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