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Questions and Answers
A family with health insurance is burdened by significant medical debt after childbirth. Which factor most likely contributes to their financial strain, considering common healthcare system challenges?
A family with health insurance is burdened by significant medical debt after childbirth. Which factor most likely contributes to their financial strain, considering common healthcare system challenges?
- Their insurance policy covers all costs associated with childbirth, but they chose to use out-of-network providers.
- The timing of the twins' birth straddling two calendar years, causing a reset of their insurance deductible and out-of-pocket maximum. (correct)
- The family's income is low enough to qualify for comprehensive Medicaid coverage.
- Their insurance plan has no out-of-pocket maximum, leaving them exposed to unlimited costs.
According to the World Health Organization (WHO), what is the most accurate and complete definition of 'health'?
According to the World Health Organization (WHO), what is the most accurate and complete definition of 'health'?
- The absence of diagnosed diseases or physical injuries.
- A state of physical fitness achieved through regular exercise and a balanced diet.
- The capacity to perform daily activities without significant pain or discomfort.
- A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. (correct)
A patient requires a specialized surgery. Considering the complexities of the healthcare system, what is the MOST important initial step for the patient to take to minimize their out-of-pocket expenses?
A patient requires a specialized surgery. Considering the complexities of the healthcare system, what is the MOST important initial step for the patient to take to minimize their out-of-pocket expenses?
- Begin fundraising to cover potential expenses, assuming the insurance will only cover a small portion.
- Research the surgery online to find the cheapest option, regardless of the surgeon's qualifications.
- Immediately schedule the surgery with the first available surgeon to expedite the process.
- Consult with their insurance provider to understand coverage details, pre-authorization requirements, and in-network provider options. (correct)
Which situation best illustrates a challenge related to healthcare access, as opposed to healthcare quality or cost?
Which situation best illustrates a challenge related to healthcare access, as opposed to healthcare quality or cost?
What is the most significant implication of the World Health Organization's (WHO) definition of health for healthcare policy?
What is the most significant implication of the World Health Organization's (WHO) definition of health for healthcare policy?
A hospital implements a new electronic health record (EHR) system. What potential challenge could arise that directly impacts the 'social well-being' aspect of a patient's health, as defined by the WHO?
A hospital implements a new electronic health record (EHR) system. What potential challenge could arise that directly impacts the 'social well-being' aspect of a patient's health, as defined by the WHO?
A public health campaign aims to reduce preventable premature deaths. Based on the information provided, what action would be most aligned with this goal?
A public health campaign aims to reduce preventable premature deaths. Based on the information provided, what action would be most aligned with this goal?
A researcher is studying the impact of socioeconomic status on health outcomes. Which aspect of the WHO definition of health would be most directly relevant to this research?
A researcher is studying the impact of socioeconomic status on health outcomes. Which aspect of the WHO definition of health would be most directly relevant to this research?
Flashcards
Out-of-pocket Maximum
Out-of-pocket Maximum
The maximum amount a person pays out-of-pocket for healthcare expenses in a plan year.
Medicaid
Medicaid
A federal healthcare program for individuals and families with low income and limited resources.
WHO Definition of Health
WHO Definition of Health
A complete state of physical, mental, and social well-being, not merely the absence of disease.
Medical Debt
Medical Debt
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Insurance Policy Reset
Insurance Policy Reset
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In-network Services
In-network Services
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Deductible
Deductible
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Coinsurance
Coinsurance
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Study Notes
- The Healthcare system will be introduced.
- My insurance policy can be found online.
- Everyone has a unique story.
Child Birth and Insurance
- A middle-class, insured family was left with crippling debt after childbirth.
- One family's medical bills were a concern because their income was too high for Medicaid in Illinois.
- Their health insurance had a $28,500 out-of-pocket maximum for in-network services.
- The twins were born near the end of 2022, and one twin stayed in the hospital until January 2023.
- The insurance policy reset in January 2023 for this family.
- The family owed close to $38,000, which was almost a quarter of their annual family income.
What is Health
- Health is defined as a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.
- This definition was adopted in 1946 by the World Health Organization.
Preventable Premature Death
- Preventable premature deaths among those aged <80 years from the five leading causes of death by year–National Vital Statistics System, United States, 2010–2022 were studied.
The Goal and Strengths of US Healthcare
- The primary goal of a healthcare system is to enable all individuals to access cost-effective healthcare that meets quality standards.
- Strengths of the U.S. health system include technology, research, and medical training.
Weaknesses of US Healthcare
- The financing is primarily employer-based as a fringe benefit.
- There is a lack of overall planning, direction, and coordination.
- Administrative costs in the U.S. are 300% higher than in Canada.
- Access to healthcare is compromised for people with low socioeconomic status.
- There is a lack of long-term care insurance coverage.
- Only 3.5% of healthcare dollars in 2022 was allocated to programs focused on illness prevention.
- There is a high per capita cost with low health outcomes ranking.
- Total spending on health in the U.S. in 2023 was $14,570 per person.
- The average annual premium for a family was $25,575 in 2024.
- The average annual health insurance premium in 2024 for an individual was $8,951.
- Since 2014, premiums have increased 52%.
Health System Performance Rankings 2024
- US ranks 10th overall.
- It falls behind Australia, Canada, France, Germany, Netherlands, New Zealand, Sweden, Switzerland, and the UK.
Healthcare in Sweden vs US
- In Sweden, the GDP spent on healthcare in 2019 was 10.9%, while in the U.S., it was 17.0%.
- The infant mortality rate per 1000 births in 2019 was 2.5 in Sweden and 5.8 in the U.S.
- The life expectancy in 2019 was 84.3 in Sweden and 81.2 in the U.S.
- Public health expenditures as a percentage of total health expenditures in 2019 were 82% in Sweden and 48% in the U.S.
- Sweden invests more in the nonmedical determinants of health.
- Sweden's services related to housing, the physical environment, work conditions, supportive social environment, family allowances, income support, and unemployment support.
US Healthcare System Models
- For most working people under sixty-five, the U.S. is like Germany, France, and Canada in that workers and employers share the health insurance policy premiums. The insurer pays most expenses, and patients cover a small portion through co-payment or a percentage.
- For Native Americans, military personnel, and veterans, the U.S. is like Britain or Cuba, with the Veterans Administration using doctors who are government employees.
- Americans in these systems typically do not get direct medical bills.
- For those over 65, the U.S. is like Canada, because U.S. Medicare is a National Health Insurance system with low administrative costs.
- For the 45 million uninsured Americans, the U.S. is like Cambodia, Burkina Faso, or rural India: the uninsured can only access medical care by paying or through emergency admission.
- The U.S. maintains separate health systems for different classes and relies heavily on for-profit private insurance plans.
Health Care Reform
- Healthcare reform can involve tax increases, spending cuts, or both.
- Patient Protection and Affordable Care Act was enacted.
- The Law includes provisions to expand coverage, control health care costs, and improve the health care delivery system.
- In June 2012, the Supreme Court upheld the constitutionality of the Affordable Care Act.
Summary of Information
- Understanding why the healthcare system works the way it does is needed to both reform health care and implement change to improve access and quality care.
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Description
An overview of the healthcare system, insurance policies, and the unique challenges individuals face. A case study highlights the financial strain on a middle-class family due to childbirth costs, despite having insurance. Definition of health by World Health Organization.
