Week of October 26th Notes
Week of October 26th Notes UAPP110
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This 4 page Class Notes was uploaded by Audrey West on Wednesday October 28, 2015. The Class Notes belongs to UAPP110 at University of Delaware taught by Erin Knight in Summer 2015. Since its upload, it has received 11 views. For similar materials see Changing the World and Public Policy in Public Health at University of Delaware.
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Date Created: 10/28/15
October 26 2015 Notes Health Policy Part 1 Health Care Policy Recent history of US health insurance 1930s health insurance 1950s employer sponsored health insurance grows 1965 public health insurance Medicare amp Medicaid established 1990s2 reform attempts Clinton era state children s health insurance program 1997 2010 affordable care act Obama care How is the government involved in health care Safety net providers Public health programs for special populations conditions Quality In the US we have publicly funded health insurance and privately funded health insurance hybrid Before the Affordable Care Act most people had insurance through their employer Health care around the world Health care systems in other countries 0 Health care is a quotrightquot quotmerit goodquot Other developed countries have 0 Universal coverage 0 National health insurance or single payer o More price controls regulation 0 Fewer forprofit stakeholders What are the major problems in the US health care system Cost high Poor access Poor quality Sometimes assume If we increase access it is going to cost more If we reduce cost we might lose quality If we increase quality it will cost more 1 Cost Growing burden on government public spending Growing burden on employers 0 Large businesses offer health insurance but don t have to 0 Small businesses increasingly cannot provide Growing burden on individuals 0 Bankruptcies due to health costs 0 Cost sharing Over half of bankruptcies in the US are caused by health care costs can t afford Why are the costs so high The Health Care Market Compared to other individualized countries the US has LESS QUANTITY THAN OTHER COUNTRIES Fewer physician office visits per capita Fewer hospital impatient admissions per capita Lower average length of stay ALOS per admission Fewer hospital impatient days per capita o Etc Total expenditures price quantity Third party payer system insurance system amp market failures a lot of build in inefficiencies 00000 2 Access to care preACA Uninsured Underinsured o Preexisting conditions exclusions o Portability concertinas Other barriers 0 Language 3 Quality We have some of the best health care treatments in the world We lead the world in medical innovation 0 For certain diseases US has better results In many HEALTH measures we lag other countries 0 Infant mortality rate 59 per 1000 live births 44th 0 Life expectancy 79 years 33rd Our outcomes are not the best in the world Medical errors Every year in the US there are 12000 deaths from unnecessary surgeries 7000 deaths from medication errors in hospitals 20000 deaths from other errors in hospitals 80000 deaths from infections acquired in hospitals 106000 deaths from FDAapproved correctly prescribed medications Total annual medicallycaused deaths in the US 225000 The medical system is the third leading cause of death in the US behind heart disease and cancer One alternative solution Patient protection amp affordable care act of Key elements of the PPACA staged roll out Expands Medicaid and CHIP Mandates that individuals not covered through their employers or by public programs purchase a minimum level of insurance or pay a penalty Subsidies for those that cannot afford insurance Mandates penalties for large employers that don t provide insurance incentives for small employers to do so Coverage regulations eg no exclusions for preexisting conditions eliminate certain limits on coverage require insurance companies to cover children up to age 26 on parents plan October 28 2015 Notes Health Policy Part 2 HEALTH is a state of complete physical mental and social wellbeing and not merely the absence of disease of infirmityquot NOT JUST THE ABSENSE OF A DISEASE Shifting the frame different policy goals Treating illness VS promoting health different problems different goals different policies Root cause of poor health unhealthy communities Redefining the problem as poor health and focusing on ROOT causes General socioeconomic cultural and environmental conditions 0 Living and working conditions I Unemployment I Water and sanitation I Health care services 1015 I Housing I Agriculture and food production I Education I Work environment Social and community networks Individual lifestyle factors Background Race and Health Really about racism and racial discrimination No biological basis for differences in health Racial discrimination contributes to uneven quality and distributing of the social determinants of health Racial discrimination creates chronic stress and contributed to poor health independent of other social factors Background unhealthy places Where a person lives which is largely driven by their position in the social hierarchy determines whether she or he is surrounded by things that make it easy or difficult to maintain healthy behaviors maintain good health Place matters above and beyond the characteristics of the individuals living in that place An alternative to healthcare policy HEALTHY public policy Minimum wage
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