Study Guide for Midterm
Study Guide for Midterm HADM 3300
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This 9 page Study Guide was uploaded by Kayla Notetaker on Saturday March 12, 2016. The Study Guide belongs to HADM 3300 at Auburn University taught by Silvera in Spring 2016. Since its upload, it has received 38 views. For similar materials see Health Care Policy in Nursing and Health Sciences at Auburn University.
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Date Created: 03/12/16
HADM 3300 Heath Care Policy Exam 1 Study Guide - We’re Number One o The only industrialized nation to have a health care market economy o Physicians as independent entrepreneurs Fee for service market - Costs o The United States has the highest healthcare spending as a percentage of GDP o The US spends 2.5x the OECD average on healthcare United States: 8,233 OECD: 3,286 Germany: 4,338 France: 3,974 UK: 3,433 Canada: 4,445 o U.S. Healthcare costs per capita has risen constantly o Cost Drivers: Population growth, aging population, higher frequency of chronic illness (49% have at least one), and lifestyle, Medical technology (people want the latest and greatest), payment structures (FFS), fraud, waste, and abuse, and litigation. - Health Professions o Physicians 741,000 physicians in the U.S. 1:416 person to physician ratio Not equal distribution High Salaries ($180k for GP, and $450k for specialists and surgeons) o History of Physicians Lack of consistency in training No licensure or quality Large number of doctors – low pay - AMA and Education o Medical Education Flexner report (1910) Part of universities 4 years of training 2 years of lab science Increased physician quality Decreased quantity of physicians, so salaries went up o AMA and PhRMA Code of eithics Patent protection for pharmaceuticals High profit margins Couldn’t advertise pharmaceuticals in AMA journal – kept people from prescribing bad drugs o AMA Today Diversity issues in AMA NMA – for African Americans Gender Issues – weren’t letting women in Less than 50% of physicians are AMA members Still politically the voice of the medical profession Half of all medical students are women - Nursing o Florence Nightingale o Nursing shortage in WWI Medical assistants o Nursing shortage in WW2 Licensed Vocational Nurses (LVNs) o ANA – American Nursing Association Labor union – advocate for nurses Professional credentialing and level pay Not as powerful as other professional associations o Nursing shortage - baby boomers retiring and not training new nurses Shortage of 285k by 2020 500k by 2025 13% of RN positions unfilled 84% of hospitals short staffed Shortages lead to higher Nurse:Patient ratios Burnout Job dissatisfaction Higher mortality rates - Levels of Care o Primary – care in physicians office or clinic GP, PA, Nurse Practitioner, Pediatrician o Secondary – care by specialists in hospitals o Tertiary – Care at regional referral center Trauma, burn units, cancer units, NICU, PICU o Quaternary – Care at national referral center Mayo Clinic, Hopkins, MD Anderson o Shortage of PCP, push for Pas and Advanced Practice Nurses to make up for shortages. o Market Failure – there is no price floor. Secondary care physician’s salaries continue to rise. - Policy Making Process o Federalist Republic Democracy Federation – sovereign states that adhere to a single federal government Republic – Federal Government made up of representatives from each state Democracy – not a true democracy People choose representatives Representatives make decisions on behalf of their constituents o Division of Power Federal Government Enumerated powers (given expressly in constitution) o Taxing power o Declaration of Law o Interstate Commerce o International Commerce State Governments Reserved powers o Ratify amendments o Manage public health and safety o Trade and taxes within a state o Education o Branches of Government Judicial Branch – interpret and evaluate the laws Court system including Supreme Court o Appointed to lifelong position Legislative Branch – Congress. Write laws and declare war House of representatives (based on pop. 4 year terms) Senate (2 per state; 6 year terms) Executive Branch – Presidential Veto power Departments (secretaries) o Checks and Balances Legislative checks Executive – Legislative can override veto Legislative checks Judicial – legislative can impeach judges and approve judges Executive checks Legislative –Presidential veto of laws Executive checks Judicial – President nominates judges Judicial checks Legislative – can declare laws unconstitutional Judicial check Executive – can declare executive actions unconstitutional - Medicare o History and Facts “Trumancare” – 5 point plan Construct hospitals Expand public health, maternal health, and child health Medical Education and Research Prepayment of Medical Care Protection against loss of wages from sickness and disability Popular with the Public (Great Depression) Wage Freeze following WW2 – employer sponsored health care Opposed by small businesses (“benefits” could not compete with insurance from the government), American Hospital Association, and AMA (deemed it a socialism) Labor unions liked it National insurance system lost momentum and failed to pass By the end of the 50s, most were covered by employer-sponsored healthcare. Problem leading to Medicare 56% of Americans over 65 were uncovered o They had no income, they were retired, healthcare was expensive o Elderly are more likely to utilize the healthcare system Statistics o Medicare covers around 55M individuals o $505 billion o 14% of Federal Budget Who’s Covered? o Age 65+ (with 10 years Social Security contribution) o Social Security Disabled Must be proven 24 month waiting period Not age restricted o End Stage Renal Disease and ALS No waiting period th July 30 , 1965 LBJ signed in Medicare and Medicaid o President Truman was given first Medicare card Early Statistics o $10B o 19 million individuals enrolled first year What institutions are covered? o Hospitals, SNFs, Physicians, Home Health, Hospice, Lab, Pharmaceuticals Part A – Hospital Insurance o Covers hospitals, nursing homes, and hospice o 87% payroll taxes o 24% of Medicare Part B – Medical Insurance o Covers doctor services, outpatient hospital care, durable medical equipment o 73% General Revenue o 12% of Medicare payments Part C – Medicare Advantage (MCO) o Covers all Part A and B and fills gaps o 25% of Medicare payments Part D (George W. Bush – 2003) o Pharmaceuticals o 74% of General Revenue 14% of federal spending Who pays and how? Payroll taxes o FICA – Social Security Tax Payers o Federal taxation Beneficiaries o Premiums o Copays o Deductibles Medicare Part C – Medicare Advantage Balanced Budget Act 1997 Managed Care o HMOs and PPOs Available to all Medicare enrollees except ESRD Cheaper for patients, Medicare, and taxpayers Medicare Part D – drugs Prescription drug coverage Medicare Modernization Act (2003) (George W. Bush) Not administered through Medicare, but private companies o Cost driver C with D is the cheapest - Medicaid o Funded by U.S. federal and state governments o Voluntary participation o History and Facts Social security amendment made in 1967 Coverage for children up to age 21 Omnibus Reconciliation Act of 1981 Allowed states to make additional payments to disproportionate share hospitals Omnibus Reconciliation Act of 1986 Transfers drug coverage for dual eligible Required emergency of treatment to immigrants who would otherwise be eligible for Medicaid Option to extend Medicaid to pregnant women and children with family income at or below 100% FPL 1982, Arizona the last state to offer Medicaid o Who’s Covered? Children Pregnant Women Elderly Disabled Parents with children who have no other way to pay - Medicaid and CHIP o BBA of 1997 (Clinton) Establish SCHIP – now CHIP Gives state option to cover uninsured children with family income at or below 200% o Medicare Modernization Act of 2003 Transfers drug coverage from Medicaid to Medicare for Dual eligible o FMAP – Federal Medical Assistance Percentage The specified percentage of state Medicaid expenditures that the Federal government pays. - The Uninsured o 83.3% of Americans have some form of health insurance o Where do they get insurance? Employee Private Government VA/Tricare o Timeline 1940s Wage Freeze Employee sponsored insurance expansion 1960s Medicare/Medicaid 1970s-1990s Rapid escalation of costs CHIP o 30M uninsured by 1980 o 17% of people had no insurance We are paying for their care (expensive) o Health Security Act (HillaryCare) Individual mandate Expand employer-sponsored health insurance to all employees o Uninsured 59% are adults 16% are children 25% are parents Highest in southeast and southwest 55% minority Without insurance, people ignore illness until they get sick and then come in with a whole bunch and its expensive (woodwork effect) Death Spiral Uninsured Get insurance Individual Insurance Market High Premiums Drop Insurance - Obamacare (Patient Protection and Affordable Care Act) o Opinions 90% of Americans wanted change in health care in 2008 o Senator John McCain Tax credits for individual market insurance Tax employer based health insurance premium contributors as income National Health Insurance competition Federal assistance to states to cover vulnerable populations o Senator Barack Obama Private and public group insurance with consumer protectors and income based subsidies Expand Medicaid and SCHIP Employer Mandates National Health Insurance competition Tax credits and income based subsidies o Timeline November 2008 Madelyn Dunham (grandma) dies of cancer right before Obama’s election July 2009 Speaker Nancy Pelosi and Democrats from the House reveal health care plan August 25, 2009 D-Mass Senator Ted Kennedy, a leading supporter of healthcare reform, dies and puts the 60 Senate democratic supermajority at risk September 24, 2009 Democrat Paul Kirk is appointed interim senator which temporarily restores supermajority and prevents filibuster November 7, 2009 In the House, 219 Democrats and one Republican vote for ACA, and 39 Democrats and 176 Republicans vote against it December 24, 2009 In the Senate, 60 Democrats vote for ACA. No republicans vote for it January 2010 In the Senate, Scott Brown, a republican, wins the special election in Massachusetts to finish out the remaining term of US Senator Ted Kennedy. Filibuster-proof supermajority is gone May 23, 2010 ACA signed into law Signed in through Budget Reconciliation Created by lawmakers as a way to bring down the deficit without having to go through all the committees. o Provisions Can no longer refuse patients for pre-existing conditions Preventative Care – access for no cost to: Blood pressure, diabetes, cholesterol tests Cancer screenings Counseling for smoking, weight loss, and substance abuse Well child visits Vaccinations Pregnancy counseling and screenings Young Adults Coverage Adults under 26 can stay on parents health plan Even if married, out of school, financially sound Health Insurance Marketplaces Healthcare.gov Designed to serve the residents of the 36 states that opted not to create their own Glitches in the rollout Employer Mandate All businesses with 50+ full time employees must provide health insurance to at least 95% of them and their dependents up to age 26. Individual Mandate If you can afford health insurance But choose not to buy it, you must pay a fee called “the individual shared responsibility payment” Medicaid Expansion Extends Medicaid from 100% FPL to 138% FPL Also includes premium tax credits for 100- 400% FPL Medicaid expansion is voluntary (32 states expanded) o Most of southeast did not expand - Health Empowerment Accounts o Like HSAs but it rolls over, its transferrable, and never goes away.
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