Health Systems & Advocacy

HMOs

stay in network, gatekeeper, need referral

What is a pre-existing condition?

-Diabetes, HIV, Cancer
Insureres banned from denying coverage for a ore-existing condition.

Is the ACA constitutional

Yes, Supreme Court ruled it was a tax and under tax authority.

Can Federal government require to expand Medicaid

No, because Medicad is a part federal/part state program

Do closely help corporations have to cover contraceptives in their employer-provided health insurance?

no, according to hobby lobby decision.
-have to send a letter& insurance company has to pay.
-lawsuit from hobby lobby so they won't have to pay for workers contraceptives.

`What is a block grant?

A salary- whether work 40/60 hours, still recieve alloted amount (better for fed gov).
Medicare will turn into a block grant program.

Tax credit

reimbursement taxing out of tax (better for gov).

Subsidy

paid for upfront (better for people).

What is a high risk insurance pool?

allocated money to pay for sick. Sickest into gov. subsidizes waiting list pool. Doesn't provide best health services for the sickest.
-lowers premiums for everyone else.

What is reinsurance?

When multiple insurance companies share risk by purchasing insurance policies from other insurance policies form other insurers to limit the total loss of the original insurer would experience in case of disaster.

What is catastrophic health insurance policy?

-bare minimum
-high deductible
-premiums low
(young, broke, healthy)

Democratic proposals include

Medicare for All: Bernie Sanders- would create a single-payer system based on the current medicare.
Medicaid for All: Senator Brian Schatz- allow individual citizens to buy into medicaid plan cure.

4 Basic Models of Health Care Insurance

Out-of-Pocket, Bismark, National Health Insurance, Beveridge

Out-of-Pocket

least government involvement (uninsured) only those with money can afford.

Bismark

U.S.
2nd least gov. involved (medicare part D, ACA, ect.)
-individuals buy from private insurers
-American's with employer provided health insurance are most familiar
-government regulates
-government subsidizes

National Health Insurance

Canada
2nd most gov. involved (medicare )
-everyone pays for through a tax
-government is the insurer
-providers usually are private businesses

Beveridge

UK/Great Britain
Most gov. involved (Tricare, VA)
-Insurance is public
-Provider is public

Primary types of people served by public health insurance programs

TRICARE, Medicare, Medicaid, Indian Health Insurance, Veterans (VA)

TRICARE

Active duty

Medicare

Older age

Medicaid

Low income, young

Indian Health Service

Any native american on a reservation

Veterans Administration (VA)

retired

Economic Models

Command, Mixed Market and Market

Equality

communism" "socialism" seeks ideal of all people treated humanely- "iron rice bowl" challenges

Socialism

seeks to balance the two by providing social safety net and regulations within a free market economy

Laissez-faire capitalism

seeks freedom, creativity and individual responsibility.
-poverty

What is a tariff?

border tax on imports.
-NAFTA lowered tariffs on goods traded between the U.S. Mexico and Canada.

Types of Healthcare

Primary, Secondary and Tertiary

Primary

vaccines your regular doctor checkups. preventative care and illnesses, primary care physician, nurse, nurse practitioner

Secondary

Hospital care: usually involving referral to a specialist such as a psychiatrist, psychologist, physical therapist

Tertiary

Specialists such as cancer management, heart surgery, rehab.

What are the largest (by number of hospitals and revenue) hospital systems in the U.S.?

51% non-profit (private)- 2,845
21% federal, state, municipal (public)- 1,039
19% for-private- 983
total: 4,862
AMA employs 5.7 million U.S.
revenue: Kaiser
number: hospital corporation of America

What is FICA? Federal Insurance Contributions Act

Whatever you pay, your employer matches*
-15.3% total of an employee's gross pay (before taxes)
-employers pay 7.65%
-6.2% goes to OASDI (old age, survivors & disability) program or social security
-1.95% goes to medicate
employee (1.95%) + employee (=2.9

Who is Tommy Douglas?

The "father" of Canada's universal healthcare system 2004 voted Greatest Canadian the late premier of Saskatchewan established prototype for the country's medical system.

How did Canada's healthcare develop? how does it function (type, how is it funded, ect.)

Opposed healthcare reforms that cover more people of cheaper costs. ex: medicare
Service-plan: pay one fee (cheaper) AMA declares unethical
Fee-for-service: pays for each service
-Funded through tax

What is cultural competency?

Our perspectives on health and healthcare, expectations and biases about care, medications, ect.

Health equity

Outcomes for all are the same, income tax is equity, sales tax equality

SES

Socioeconomic status

How did the US modern healthcare system develop over the past 100 or so years?

Licensure, accreditation, attend medical school

What is the Flexner Report?

1910: The Carnegie Institute funds Abraham Flexner to write a comprehensive report on medical education, sets the framework for modern US medical education.

When did the US start to require a prescription for narcotics?

1914: Harrison Narcotics Act requires a prescription for narcotics above a center limit.

When did the US start to require a prescription for all but OTC medications>

1951: The Durham-Humphrey Amendment to the 1938 Food and Drug Act requires pharmacists to now need a prescription before dispensing medications.

Primary Care Physicians

provide primary ease at your loval doctors office
-family physicians, pediatricians, internists (treat adults)

Specialists

treat only a specific part of the body and its malladies.

Hospitlists

terat patients only in a hospital; other specialists may see their patient at their offices outside of hospital.

Advanced Practice Registered Nurse (APRN)

Master's- median salary $96,460 also jknown as NP or specialty nurse

Registered Nurse (RN)

Associates or Bachelor's $65,470

Licensed Practitioner Nurse (LPN) `

One-year vocational program- $41,540

Certified Nursing Assistant (CNA)

75-hour vocational program $24,000 also known as orderlies

What are some of the legal restrictions on NPs and PAs?

PA's in all states must work under physician supervision
-NP's are having laws in increasing states pass to practice full scope
-PAs charts must be co-signed by MD's
-some states can write prescription