyrocked (2x) → millions will lose health insurance coverage** 

• AFFORDABLE CARE ACT changes: increased eligibility to Medicaid

  • Adults with incomes up to 133% of poverty are eligible 

  • All children 6-19 ages at 133% of poverty level MUST be covered 

  • States have option to cover legal immigrant pregnant women/children who have been in country for less than 5 years 

Medicaid

• federal-state public health insurance for low income (pregnant women/children/disabled/elderly)

  • Federal: outlines mandatory and optional populations and benefits covered 

  • State Medicaid Agencies: run programs & select with populations and benefits to cover 

    • All States participate in Medicaid… eligibility just differs by income threshold 

    • States may apply to fed. gov. for waivers of Medicaid requirements 

what are the 5 requirements for eligibility to be determined for medicaid

• Categorical 

• Income Level 

• Resources

• Residency 

• Immigration Status (immigrants have 5 year bar) 

t or f: Medicaid reimbursement is much HIGHER than private or Medicare (varies across states/provider type) 

false- Medicaid reimbursement is much LOWER than private or Medicare (varies across states/provider type) 

CHIP (Children’s Health Insurance Plan)- structure, eligbility, benefits?

• provides health insurance to low-income children whose family income is above Medicaid eligibility level in their state 

  • All states participate (states receive payments in 2 year allotments) 

  • 3 structures used by states: separate CHIP program, CHIP incorporation into Medicaid, hybrid option where some children are in separate CHIP while other CHIP children are in Medicaid 

  • States may apply to fed. Gov. for waivers of CHIP requirements

  • Eligibility: children up to 300% of Federal Poverty Level 

  • Benefits: X-rays, inpatient/outpatient care (may include mental health, vision, hearing, prescription drugs). 

Medicare- definition, what are the parts, requirements, and other things to note?

federal health insurance for elderly and disabled

• Part A: hospital insurance (inpatient, hospice) 

• Part B: supplemental (physician services, outpatient) 

• Part C: managed care 

• Part D: prescription drug coverage 
  

• No state administration → national rules for all states

• Elderly requirements: 65 y/o, eligible for social security (worked/contributed to social security for 10 yrs)

• Disable requirements: permanently disabled or has end stage renal disease 

no-duty-treat-principle

individuals have no legal right to health services/insurance in US

• US is only high income nation that doesn’t include healthcare as a fundamental right 

how are healthcare rights recognized in 3 ways

• 1. Rights related to receiving services EXPLICITLY provided under healthcare, health financing or health insurance laws 

  • Ex: Medicaid or Affordable Care Act 

• 2. freedom of choice + freedom from gov interference when making health decisions 

  • Ex: right to refuse treatment 

• 3. Right to be free from discrimination when receiving health care. 

Patient centered care definition by Institute of Medicine

providing care that is respectful/responsive to individual patient preference/needs/values

8 principles of patient centered care

• fast access to health advice

• effective treatment

• continuity of care

• support for caretakers

• clear information

• respect for preferences

• emotional support

• attention to physical/environmental needs 

what do we need to consider when looking at individual rights in public health and social contracts 

consider legal trade offs b/w private/industrial rights and public health/welfare 

police powers

represent gov. Authority to require conformance to standards of conduct which are designed to promote public health/safety

ex. Consider recent calls to improve police accountability → how can we purge existing personnel yet still have experienced personnel?? How do we maintain external oversight??

negative constitution

The Constitution empowers gov. to act in name of public health but doesn’t REQUIRE it to do so; constitution doesn’t require gov. to provide any services even in case of public health (derived from the fact that constitution is phrased in negative terms)

constitution can be looked at as what type of contrac

social contract; agreement among society members to cooperate for social benefits

why is a social contract or a constiution important 

• Civil gov is needed to protect individual rights

• Individuals need to consent to be governed but need to abide by decisions made by majority 

• Any gov that infringes on the Power of The People has broken social compact 

• Thoman Jefferson believed constitution should have been revised every 19 years  (“earth belongs to the living and not to the dead”, “no society can make a perpetual law”) 

medical errors

failure to complete intended medical course of action, implementation of wrong course of action, use of fuauty equipment/products → more people die each year from medicare errors THAN from road accidents, breast cancer or AIDS

how have policymakers shifted attention from medical error reforms

• Policymakers have shifted attention from medical error reforms that are less reactive to being centered on error prevention and patient safety. 

  • Objective 1: redesign healthcare delivery methods/structures to limit human error

  • Objective 2: prepare inevitable errors that occur in healthcare delivery regardless of amount/type precautions taken 

care should be

• Safe 

• Effective (evidence-based) 

• Patient centered

• Timely (reduce wait times) 

• Efficient (reduce waste of resources) 

• Equitable (not differ based on race/sex/loc) 

• Integrated 

how to improve quality of care

• Move towards Universal access

• Up regulation on medical products 

• Patient centered care 

• Strengthen health information systems 

professional standard of care

• legal standard used in medical negligence cases to determine wether doctors have adequately discharged their responsibility to provide reasonable care to patients. 

note: A doctors actions are measured OBJECTIVELY against those of a reasonably competent doctor under similar circumstances… NOT against actions of doctors who practice within the defendant’s locality 

• Patient trying to charge provider for medical negligence must demonstrate:  

• Appropriate standard of care

• Bread of that standard by the defendant 

• Measurable damages

• Causal link between defendant’s breach and patient’s injury

vicarious liability

• 1 party can be held legally accountable for actions of another party based solely on type of relationship between the parties

are employers liable for impromper actions of independent contractors?

no but there is an exception in the courts → exception is: actual agency and apparent agency → more concerned w scope of relationship than formal characterization of relationship as determined by the parties 

corporate liability

• holds entities accountable for “institutional” acts/omissions when their negligence causes an injury 

  • Ex: failure to screen out incompetent providers, failure to maintain high-quality practices, failure to take action against clinicians who fall below acceptable standards, failure to maintain proper equipment/supplies 

economic decision making

•  Economists assume ppl are rational (nvr purposefully choose to make themselves worse off) 

resource scarcity

• decisions regarding production, distribution, consumption of health care resources (i.e. goods, personnel & healthcare capital inputs)

demand

• Amount of goods/services consumer is able to buy over specified time

common demand shifters examples

• price of original good, substitute good or complimentary good. Quality. Income 

demand elasticity

• % change in quantity demanded resulting from 1% change in price/income (ex: does 1% decrease in price of product result in demand increase)

elastic product

• change in price/income results in equal/greater change in demand (ex: preventative care price)

inelastic product

• damage for good is NOT sensitive to change in price/income (ex: life-saving treatment/meds)

supply

• Amount of goods/services producers are able/willing to sell at given price over specified time

• Suppliers driven to MAXIMIZE PROFIT

  • Equilibrium = balance between quantity supplied vs quantity demanded

supply elasticity 

• relationship between the quantity of good supplied and price of goods (similar to demand elasticity). Percentage change in quantity supplied resulting from a 1% increase in the price (or other variables, such as inputs) of buying the good/service

  • Mostly positive because producers have an incentive to increase output as the price they will receive for the goods rises

  • If Supply elasticity refers to variables other than the price of the good (like wages/raw materials) then it will be negative because the quantity supplied will fall since prices of labor or other inputs rise

health insurance & supply 

Wether or not a patient has health insurance impacts a provider’s willngness to treat.

supplier induced demand

•  providers create a demand beyond amount consumer would have chosen 

monopolies (a type of market structure)

• single seller controls market

oligopolies (type of market structure)

• ew dominant firm control market (ex: health insurance) 

  • Health insurance is dominated by a few large companies and is seen as an oligopoly...the sellers have enough market power to set prices and the market does not allocate resources efficiently

if the market structure is perfectly competitive, what are the 3 parties involved in health care transaction with an insured patient

consumer (patient), supplier (provider), insurers (third party) → presence of third party (insurers) changes consumer and supplier analysis of costs and benefits of each transaction

advocacy

• a strategy to influence policy-makers to make a policy changesupporting or recommending a cause or a course of action; the process of building support for an issue/ cause and infleuencing others to take actino

• can include a “change in command” to achieved desired outcome

• requires: problem solving, communication, influence, COLLABORATION

steps for organization or institutional advocacy

• Find out who makes the policies, procedures and budget decisions, and when these are made

• • Break down large issues into solvable pieces and propose concrete, constructive solutions

• • Prepare to counter negative responses

• • Use tactics that are least likely to create conflict

• • Work through established channels and procedures where possible

• • Advocate for financial resources to support policy changes

• • Monitor implementation and make modifications as needed

how do actually create change- selecting your approach 

• build support for policy change (policy awreness campaign- includes media advocacy)

• capacity building (community development)

• engage stakeholders (policymaker/stakeholder education)

• model legislation, regulation, practices

when do you use media advocacy and how do you develop it

use when:

When increasing public understanding of specific health issues

When reframing public health concerns as the result of community rather than individual causes or problems

When high visibility is desired and debate or discussion is useful

• How do you develop a media advocacy campaign?

Identify your goals, objectives and main audience

Develop and tailor messages to your specific audience with input from community members and partners

Invite media representatives to become involved in the process – if appropriate

Consider the most appropriate media outlets

Identify the problem and offer strategies to address it

Continue media efforts through additional outlets

what you might want to achieve: policy change through 

• voluntary agreements

• regulations

• legal actions, laws

• moratorium (no actions can be taken until…)