Financing Healthcare: Legal, Ethical, and Policy Implications (see following flashcards)
Financing Healthcare: Legal, Ethical, and Policy Implications (see following flashcards)
What elements must be considered in financing healthcare?
- Must balance healthcare costs, benefits, and responsibilities
- What is the "right thing to do" and who decides?
- Sources of law (the Constitution is our primary source of law in America)
- How are populations motivated to change behaviors?
How does
supply and demand
and the
allocation of scarce resources
related to the health care delivery system?
- Health care is ALWAYS subject to the laws of
supply and demand
- Health care is ALWAYS subject to
the allocation of scarce resources
- There is always some form of
rationing
, either organized and systemic (think government) or informal and personal (th
How do economics (and more specifically anarchy and totalitarianism) relate to the American Health Care Delivery System?
-
Anarchy vs. totalitarianism
continuum: no regulation vs. smothering control
-
Anarchy
in healthcare: this refers to no policing of providers, medications, and treatments
-
Capitalism or market economy
in healthcare: some regulation, balancing competitio
How is control of the economics of the U.S. Healthcare Delivery System achieved?
Control is achieved through a combination of:
a. Law
b. Economics (supply and demand)
c. Bureaucratic regulation
d. Reward and punishment
e. Suppression of dissent
Describe the economics of the Affordable Care Act: who is paying for the ACA?
Everyone who is working
Describe the economics of the Affordable Care Act: describe the economics of insurance
Everyone in the pool and unlimited coverage for all
Who does the ACA provide for and what does it entail?
- Increased variety of taxes (taxes on medical devices; i.e. pacemakers)
- Increased insurance costs, increased deductibles, and increased co-pays
- Decreased Medicare (age 65+) coverage
- Increased Medicaid expansion
Who is exempt from the ACA?
- Amish
- Indian Nations
- Unions
- Some large corporations
- Elected leaders
List the two sectors of the population.
1. Private sector
2. Public sector
Describe the private sector.
1. Our "eclectic system"
2. Refers to those portions of society who have insurance through employers or are self-funded
3. Voluntary agencies (PPO, health networks)
Who funds the public sector?
The public sector is TAXPAYER funded.
What three categories are included in the public sector?
1. Federal
2. State
3. Local
Who is included in the FEDERAL public sector?
- Health and Human Services (Medicare, Medicaid, CDC)
- United States Public Health Service (USPHS)
- FDA
- Tribal/Indian Health Agencies
- National Institute of Health
- Department of Agriculture
- Department of Homeland Security Health Affairs
Who is included in the public STATE sector?
- State health departments
- SON
- Doctor of Dental Surgery (DDS)
- Medical director (MD)
- Doctor of Osteopathy (DO)
- Doctor of Veterinary Medicine (DVM)
- Special funding for agencies, clinics
Who is included in the public LOCAL sector?
- County health department
- Inspectors
- H2O
- Clinics
- Disaster Management
When did Medicare begin?
1965; sky rocketed since
What does Medicare Part A include?
Hospitalization
What does Medicare Part B include?
- Supplement tx
- Voluntary tx
- Providers
- Home health
What does Medicare Type C include?
- Called the "Medicare Advantage"
- For additional services, you contract with private providers - voluntary
What does Medicare Type
D
include?
Partially covered prescription
d
rugs
What is not covered by medicare?
- Nursing home room and board
- Tx for chronic issues
- Dental (dentures)
- Eye (glasses)
- Ears (hearing aids)
- Foot care
- Medicare mandates the need for "spending down" to qualify for Medicare
Changes in Medicaid
- Medicaid
blocks grants to states.
So, more
local
control of services; however, string attached.
-
Coverage
for poor/needy -
varies by state
- Elderly and disabled receive most of medicaid $$.
- But more children get care under Medicaid.
- Medicaid pays
Medicaid: how do providers and patients feel?
Excellent services for clients; not so great for providers!
What is the program under Medicaid that cares for uninsured children or under-insured children? Who controls this program (federal, state, or local)?
CHIP. It is controlled at a STATE level, not federal.
Medicaid and Clinics?
Medicaid allows clinics to offer AIDS, TB testing and vaccines under grant funding.
Public Health Law: PRIMARY purpose
All legislation, regulations, and court decisions enacted by federal, state, and local governments serve to
protect the PUBLIC'S health
.
*P*rimary = Protect
P
P
rimary = Protect *P*ublic health
Public Health: SECONDARY purpose
To protect
GROUPS
of persons.
Public Health: TERTIARY purpose
To protect the
INDIVIDUAL
Public health: mostly funded by _____?
The taxpayer
List the three levels of public health and examples of each.
1. Federal: medicare, medicaid
2. State: Medicaid, SCHIP/CHIP (the state children's health insurance program)
3. Local: pet leash laws
What is administration regulation?
How laws are carried out.
What writes/composes administrative regulation?
Bureaucrats and policy people.
Public health services: are the constant across America or do they vary?
Public health services vary from jurisdiction to jurisdiction and from state to state.
Describe various public health (BSN or greater) nursing roles.
- Home health nurse
- Visiting nurses
- School nurses
- Others
Flexible settings for nursing?
- Homes
- Schools
- Residential care
- Others
LOCAL
public health funding: where does funding come from (2)?
1.
Local levies
(millage: amount of $ per assessed values of homes/property)
2.
State and/or federal funds and grants
Public Health: payments?
Use of a sliding fee scale for clients
State and federal grants help fund local public health programs. Where does the state and federal government get this money from?
- Taxes and fees
- Line items in budgets and earmarks (CDC)
- Block grants (community block development grant)
- Medicare/medicaid
- Private foundations
- Legal settlements
What is an earmark (internet)?
An earmark is a legislative provision that directs approved funds to be spent on specific projects, or that directs specific exemptions from taxes or mandated fees.
What is a line item in a budget (internet)?
A budget in which the individual financial statement items are grouped by cost centers or departments. It shows the comparison between the financial data for the past accounting or budgeting periods and estimated figures for the current or a future period
What are common services provided by local public health departments?
- Immunizations
- TB testing and treatment
- AIDS/HIV testing and counseling
- EPSDT (Well-child HealthChek exams)
- Family Planning
- Home health
- Prenatal care
- Dental
What is the purpose of policy?
Purpose of policy is to offer: direction, effort, goals, funds, and behavioral control
How do you establish policy?
Political or research-based
What is the carrot and stick approach to policy?
Carrot and stick"
approach refers to a system in which policy
demonizes or punishes the "bad"
and
incentivizes the "good.
Describe the economics of the Affordable Care Act
1. Who paying is paying for ACA? Everyone
The United States Health Delivery System PP
The United States Health Delivery System PP
*What are the three basic types of health care delivery systems?
1. Government provided health care
2. Comprehensive private (free-market) health care
3. Combination of private + public health care
3. No health care
What three terms would you use to describe the U.S. Health Care Delivery System
pre-ACA?*
-
DECENTRALIZATION
to some extent
- Laissez faire philosophy (an economic system in which transactions between private parties are free from government interference)
- History of abundance of economic and spiritual resources
Health care and economics: supply and demand and scarce resources?
Health care is always subject to the laws of supply and demand. With scarce resources, there is always a form of rationing!
What are examples of current health care services in America?
1. Public health
2. Preventative medicine
3. Emergent care and triage
4. Non-emergent care (chronic conditions)
5. Inpatient care and surgery
6. Long-term and rehabilitation care (nsg homes)
7. social, emotional, and developmental care
8. Transportation o
Costs are up for health care... why (as it relates to government and inflation)?
- Increased government spending
- Increased government regulation
- Cost inflation (overall vs. health care delivery system)
Costs are up for health care... why (as it relates to drug costs and technology)?
- ^ consumer demands for technology (i.e. Also, increased consumer demands for technology - it used to be that a sprained ankle required only RICE. If you have a sprain, nowadays, you go to the ER or the minute clinic - and they do an XRAY or an MRI to dx
Costs are up for health care... why (as it relates to the population)?
- Aging population
- Increasing life expectancy
- Population changes
Costs are up for health care... why (as it relates to the health care workers/system)?
- Increased wages of health care workers
- Administrative and medical excesses
- Tax implications
What do some people support about ACA (how long can kids stay on their parent's insurance)? (1)
Children can remain on parents' insurance until age 26.
Why do some people support ACA (what concept is ACA founded on)? (2)
The Affordable Care Act is based on the concept of "healthcare for all.
Why do some people support ACA (cost for male and female)? (3)
The ACA cost the same for males and females.
Why do some people support ACA (pre-existing conditions)? (4)
Coverage for pre-existing conditions right away.
Why do some people support ACA (cost)? (5)
Less expensive or "free" for some, especially low income or no income.
Why do some people support ACA (coverage)? (6)
- There is more and less coverage for preventative care (i.e. the ACA covers abortions; but, now they don't cover mammograms until later in life - to adjust for the cost of the expensive abortions)
- There is more coverage for cost-prohibitive care (maybe
What do some people oppose about the ACA (issues with government)? (1)
1. The
government mandates purchase
of insurance > loss of "life, liberty, and pursuit of happiness,"
loss of freedom
2.
Government intrusion
into:
a. Private health matters
b. Loss of privacy of financial information
c. ^ hacking
What do some people oppose about the ACA (issues with economy/jobs)? (2)
- Decreased jobs and decreased economy
What do some people oppose about the ACA (specifically with jobs)? (3)
The ACA decreases medical professions; increases nursing professions.
What do some people oppose about the ACA (conceptual issues)? (4)
The ACA takes a "one size fits all" approach (covers maternity, abortion, and birth control for EVERYONE, regardless of need)
What do some people oppose about the ACA (issues with cost)? (5)
^^^^^ cost
What do some people oppose about the ACA (issues with policy makers; specifically, which policy maker)? (6)
The Independent Payment Advisory Board (IPAB).
What is the Independent Payment Advisory Board (IPAB) as it relates to the ACA?
The IPAB consists of unelected policy people making life and death decisions about YOUR coverage.
Describe how the ACA is supposed to work (5 steps).
1. Insurance purchased on healthcare exchanges or enrolled in Medicaid expansion.
2. Consumers "shop" for a plan (bronze, silver, or gold)
3. Subsidies (tax dollars) to those making up to 4x the poverty rate (about 96,000/year) - the less you make, the mo
Describe how the ACA will impact you - as an employed taxpayer.
1. As an employed taxpayer, you will pay a lot more for healthcare for yourself and others.
Describe how the ACA will impact you - more specifically, your freedom.
You cannot opt out of insurance coverage. You will be fined for non-participation at increasing amounts.
Describe how the ACA will impact you - ethically.
You may have ethical issues with the care you pay for (abortion, gender-reassignment surgery).
Describe how the ACA will impact you - as an ethical provider?
You may have ethical issues with the care you are expected to provide (abortion, promotion of gay lifestyle).
Describe how the ACA will impact you - and your use of the health care system.
1.
Fewer MDs and more patients
- this means longer waits for appointments, surgery, and treatment.
2. Available providers may not be the quality you want; you
may not have alternatives
.
Describe how the ACA will impact you - and the care you quality to receive (think of what agency determines this)?
- Bureaucrats (Independent Payment Advisory Board) will decide what treatments/surgeries/medicine you and your family may receive based on criteria such as age.
Describe how the ACA will impact you - and the
quality
of your treatments.
Treatments, surgeries, and medications you are offered may not be the quality or effectiveness you want.
You may not be allowed to purchase alternatives
(i.e. you may not get coverage for brand name medications; the insurance company may only pay for gene
Community Health Nursing Powerpoints
Community Health Nursing Powerpoints
Define: Community Health Nursing
Denotes setting for nursing practice.
Define: Community-Based Nursing
ADN
(associate's degree of nursing) practicing in a community setting at a
family or individual level
.
****Define: Public Health Nursing
BSN or ^
practicing in a community setting at a
GROUP OR POPULATION LEVEL
...To remember...
public
bathrooms are full of
BS
...BSN = ^ public health nursing = higher education...
Public Health Nursing: how is preparation for public health nursing (BSN and ^) different from community-based nursing (ADN)?
Public health nursing: requires specific educational preparation (epidemiology, statistics, research, systems, population, and regulations)
Define epidemiology.
The study of health in human populations.
Define population.
A
group of persons under study
, residing in an area.
Define group.
A set of persons, engaged in face-to-face interactions.
Define aggregate.
People without relatedness but with one or more characteristics in common.
Brief history of health care: Europe in the Victorian Era
Who is the primary health care professional of this time?
Florence Nightingale
Florence Nightingale: what four things did she advocate?
1. Sanitation
2. Hygiene
3. Health promotion
4. Health teaching
What 2 organizations did Nightingale establish?
Established:
1. Visiting Nurse Association
2. District Nursing
Who helped support/fund Nightingale's establishment of the Visiting Nurse Association and District Nursing?
William Rathbone
Florence Nightingale was a member of what two societies?
Nightingale was a member of:
1. Royal society of statisticians
2. Honorary member of the American Academy of Statisticians
What is notable about the American Academy of Statisticians (Nightingale as a member)?
The American Academy of Statisticians (Nightingale was an honorary member) produced the
first meaningful empirical research in health care.
Prior to the American Academy of Statisticians (of which Nightingale was an honorary member), only traditional and
What was the main impetus for health care in the United States?
Wars and epidemics.
Wars and epidemics in America go hand in hand with the history of health care and ______?
Nursing
Nursing in America: "Born in the _______, raised in the
Nursing in America = Born in the
church
, raised in the
military
.
America and community health nursing corresponds to what system?
America and community health nursing corresponds to the
British system
(as do most of our traditions and customs).
Who are the four notable individuals related to community health nursing?
1. Dorothea Dix
2. Lillian Wald
3. Margaret Sanger
4. Mary Breckinridge
Four notable individuals related to community health nursing: Dorothea Dix, describe
Dorthoea Dix:
Superintendent of women nurses of the army (Union)
...remember, some people in the army are "dix"s...
Four notable individuals related to community health nursing: Lillian Wald, describe
1. Lillian Wald established the
Settlement House on Henry street (1983)
2. Wald later founded the
National Organization of Public Health Nurses
3. Impetus for school nursing
4. Giant in PHN/CHN history
...remember: sometimes you have to "wald" (wad) up yo
Four notable individuals related to community health nursing: Margaret Sanger, describe
Margaret Sanger >1912 early birth control efforts
...remember: you never "sing" (think:sang) if birth control doesn't work...
Four notable individuals related to community health nursing: Mary Breckinridge, describe
Frontier Nursing Service, 1925
...remember, you cross a lot of "bridges" (ridges) in the "frontier"...
Education's role in Community Care Nursing
- In 1963, the government mandated public health nursing in BSN curriculum
- Constantly evolving today
Global Health Concerns (8)
1. Disparity in resources
2. Infectious diseases vs. chronic diseases
3. Diarrhea associated with poor sanitarian or contaminated water supply
4. Malnutrition
5. HIV/AIDS, Malaria, TB, Ebola, Polio
6. Maternal morality
7. Refugees
8. Modern slavery/human
What are the 8 roles of the community health nurse?
1. Employees or volunteers
2.
Epidemiologic studies
- health of a population
3.
Communicable disease control
4. Health care planning
5.
Education
of nurses and other professional
6. Provision of direct care
7. Program administration
8.
Research and advoca
Health and Wellness Power Point: Ch. 18-20
Health and Wellness Power Point: Ch. 18-20
Define health.
Health is a state of being that people define in relation to their own values, personality, and lifestyle (absence of disease).
Define wellness.
Quality or state of being in good health; process of moving toward maximum potential (QOL).
What three variables influence health and wellness?
1. Lifestyle
2. Genetics
3. Environment
Models of Health and Illness: Becker's Health Belief Model
- Becker's Health Belief Model:
B
elief vs.
b
ehavior
- Focuses on
prevention of disease
- Becker's Health Promotion Model looks at SUSCEPTI*B*LITY, severity, benefits,
B
B
ecker's Health Promotion Model looks at SUSCEPTI*B*LITY, severity, benefits, *B*AR
Models of Health and Illness: Pender's Health Promotion Model
- Active pursuit of health
- Goal of Pender's Health Promotion Model: to improve well-being
...remember: the desire to "improve well-being" is "pending" (think Pender's model)
Models of Health and Illness: Maslow's Hierarchy of Needs
- Begin with FIRST meeting basic human needs - physiologic needs
- Then, you can progress to safety > love/belonging > self-esteem > self-actualization
Models of Health and Illness: Primary Health Care Model
Six sectors r/t health of the community:
a. Education
b. Economics
c. Environment
d. Health care services
e. Politics
f. Agriculture
Health services
Is the impact of illness an isolated event?
No. The impact of illness is NOT an isolated event.
Illness is not an isolated event. What five variables does illness affect?
1. Illness causes behavioral and emotional changes
2. Body image
3. Self-concept
4. Family roles
5. Family dynamics
What two variables affect illness and illness behavior?
1. Internal variables
2. External variables
Describe the
internal
variables that affect illness and illness behavior.
1. Belief/perception
2. Spirituality
3. Self-esteem
Describe the
external
variables that affect illness and illness behavior.
1. Visibility of symptoms
2. Social groups
3. Cultural background
4. Economic variables
5. Accessibility of health care
6. Social support
Additional internal variables that affect illness and illness behavior.
1. Developmental stage
2. Intellectual background
3. Perception of functioning
4. Emotional - stress
5. Spiritual factors - relationships, hope, life, meaning, religion
Additional external variables that affect illness and illness behavior.
1. Family practices
2. Socioeconomic factors
3. Cultural background
What are the three levels of preventative care?
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention
Explain primary prevention (levels of preventative care).
- Primary prevention refers to interventions that promote health and wellness; they occur PRIOR to disease
- Examples:
health education
, immunizations, fitness, and nutrition
Explain secondary prevention (levels of preventative care).
- Secondary prevention occurs when their is a disease PRESENT
- Secondary prevention includes: prompt care,
minimize disability
, and return to health
Explain tertiary prevention (levels of preventative care).
- Tertiary prevention involves treatment of a
permanent and irreversible condition
with the goal to
MINIMIZE
a problem and
REDUCE
disability
Health promotion activities: a primary, secondary, or tertiary prevention?
Primary prevention; these are health promotion activities that occur PRIOR to disease.
Health promotion activities consist of what two categories?
1. Passive
2. Active
Define and describe PASSIVE health promotion activities.
1. Define: health promotion activities that YOU do not do personally, they are preformed on your behalf
2. Examples:
- Fluoride in drinking water
- Homogenization of milk
- FDA activities
Define and describe ACTIVE health promotion activities.
1. Define: health promotion activities that YOU engage in
2. Examples:
- Exercise
- Nutrition
- Stress reduction
- Immunizations
What are the benefits of community health promotion?
- Community health promotion reaches many (hence, the community portion)
- Community health ^ awareness
- Cost-effective
- May act as a trigger for healthier behaviors
- Develops social support for idea
- Encourages information for sharing
What are various settings for community health promotion programs?
- Families
- Schools
- Workplace
- Faith communities
- Healthcare facilities
- Community-wide
What are the stages of health care behavior?
1. Pre-contemplation - no interest in change
2. Contemplation - considering change, may plan to change in six months or so
3. Preparation - planning and making SMALL changes
4. Action - actively involved in the change
5. Maintenance stage - change occurre
Screening and referral: is this a primary, secondary, or tertiary prevention? What is a screening/referral?
Screening and referrals are SECONDARY prevention strategies.
Screening and referrals are tests or procedures used to evaluate if a disease or condition is present.
Refresh: what is secondary prevention?
Secondary prevention - Early detection and treatment of illness (pathogenesis)
Validity vs. reliability?
1. Validity: always correct, no false positives or negatives
2. Reliability: are results reproducible?
Who is screened and why?
-
Population-based care
screens on a basis of
demographics
, NOT on the basis of individual risk factors
- Why screening? It is simple, accurate, inexpensive, and low risk.
Why screening (a secondary promotion)?
EARLY detection and treatment often results in better outcomes.
What is important in relation to screening?
Follow-up recommendations are important for better outcomes.
Community Nursing Process and Screening
1. Assessment - community needs and resources
2. Planning - have a
referral
plan
3. Implementation - document
4. Evaluation - include both outcomes and processes
Why is REFERRAL essential to screening?
- It is unethical to obtain data indicating an individual might be ill and do nothing about it
What are the four criteria to referral?
1. Establish referral criteria
2. Write a referral, maybe follow-up call
3. Resources directory or list
4. Evaluate effectiveness of referrals