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Study Guide for test 2

by: Amanda Green

Study Guide for test 2 BPH 206

Marketplace > University of Miami > Public Health > BPH 206 > Study Guide for test 2
Amanda Green
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Role of Government on Public Health (ch. 12) Health Law, Policy, and Ethics (ch 5) Healthcare Institutions (ch. 10) U.S Health Insurance prior to Patient Protection and Affordable Care Act (ch 11)
Introduction To Public Health
Alexis Koskan
Study Guide
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This 20 page Study Guide was uploaded by Amanda Green on Tuesday December 8, 2015. The Study Guide belongs to BPH 206 at University of Miami taught by Alexis Koskan in Fall 2015. Since its upload, it has received 177 views. For similar materials see Introduction To Public Health in Public Health at University of Miami.


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Date Created: 12/08/15
Study Guide Public Health Test 2 Role of Government on Public Health (ch. 12) Role of Local, State, Federal government- public agencies Public Health Responsibilities by level Federal- US Constitution main guide; states also have abilities to set guidelines; funds State- Mix between local departments; vote Local Health Department- In charge of restaurant inspections etc. Local Board of Health- Infectious diseases reported back to state Local- Most local health departments lie in between these 2 extremes (relatively independent local agency or branch offices) 1. Home Rule (local autonomy model)- authority is delegated from the state to the local health department o Local health department, or local govt., has great deal of autonomy in setting own structure and function and often raising own funding. 2. Branch Office Model- local health department can be viewed as a branch of the state agency with little or no independent authority or funding Typical Responsibilities and Authority for all local departments  Immunizations for those not covered by the private system  Communicable disease surveillance and initial investigation of outbreaks  Communicable disease control, often including at a minimum tuberculosis and syphilis case finding and treatment  Inspection and licensing of restaurants  Environmental health surveillance  Coordinating public health screening programs (Newborn and lead screening)  Tobacco control programs  Public health preparedness and response to disaster Healthcare Safety Net- Health departments that serve as the healthcare provider for those without sources of health care.  Been reduced- but agencies still have responsibility to ensure access to and the quality of services  Local public health agencies can’t be viewed in isolation o State health departments usually retain important roles even in those states where local departments have home rule authority State- may retain their authority, voluntarily request or accept help from the federal government, or delegate their responsibility and/or to local agencies at the city, country, or other local levels  Complex history- more structures than there are states (large cities, DC, and several U.S territories have their own systems and often have the authority to make public health system decisions as if they were states)  5 US Territories and 3 freely associated states- partially receive Fed Govt. help also operate on their own  Tribal Public Health o Tribal Health Department and Tribal Health Organizations  US Governance by State o Local= all LHDs in the state are units of local government o Mixed= LHDs in state have more than one government type o State= all LHDs in the state are units of the state government o Shared= all LHDs in the state are governed by both state and local authorities Federal Govt.- Public Agencies- oversee, involved in national and global issues of public health and works closely with local agencies. Role in Public Health isn’t mentioned in Constitution  Justified by the Interstate Commerce Clause- provides fed govt. with the authority to regulate commerce between the states  Fed public health authority rests on voluntary acceptance by the states of funding provided by the federal government (requirements for state action to qualify) Role of agencies: Public Health in America Statement- What did it outline as essential roles of government- related to public health?  Provides framework that defines the goals/ services of govt. public health agencies Goals  Prevent epidemics and the spread of disease  Protect against environmental hazards  Prevent injuries  Promote and encourage healthy behaviors  Respond to disasters and assist communities in recovery  Ensure the quality and accessibility of health services 3 Core Functions- IOM created goals that governmental public health agencies need to perform  The job cant be delegated to other agencies or to nongovernmental organizations  Govt. public health agencies will work together to accomplish these functions as a group  Responsible for health as a whole- no one agency at local, state, or federal level is specifically/exclusively responsible for accomplishing the essential public health services 1. Assessment- (determining problem) obtaining data that defines the health of the overall population and specific groups within the population, includes defining the nature of new persisting health problems  Monitor health- vital stats, health surveys  Diagnosis and investigate- epidemiological identification 2. Policy Development- (creating intervention) developing evidence based recommendations and other analysis of options, such as, health policy analysis to guide implementation, including efforts to educate and mobilize community partnerships.  Inform, educate, empower- health education  Mobilize, community, partnerships (partnerships with private sector, civic groups, faith community etc.)  Development policies- collaborate on strategic 3. Assurance- (using info to fix problem) governmental public health’s oversight responsibility for ensuring that key components of an effective health system, health care and public health, are in place even though the implementation will often be performed by others  Enforce laws- enforce and review laws  Link to/provide care  Assure competent workforce  Evaluate Major federal public health agencies (what do they do?) Administration for Children and Families (ACF)  Promotes the economic and social well-being of families, children, individuals and communities through a range of educational and supportive programs Administration for Community Living (ACL)  Increase access to community support and resources for the unique needs of older Americans and people with disabilities across the lifespan. Agency for Healthcare Research and Quality (AHRQ)  Supports research designed to improve the quality of healthcare, reduce its costs, address patient safety and medical errors, and broaden access to essential services. Agency for Toxic Substances and Disease Registry (ATSDR)  Prevents exposure to toxic substances and adverse health effects and diminished quality of life associated with exposure to hazardous substances from waste sites, unplanned releases, and other sources of pollution present in the environment. Centers for Disease Control and Prevention (CDC)  Provides leadership and direction in the prevention of and control of diseases and other preventable conditions, and responding to public health emergencies. Centers for Medicare & Medicaid Services (CMS)  Combines the oversight of the Medicare program, the Federal portion of the Medicaid program and State Children's Health Insurance Program, the Health Insurance Marketplace, and related quality assurance activities. Food and Drug Administration (FDA)  Ensures that food is safe, pure, and wholesome; human and animal drugs, biological products, and medical devices are safe and effective; and electronic products that emit radiation are safe. Health Resources and Services Administration (HRSA)  Is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. Indian Health Service (IHS)  Provides a comprehensive health services delivery system for American Indians and Alaska Natives National Institutes of Health (NIH)  Supports biomedical and behavioral research domestically and abroad Substance Abuse and Mental Health Services Administration (SAMHSA)  Provides national leadership to ensure that knowledge acquired is effectively used for the prevention and treatment of addictive and mental disorders. It strives to improve access and reduce barriers to high quality, effective programs and services for individuals who suffer from or are at risk for these disorders, as well as for their families and communities. Essential public health services (as defined by the IOM- make sure to review in textbook) pg. 235, 236 10 services come to define responsibilities of the combined local, state, and federal governmental public health system 1. Monitor health status 2. Diagnose and investigate 3. Inform, educate, and empower 4. Mobilize community partnerships 5. Develop policies and plans 6. Enforce laws and regulations 7. Link people to needed services/assure care 8. Assure a competent workforce 9. Evaluate health services 10. Research Goal is to make integrated system of partnerships Leaders in public health- Individuals/ positions in power (review slides) Secretary: Sylvia Mathews Burwell Deputy Secretary: Bill Corr Chief of Staff and Senior Counselor: Andrea Palm Executive Secretary: C’Reda J. Weeden Director, Office of Intergovernmental Affairs and Regional Directors: Paul T. Dioguardi Assistant Secretary for Health: Karen DeSalvo Assistant Secretary for Management and Budget: Ellen Murray (New Title – Assistant Secretary for Financial Resources) Assistant Secretary for Planning & Evaluation: Richard Frank Assistant Secretary for Legislation: Jim Esquea Assistant Secretary for Public Affairs: Kevin Griffis General Counsel: William B. Schulz Director, Office for Civil Rights: Jocelyn Samuels Inspector General: Daniel R. Levinson Chair, Departmental Board: Constance B. Tobias Assistant Secretary, Administration for Children and Families (ACF): Mark Greenberg Assistant Secretary for Aging: Kathy Greenlee (And Administration for Community Living) Administrator: Health Care Financing Administration: Marilyn Tavenner – This agency was renamed Centers for Medicare & Medicaid Services Administrator: AHRQ: Richard Kronick, Ph.D Director of CDC: Tom Frieden Administrator, Agency for Toxic substances and Disease Registry: Tom Frieden (this was combined with CDC) Commissioner, FDA: Margaret Hamburg Administrator, Health Resources and Services Administration: Mary K. Wakefield, PhD Direction, Indian Health Service: Dr. Yvette Roubideaux Director of the NIH: Francis S. Collins, MD, MPH Administrator, Substance Abuse and Mental Health Services Administration: Pamela S. Hyde, J.D. Director, Program Support Center: Paul Bartley Health Law, Policy, and Ethics (ch 5) Trigger Events Ethical Milestones The Nazi Experiments Nuremburg Code 1947 Tuskegee Syphilis Study National Commission for the Protection of Human Subjects of Biomedical & Behavioral Research 1974 *Belmont Report 1978 *Common Rule 1991 3 basic principles of the Belmont Report (know well) Belmont Report  The principles of the Belmont Report govern all research supported by the U.S. Government.  The ethical principles outlined in the report are the basis for subsequent regulations designed to ensure protection of human subjects in research.  Focused on the key issues of defining informed consent and the selection of participants Principles: 1. Respect for Persons-  Incorporates 2 ethical convictions and 2 moral requirements o Individuals should be treated as autonomous agents o Do not use people as a o Allow people to choose for themselves o Provide extra protections to those with diminished autonomy (i.e. Prisoners, Children, Cognitively Impaired, etc.) 2. Beneficence-  Treating in an ethical manner not only by respecting their decisions and protecting them from harm, but also by making efforts to secure their well-being  Treatment (2 rules as expressions of beneficent actions) o Do no harm (non-maleficence) o Maximize possible benefits and minimize possible risks 3. Justice  Treat people fairly  Fair sharing of burdens and benefits of the research  Injustice occurs when: o Benefits to which a person is entitled are denied without good reason o When burdens are imposed unduly Rules Derived from Principles - Respect for Persons o Informed Consent Process o Respect for Privacy - Beneficence o Good research design o Competent investigators/ researchers o Favorable risk-benefit analysis - Justice o Equitable selections of subjects Disease and Injury Prevention; Law of Populations  Self­ imposed risk= risk an individual knowingly and willingly takes on through his/her own  actions (not wearing motorcycle helmet)  Imposed risk= risk to individuals and populations that is out of their control (exposure to  environment toxins from a local factory)  Disease­ quarantine­ used to control those at high risk of developing a disease  Responsibility differs depending on if risk is self­ imposed or imposed   Health Care  o Access, quality, cost of care o Organizations and professional structures for the delivery of care  Ex: Medicare, Medicaid, professional licensure  Public Health  o Population health and safety o Providing services to all populations (food and drug laws, environmental laws, ID  control, quarantine) Laws that govern public health 1. U.S Constitution  Fundamental document that governs the issues of public health and healthcare law  Constitution doesn’t mention health o Negative Constitution= US constitution doesn’t require governments to act to protect public health or provide healthcare services Police Power- allows states to pass legislation and take actions to protect the common good Protecting common good (various state actions)  Regulation of healthcare professionals and facilities  Establishment of health and safety standards in retail and other occupational settings  Control of hazards ranging from requiring the use of car restraint systems, vaccinations, to restricting the sale of tobacco products  Police Power limited by: o Individual rights (created through constitution, states const., or laws passed) o Freedom of speech, religion, assembly, right to bear arms  Procreation, privacy, bodily integrity (inferred from Constitution) 2. Interstate Commerce Clause (federal) o Major source of federal authority o Authority to tax, spend, and regulate interstate commerce  Often exerted through incentives to states (e.g. if states enact specific types of legislation, fed government provides extra funding) o Public health examples:  Rules governing Medicaid  Defining blood alcohol levels for driving under the influence 3. Individual Rights (state, local, individual)  Basis for individual protections in public health and health care Health Law informed by:  Constitutional law  Derived from national and state constitutions  State constitutions more clear (less interpretation) o Outlines which activities performed how funded o Limit role of government and define processes o Easier to amend or change than federal law Legislative Law (statutes) o Written by legislative bodies (local, state, federal) o All act/statutes enacted by congress  o Includes:   Mandates: (Local government require restaurant owners to obtain license, pass  inspections; prohibit smoking in certain areas)  Resources: (HIV medication distribution, refunds for healthcare services  professional licensure) Administrative Laws o Produced by executive agencies of federal, state, and local, governments to implement  legislative statues o Operationalize statues or legislative laws o Extensive impact on daily life: (regulation of septic tanks; requirement of vaccines for  school entry; who is eligible for services, levels of reimbursement, etc.) Judicial Law (common law)  o Law made by courts when applying other types of laws to specific cases  o Fill in holes when statutory law doesn’t provide guidance  Statues/administrative laws vague­common law fills in grey area  Includes tradition, legal custom, previous state/ federal decisions (Duty of  Confidentiality­ Use of patient informa)ion The Common Rule (1991) = the set of regulations developed to ensure compliance with the principles of the Belmont Report - Institutional assurances of compliance - Review of research by an IRB - Informed consent of subjects IRB= an appropriately constituted group designated to review and monitor biomedical research  involving human subjects - Purpose= to review research and to ensure the rights and welfare of human subjects involved in research are adequately protected - When to consult IRB o Conducting human subjects research, Proposing a study, Need data prior to study Market vs. Social justice 2 contrasting philosophies towards govt. in Health Policies = Social Justice vs. Market Justice Implications: Bioethics • Branch of "applied ethics" that requires the expertise of people working in a wide range disciplines • Elements of both health care and public health and focuses on applying morals or values to areas of potential conflict • Application of individual and group values and morals to controversial areas Concerned with questions about basic human values: • Rights to life and health • End- of- life care • Rightness or wrongness of certain developments in healthcare institutions • Life technology • Medicine and the health professions • Society's responsibility for the life and health of its members Examples of research areas related to bioethics: Abortion, Cloning, Consent, Contraception, Disability, Euthanasia, Organ Donation, Reproductive Technology, Research Ethics, Stem Cells, Substance Abuse, Surrogacy Healthcare Institutions (ch. 10) Health Care Levels: Primary:  1st contact providers of care (prepared to handle majority of common problems) 6 Cs of Primary Care 1. Contact 2. Comprehensive 3. Coordinated 4. Continuity 5. Caring 6. Community Secondary:  Obstetrics/ Gynecology  Anesthesiology  Emergency Medicine  Pediatrics Tertiary:  Subspecialty care o Plastic surgery (head and neck) o Child abuse pediatrics o Medical toxicology Hospitals: offer both inpatient (stay for at least 24 hours) and outpatient services Community Health Centers:  Designed based on community empowerment philosophy  Located in federally designed medically-underserved areas or serve federally-designated medically-underserved populations Different types of hospitals… By funding:  Non-profit  For- profit  State and Country Run Hospitals (investor-owned) o Public or government hospital o Provides medical care free of charge o Urban public hospitals associated with medical schools By specialty:  General: attempt to serve a wide spectrum of patients and problems, though they may concentrate on serving only children or only those who qualify for services such as Veterans Admin (VA) hospital  Specialty/specific hospitals: institutions focused on cancer, heart disease, psychiatric illness, and orthopedics By population served, etc.: Long-term Healthcare Facilities:  Nursing facilities  Nursing homes o Designed for long term care (limited amount of health services) o States enforce rules and regulations o Most run as private non-profits  Assisted living o Long term care for those who have less severe impairments o May provide or coordinate health care  Dementia Care  Hospice o Goal= provide comfort, emotional support; relieve pain U.S Health Insurance prior to Patient Protection and Affordable Care Act (ch 11) Questions related to the film In Sickness and in Health Recision- taking back health insurance policies after people file claims  Insurance companies say to prevent fraud  Allow companies to reject people based on unimportant details (wrong) Lack of health insurance-  2,000 Americans die from not having insurance for receiving proper treatment  People wait till they become ill to file for insurance; or till they qualify for Medicaid or Medicare Need for increasing health care access  Need to cover everyone without medical underwriting  Make mandate requiring insurance for everyone and then can lower insurance prices How access to insurance coverage affected individuals’ personal life choices  Decisions about retirement  People put in “job lock” or locked into either job or marriage because of health care benefits  People for going important operations and surgeries because of costs  People’s decisions to go back to another country (in this case New Zealand- kiwi;)) Medicare: A federal health insurance system that covers most individuals 65+, the disabled, and those with end- stage renal disease  Funded through payroll tax- 1.45% from employers and employees  >44.6 million insured elderly & disabled  4 parts: A- covers hospital care, skilled nursing care, home health care after hospitalization, and hospice care B- voluntary supplementary insurance- covers range of diagnostic and therapeutic services provided by physicians, emergency departments, and other outpatient services C- program designed to encourage Medicare beneficiaries to enroll in prepaid health plans D- relatively new- prescription drug coverage plan Medicaid: A federal-state program that covers groups defines as categories needy, groups that may be covered at the discretion of the state, including those defined as medically needy, such as those in need of nursing home care  Impoverished; have to apply (must be under federal poverty line)  Government pays a variable amount of cost ranging from 50-83% depending on per capita income of the state  Pay for health services for specific categories of poor people and other designated categories of individuals  ~50 million low-income & elderly in nursing homes (joint program with federal and state governments) SCHIP (State Child Health Insurance Program) A federally founded health insurance program that provides funds to the states to use to expand or facilitate the operation of Medicaid or for other uses to serve the health needs of lower income children  Additional funds that states may use to enhance Medicaid program  ~4.4 million children Definitions associated with insurance Cap: a limit on the total amount that the insurance will pay for a service per year, per benefit period, or per lifetime Copayment: an amount that the insured person is responsible for paying even when the service is covered by the insurance (part of the bill) Covered service: a service for which health insurance will provide payment if the individual is otherwise eligible (insurance covers 100%) Deductible: Pay x amount before insurance begins: amount that an individual or family is responsible for paying before being eligible for insurance coverage Eligible: an individual may need to meet certain criteria to be eligible for enrollment in a health insurance plan Medical loss ratio: (Benefits paid: Premiums Collected): The ratio of benefit payments paid premiums collected, indicating the proportion of the premiums spent on medical services (spending more than expected on you insurance losing $) Out-of-pocket expense: Payments for health services not covered by insurance that are the responsibility of the individual receiving the services Portability: after job ends: the ability to continue employment-based health insurance after leaving employment, usually by paying full cost of the insurance. A federal law known as COBRA generally ensures employees 18 months of portability Premium: amount per month: the price paid by the purchaser for the insurance policy on a monthly or yearly basis Prior to ACA- who was insured, uninsured, underinsured Employment Based Insurance  PPO = Preferred Provider Plans o Evolved from fee-for-service model  HMO = Health Maintenance Organization- turned into Point of Service Plans o Can choose provider outside of plan – may pay more  COBRA o Up to 18 months of portability Private Insurance  Private/non-group/individual market o Expensive o Medical underwriting (experience rating; health insurance rates set on the basis of group’s past history of healthcare expenses) / rescission Uninsured/ Underinsured Who are they?  Young, healthy choose not to get insurance  “Near-poor” don’t qualify for Medicaid  Men without children  Self-employed or employees of small businesses  Working families  >61% no college education Consequences?  Less preventive care, more advanced stages of disease, less treatment once diagnosed  Less likely usual source of care  Increased mortality rate (~20,000 excess deaths/year) Why was there a need to expand access to health care?  Patients needed healthcare reform  US economy needed healthcare reform o 2013 U.S spending 2x as much per capita on health insurance but more cost related access problems than other countries Affordable Care Act (info in ch. 11; make sure to read few posted articles about ACA) “Obamacare”- March 3 rd2010 What does it seek to accomplish?  Ensure more comprehensive and secure health insurance coverage: (restricted from denying customers with preexisting conditions; can stay on parents plan until 26)  Expand Medicaid  Individual and Employer Mandates  Exchanges (Health Insurance Exchanges)  Essential benefit packages included in insurance sold through the exchanges  Encourage cost sharing but limit its impact (Coverage in detail…) Employer (about ½) - Caps on amount have to pay-out of-pocket; free preventative care (no cost-sharing) - Employer Mandate= Require bigger companies with 50 or more employees to cover full time workers or pay a penalty - Smaller companies (no penalties) encouraged o Govt. setting up special market places and offering incentives (temporary tax breaks) to provide coverage - Insurers cant inflate prices if employees are sick rd Government (about 1/3 through Medicare/Medicaid)  Medicare- continue bettering preventative care/ access to prescription drugs  Medicaid- expanding (up to 138% of the poverty level= $15,856 for 1 person) o Governors of each state choose to be part of expanding or not (if on board feds cover costs) Buy my own (1 in 10)  Health Insurance Exchanges or Marketplaces= (virtual insurance megamall) where private insurers compete for your business o Pick different plans on how much coverage you want for what you want to pay o Cheaper high deductible bronze to more expensive less deductible platinum  Federal govt. will provide most people with tax credit if income is up to 400% of poverty level= $78,120 (for family of 3)  Rules set for insurance companies o Prevent insurers from rejecting individuals or charging higher premiums based on health status or preexisting conditions. o Men and women will pay the same price o Prices for older people reduced; younger people increased but can stay on parents plan until 26 and buy low budget catastrophic plans until 30  All plans provide coverage for services under four categories: o Evidence-based screenings and counseling, Routine immunizations, Childhood preventive services, Preventive services for women  Ex. hospital/doctor visits, maternity and mental health care, prescription drugs (essential health benefits) None (30 mil; >1 in 10)  Can only get coverage during special enrollment periods  Individual Mandate= if you’re not insured have to pay penalty fine How does it seek to expand healthcare?  Greater protections for individuals and families  Fewer uninsured  More standardized coverage  More competition in offering insurance  Expansion of the exchanges  Higher taxes on high-income individuals  Continuing efforts to control costs How is it expanding care to those who didn’t have health insurance prior to this law? - Youth highest uninsured but now be able to remain on a parent’s private health insurance plan until age 26 - Will provide additional employer incentives to provide coverage to lower- income workers - The new health reform law will set a uniform floor for Medicaid eligibility that will extend the program to almost all individuals with incomes at or below 138% of poverty What is meant by the Essential Health Benefits? What are they?  ACA mandates a package of essential benefits that must be included in insurance polices sold through exchanges except for limited option to purchase catastrophic policies for those under 30  Includes at least ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health, prescription drugs, rehab services, habilitative services to address existing disabilities, lab services, wellness services, chronic- disease management, and pediatric services  Approved preventive services must be offered without cost-sharing (shifting costs to individuals) o Include: vaccines, recommended screening and preventive care for women, and preventive interventions given grades of A or B by the U.S.  Preventive Service Task Force, indicating the net benefit is moderate to substantial


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