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by: Adah Reilly


Adah Reilly
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April Temple

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April Temple
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This 11 page Class Notes was uploaded by Adah Reilly on Saturday September 26, 2015. The Class Notes belongs to HTH 354 at James Madison University taught by April Temple in Fall. Since its upload, it has received 46 views. For similar materials see /class/214061/hth-354-james-madison-university in Health Sciences at James Madison University.




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Date Created: 09/26/15
HTH 354 Final Exam Study Guide lnegualities Quiz How does the smoking rate in the US compare to the smoking rates of other wealthy countries 9 Ranked below 25 Japan ranked 1 for highest smoking rate What is the greatest difference in life expectancy observed between different counties in the US 15 years On average how many more supermarkets are there in predominantly white neighborhoods compared to predominantly black or Latino neighborhoods 9 4 times as many lack public transportation more access to fast food and liquor The predominantly white neighborhoods in west LA contain approximately 318 acres of park space per 1000 residents How many acres of park space exist per 1000 residents in the predominantly black and Latino neighborhoods of south central LA 9 17 acres more parks means cleaner air room for exercise and community gathering How much does chronic illness cost in the US each year in lost work productivity not including medical expenses 9 11 trillion extra sick days poor performance etc What is the best predictor ofone s health 9 Whether or not you are wealthy those at the to have more access to resources and live longerbetter while those at the bottom live in poor conditions that can contribute to chronic illness and increase mortality rates Children living in poverty are how many times more likely to have poor health compared with children living in highincome households 9 4 times children most vulnerable The top 1 of American families has more wealth than the bottom 9 90 not enough combined income compared to the top 1 Which minority group has the worst overall health in the US 9 Blacks higher rates of depression and mental illness Which minority group is most diverse in terms of education income and health status 9 AsianPacific Islanders Chapter 11 Underserved Populations 0 Introduction 0 Certain populations face greater challenges accessing and financing health care 0 These people are at greater risk of poor physical psychological andor social health 0 Terms underserved populations medically underserved medically disadvantaged underprivileged Vulnerability at risk of experiencing poor health or illness I Due to unequal social economic health or geographic conditions I Vulnerable populations include 0 o Racial and ethnic minorities o Uninsured children 0 Women 0 Rural dwellers o Homeless Mentally ill Chronically ill or disabled o HIVAIDS o Vulnerability Model 0 Also called the Behavioral Model of Health Services Use 0 Used to study access to health care 0 Suggests people s use of health care is a function of three factors I Predisposing attributes that predispose people to health care 0 Examples demographics education health beliefs I Enabling personal or financial resources that influence use of health care 0 Examples income insurance social support I Need perceived and evaluated illness 0 Examples ADLs IADLs chronic diseases selfrated health 9 Example A 64yearold black female is a retired bus driver She lives in a small town in Virginia with her husband She has arthritis high blood pressure and heart disease She has no form of health insurance until she qualifies for Medicare next year 0 RacialEthnic Minorities 0 Black 122 HispanicLatino 148 Asian 44 Pacific Islander 014 and Native American 08 0 Have poorer access to health care receive poorer quality care and experience worse health outcomes I Even after controlling for insurance socioeconomic status and health status 0 Federal Programs I REACH 2010 Racial and Ethnic Approaches to Community Health I Health People 2010 I Health and Human Services Initiative 1998 US Office of Minority Health 1995 I Minority Health Initiative 1992 Indian Health Services 1954 0 Women 0 Live longer than men BUT generally have I Greater morbidity rates I More short and longterm disability I Poorer health outcomes I Higher rates of mental illness 0 Children 0 Children experience a developmental vulnerability o Depend on their parents or others to meet their health care needs 0 May suffer from quotnew morbidities 0 Rural Health 0 Poverty and poor health status are common in rural areas 0 Shortage of health care providers and services 0 Long distances and limited availability of personal transportation may also affect access to care 0 Uninsured 0 Approximately 16 of our population is uninsured o More likely to be uninsured poor less educated minorities parttime or social business employees young adults 0 Costs of providing uncompensated care is estimated to be up to 28 billion a year 0 Homelessness 0 Approximately 35 million Americans are homeless 0 Face several barriers to getting adequate and appropriate health care 0 High prevalence of untreated chronic conditions mental illness and substance abuse 0 Mental Health 0 Serious public health concern 9 1 in 5 Americans suffer from a mental illness Most common disorders include substance abuse and affective disorders Increases the risk of morbidity and mortality Many do not receive adequate treatment Access to mental health services is often limited I The Mental Health Party and Addiction Equity Act of 2008 requires mental health benefits to be equal to traditional medical benefits under insurance coverage 0 Most mental health services are provided in primary care settings 0 Chronic IllnessDisability 0 Chronic diseases are longterm in nature and may result in residual disability 0 Responsible for the major causes of death cardiovascular disease cancer diabetes 0 Chronic diseases account for a large portion of health care spending yet many are preventable o HIVAIDS 0 Current therapies have been effective in delaying the progression of HIV to AIDS 0 Treatment is expensive making it unavailable to many 0 This group is also at risk of many related complications 0 Conclusion 0 Certain groups face challenges and barriers to accessing health care 0 These gaps represent the need for efforts to address the unique health concerns of these subpopulations I 1 out of every 2 African Americans and Latinos will develop diabetes I 30 of Americans have chronic diseases effects 100 million Americans I Of those who have chronic illnesses about 40 have 2 or more chronic illnesses O O O 0 Chapter 12 Cost Access and Quality 0 Introduction 0 Cost access and quality are three major outcomes of health care delivery 0 All three also represent primary concerns with our health care system I What you do to one of these outcomes makes the others uneven o All three form an interactive relationship known as the lliron triangle 0 Definitions of Cost 0 Price I From the perspective of consumers and financers 0 Example the physician s bill or insurance premiums 0 Health Care Expenditures I A national perspective of how much we spend on health care services 0 Salaries medical equipment research and development I Reflect consumption of all resources in the delivery of health care I Usually expressed as a proportion of the gross domestic product GDP 0 Expressed as a percentage of GDP 16 o Providers Cost I From the perspective of health care providers 0 Example staff salaries capital costs purchase of supplies 0 High in Cost 0 Trends in national health expenditures are evaluated by I Comparing medical inflation goes up year to year to general inflation how much a commodity goes up year to year usually 2 or I Comparing charges in health spending to changes in GDP Doubledigit rates of growth during the 1970s 140 annual growth Rate of increase slowed during the 1980s1990s 57 annual growth However the rate of growth has started to accelerate 87 15 We spend more than any other country on health care I 6400 per capita I 28 trillion I 17 in GDP 0 The Good job opportunities 0 The Bad sustainability 0 Reasons for High Cost 0 ThirdParty Payment I The patient and provider have little incentive to be cost conscious o Providerinduced demand 0 Imperfect Market I The prices charged for health care will be higher than the true economic cost 0 Growth of Technology I Use of technology escalates costs 0 Increase in the elderly population I The elderly consume more health care 9 why Medicare costs are so high 0 Medical Model I More costly health care to threat health problems that could have been prevented o Multiprovider System I High administrative cost 25 because of the complexity of a multipayer system 0 Defensive Medicine I Unnecessary care and expensive malpractice insurance 0 Waste and Abuse I Fraud in billing for health care 0 Practice Variations I Variation in treatment patterns increase costs without appreciably better outcomes 0 Cost Containment o In other countries with a onepayer system centralized controls contain costs 0 Cost containment measures in the US can only be applied because of cost shifting I Health Planning 0 The government aligns and distributes health care resources that would achieve desired outcomes for all people 0 Employs supplyside rationing o This does not really work in our largely private system I Price Controls 0 Ratesetting mechanisms in public programs to control prices 0 Conversion of Medicare 39 from a 39 system These controls have successfully slowed the annual growth of Medicare expenses but there is still cost shifting O O O O r tor r I Competitive Approaches in the Private Sector 0 Cost sharing mechanisms which place a larger burden on consumers o Antitrust laws that prohibit practices that stifle competition 0 Competition among plans and providers 0 Managed care and utilization control I Electronic Health Records 0 Will result in costcontainment benefits as well as a more coordinated health care system 0 Broad support among policy makers I Focus on Prevention 0 Current system is inefficient in regards to the treatment of chronic conditions 0 Improving preventative programs has the potential to reduce costs Access the ability to obtain needed affordable convenient acceptable and effective personal health services in a timely manner 0 A key determinant of health status and the effectiveness of the health care system 0 Data collected by the federal government states and other research institutions 0 Unequal Access I Low socioeconomic status 0 Near poor and poor more likely to be uninsured 0 Less likely to have a specific source of ongoing care I Racialethnicminorities 0 Less likely to be insured o More likely to have hospitalbased care rather than officebased care 0 Fewer cancer screenings flu shots or physician and ambulatory visits I Rural Dwellers o More likely to be poor and uninsured I Others 0 Loweducationoccupation 0 Disabled and chronically ill 0 Underinsured I Access best predicted by race income and occupation 0 Access Initiatives I Expansion of public health programs 0 Medicare and Medicaid 1965 o SCHIP 1997 I Governmentfunded community health centers I Free clinics and other safety net providers Quality the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge 9 leaves out roles of cost and access 0 Framework of Quality I Purpose measuring and monitoring quality of care STRUCTURE 9 PROCESS 9 OUTCOME I Structure the relatively stable characteristics of the providers of care of the tools and resources they have at their disposal and the physical and organizational settings in which they work 9 indicate the extent to which health care organizations are capable of providing adequate levels of care 0 Examples electronic health records the Agency for Health Care Research and Quality I Process the specific way in which care is provided 0 Examples correct quot39 g t39 tests r 39 39 drug 39 39 39 pharmaceutical care waiting time to see physician interpersonal aspects of care delivery I Outcome the effects or final results obtained from utilizing the structure and processes of health care delivery 9 bottom line measure of effectiveness 0 Examples postoperative infections nosocomial infections rates of rehospitalization patient satisfaction 0 Quality Improvement Efforts I Electronic health records I Clinical practice guidelines I Cost efficiency I Risk management 0 Conclusion 0 Increasing costs lack of access and concerns about quality pose the greatest challenges to our health care system 0 All these are interrelated and need to be addressed to improve the system Chapter 13 Health Policy 0 Introduction 0 History of federal state and local government involvement in health care 0 Americans possess a desire to have access to affordable high quality care 0 Thus the government is keenly interested in health policy 0 Health Policy the principles that characterize the distribution of resources services and political influences that impact the health of the population 0 Authoritative decisions made in the legislative executive or judicial branches of government I Affects the production provision and financing of health care services I Affects groups or classes of people I Affects types of organization 0 Can be used as regulatory tools I The government controls behavior ofa particular group by monitoring and imposing sanctions for failure to comply 0 Example state health departments regulate licensure of providers to protect consumers 0 Can be use as allocative tools I Provision of income services or goods to certain groups of individuals or institutions I Usually money 0 Example using taxes to fund Medicare and Medicaid 0 Examples of Health Policies 0 Adoption of legislation creating Medicare and Medicaid o Policies that exclude health care benefits from income taxes 0 Court ruling that employee benefits could be included in collective bargaining o Appropriations for biomedical research and development 0 Features by US Health Policy 0 Government Second to Private Sector I Health care is NOT seen as a right or responsibility of the government 0 That is why it is not universal I Americans prefer market solutions over government intervention I Government s role is to fill the gaps and respond to problems o Fragmented Reform I Complex system and multiple payers contribute to piecemeal reforms I Change is achieved incrementally over several years I The legislative process and policy implementation are daunting tasks 0 Interest Group Politics I Represent a variety of individuals and entities I Policy agenda is reflective of their own interests I Most effective at demanding reform I Employees are concerned with the provision of health insurance benefits I Consumer groups have varying interests that represent the diversity of the public I Manufacturers of technology are concerned with cost effectiveness 0 Decentralized Role of the States I States have their own health policies 0 License and regulate health care facilities professionals and insurance carriers 0 Finance and administer Medicaid 0 States finance about 50 of Medicaid I Greater control the states have more difficulty developing a national strategy 0 Impact of Presidential Leadership I Important Influence on Congressional Outcomes o Roosevelt Social Security 0 Johnson Medicare and Medicaid 0 Clinton SCHIP and HIPAA 0 Obama 2010 Health Care Reform I To be successful need political skill and political opportunity 0 How Policy Develops Issue Raising policy exists that needs to be addressed Policy Implementation used In everyday life Policy Design congress formulate policies interest groups come into play Public Support get support for policy that they came up with feel from Americans on whether they want this policy or not Decision Making Congress would vote on policy either it is passed or vetoed V o The Legislative Process 0 Health care bill is introduced in the House 0 Bill is then sent to an appropriate committee Committee andor subcommittee holds hearings and testimonies from interested parties If the committee recommends the bill the full House hears the bill The full House may add amendments When the bill is approved it is sent to the Senate where the process repeats itself When both the House and Senate approve a bill it goes to the president It becomes law after the President signs the bill If the bill is vetoed by the President Congress can overturn it with a 23 majority vote After the legislation has been signed into law it is forwarded to appropriated agencies for implementation 0 Implementation involves writing rules and regulations at the federal andor state level 0 Critical Policy Issues 0 Access to Care I Purpose of these policies is to expand care to the most needy and underserved populations I Past examples 0 Policies to ensure sufficient number of providers 00000000 0 Policies to provide or improve access to care for specific groups 0 Universal Health Coverage I Purpose is to extend health care to all eligible citizens funded publicly through taxes I Growing pressure due to increasing numbers of uninsured and underinsured I Current example 0 Employer and individual mandate by 2014 with subsidies for lowincome 0 Cost Containment I Policies are needed to contain escalating health care costs I Past examples 0 Prospective payment system under Medicare and Medicaid o Policies to stimulate the growth of HMOs 0 Quality of Care I Policies giving greater attention to policing the quality of medical care I Past examples 0 National database on legal actions against providers 0 Funded research to establish practice guidelines 0 Conclusion 0 Health providers are developed to serve the public s interest but these interests are very diverse 0 Policy makers have to find a balance for health policy to be successful Chapter 14 The Future of Health Services Delivery 0 Introduction 0 Historical precedents and current reform efforts can predict future directions 0 The lack of access to health care is a concern to many yet Americans generally are not in favor of national health care 0 It will be impossible to expand access without addressing costs 0 Costs vs Coverage 0 Two conflicting issues I Increasing costs of health care I Increasing numbers of uninsured 0 Unique factors affecting cost I We absorb the cost of research and development of technology I We assimilate a disproportionate share of immigrants I We are reluctant to pay taxes for national health care I Health insurance coverage does NOT translate to access I Expanding coverage may diminish access for many because of provider shortages I Managed care has contributed to some dissatisfaction with insurance coverage 0 Trends in Health Insurance 0 Move from definedbenefit to definedcontribution health benefits I Definedbenefit one or more insurance plans are preselected by the employer I Definedcontribution employers give a fixed amount and the employee selects the insurance plan 0 Would have more choice and portability 0 Would give spouses an incentive 0 High deductible health plans are becoming more popular because of lower cost 0 Tax credits will be used to help low income or small businesses purchase private health insurance 0 Highrisk pools will be able to purchase subsidized health insurance coverage I Who otherwise wouldn t be insured 0 Options for Reform 0 Single Payer Approach I The government will take primary responsibility for financing health care I All Americans would be entitled to benefits I Government would give access to services and reimbursement I Most cited problems with government involvement 0 Escalating costs 0 Excessive regulation 0 Irrational paperwork 0 Fraud and abuse 0 Inadequate reimbursement o Consumerprovider dissatisfaction o PlayorPay I Employers must provide health insurance to employees quotplayquot or quotpayquot a penalty I If choosing to pay the employer would pay through a payroll tax 0 Employer Mandate Hawaii I Employers are required to help pay for insurance coverage for their employees 0 Double Mandates Massachusetts I Requires an employer mandate and an individual mandate 0 Massachusetts as an Example 0 Positives I Reduction in the numbers of uninsured I Employees costs are tax deductible or subsidized for the lowincome o Negatives I Costs to the state are unsustainable I Taxes and premiums have increased I Employers have struggled to offer coverage 0 Future of Managed Care 0 Managed care will continue to be dominant but it will need to evolve to face cost pressures 0 May need to offer greater variety of plans for all income levels 0 May be necessary to employ tighter civilization lower reimbursement and ration the supply of services 0 Future of Health Care Costs 0 National health expenditures are projected to outpace growth in the GDP and consume 20 of the GDP by 2016 0 Health insurance premiums continue to outpace workers earnings and inflation 0 Fewer employers can afford to offer health insurance coverage 0 Future of Public Programs 0 Medicare and Medicaid will be an increasing burden to society due to I Increasing population of older adults I Increasing numbers of unemployed and uninsured o Unsustainable costs will require increases in taxes and cost sharing andor reductions in benefits 0 Future of System Reform 0 Most Americans want reform but are divided on the government s role in health care I Democrats want the government to have primary responsibility for providing coverage and administering health care I Republicans believe coverage is an individual responsibility best administered by the private market 0 Future Directions 0 Move from acute care to preventative care I Focus on wellness and disease prevention I Take a proactive approach in the workplace I Integrate health promotion into managed care 0 Meet the challenges posed by chronic diseases and disabilities I Reform longterm care benefits in Medicaid and Medicare I Expand communitybased services and improve care coordination I Need to train and compensate providers according to care of chronic conditions 0 Devise efforts to control infectious diseases I View from a global perspective I Link foreign and national public health policies I Work with other countries to share information and financial assistance 0 Emphasize public health I Recognize threats chemical biological and nuclear and develop measures to contain outbreaks I Safeguard the nation s food and water supply I Forge partnerships at all levels of government 0 Address problems with the health care workforce I Decline in primary care physicians I Shortage of nurses I Lack of health professionals trained in geriatrics I Need for cultural competency knowledge skills attitudes and behaviors required to provide optimal health care to people from a wide range of culturalethnic backgrounds 0 Improve medical technologies I Imaging devices I Pharmaceutical drugs I Minimally invasive surgery I Genetic mappinggene therapy I Vaccinations 0 Implement evidencebased medicine EBM I Use best practices derived from research to improve quality while reducing costs I Incorporate EMB into computer decision making systems I Create financial incentives for providers who use EBM 0 Conclusion 0 Social cultural technological and economic changes will determine the future of the health care system 0 The health care system is always evolving stay tuned Health Reform 39 39 39 Timeline 0 Patient Protection and Affordable Care Act 0 Comprehensive health reform signed into law by President Obama on March 23 2010 o 2010 0 Insurance Reforms I Provide dependent coverage for adult children up to age 26 for all individual and group policies I Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prior to 2014 plans may only impose annual limits on coverage as determined by the Secretary Prohibit insurers from rescinding coverage except in cases of fraud and prohibit preexisting condition exclusions for children I Require qualified health plans to provide at a minimum coverage without costsharing for preventive services rated A or B by the US Preventive Services Task Force recommended immunizations preventive care for infants children and adolescents and additional preventive care and screenings for women 0 Medicare I Provide a 250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010 and gradually eliminate the Medicare Part D coverage gap by 2020 o 2011 o PreventionWellness I Eliminate costsharing for Medicare covered preventive services that are recommended rated A or B by the US Preventive Services Task Force and waive the Medicare deductible for colorectal cancer screening tests Authorize the Secretary to modify or eliminate Medicare coverage of preventive services based on recommendations of the US Preventive Services Task Force 0 Quality Improvement I Improve access to care by increasing funding by 11 billion for community health centers and the National Health Service Corps over five years establish new programs to support schoolbased health centers and nursemanaged health clinics o 2014 0 Individual and Employer Requirements I Require US citizens and legal residents to have qualifying health coverage phasein tax penalty for those without coverage I Assess employers with 50 or more employees that do not offer coverage and have at least one fulltime employee who receives a premium tax credit a fee of 2000 per fulltime employee excluding the first 30 employees from the assessment Employers with 50 or more employees that offer coverage but have at least one fulltime employee receiving a premium tax credit will pay the lesser of 3000 for each employee receiving a premium credit or 2000 for each fulltime employee excluding the first 30 employees from the assessment Require employers with more than 200 employees to automatically enroll employees into health insurance plans offered by the employer Employees may opt out of coverage 0 Insurance Reforms


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