Long-Term Care & Prescription Drug Policies

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Questions and Answers

What is the primary function of certificate of need statutes in healthcare?

To regulate healthcare costs across the nation

To streamline patient admission processes

To increase competition among health facilities

To control capital expenditures by health facilities (correct)

Which domain of the Donabedian Model is considered the foundation of healthcare?

Process

Quality

Structure (correct)

Outcome

What is a significant shortcoming of the government price transparency initiative regarding healthcare pricing?

Lack of understanding among consumers about the provided prices

Shortage of geriatric physicians due to generational disinterest (correct)

Consumers have no access to online pricing tools

Too many hidden fees associated with health services

Which factor does NOT contribute to medical cost inflation?

Decrease in uninsured individuals Signup and view all the answers

What facilitated the passage of the Affordable Care Act (ACA)?

A confluence of favorable political conditions Signup and view all the answers

What is the primary financial support for long-term care expenses in the United States?

Medicaid Signup and view all the answers

To qualify for Medicaid, an individual must generally have assets limited to what amount?

$2,000 Signup and view all the answers

Which act is designed to provide resources for individuals with AIDS?

Ryan White Comprehensive AIDS Resources Emergency (CARE) Act Signup and view all the answers

What is a common concern regarding pharmaceutical companies discussed in the study materials?

Excessive profit-making at the expense of society Signup and view all the answers

What problem does Wollmann highlight regarding company mergers?

Larger mergers rarely get scrutinized Signup and view all the answers

What does the Child Caregiver Exemption allow an older individual to do?

Transfer their home to a qualified adult child Signup and view all the answers

Which of the following is a significant issue with Medicare's coverage of long-term care?

It offers minimal coverage for long-term care Signup and view all the answers

What is a threshold of merger value that can determine whether a merger needs to be reported?

$80 million Signup and view all the answers

What is necessary for an adult child to qualify for the Child Caregiver Exemption?

They must have provided care for their parent for at least two years. Signup and view all the answers

Which of the following best describes the 'Iron Triangle' of health care?

Cost, Quality, and Access Signup and view all the answers

Why is it crucial to understand Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)?

They determine the level of care and safety for older individuals. Signup and view all the answers

What factor does NOT contribute to the high cost of healthcare?

Standardized pricing across all services Signup and view all the answers

What is the increased demand for healthcare attributed to?

The aging baby boomer generation. Signup and view all the answers

What does the term 'irregular profit' imply in the healthcare industry?

Excessive profit resulting from price manipulation. Signup and view all the answers

Which statement best describes the role of lobbyists in healthcare policy?

They communicate special interest group views to Congress. Signup and view all the answers

Why might it be less profitable to bring a new antibiotic to market?

Antibiotics are often short-term treatments. Signup and view all the answers

What did the 10th Amendment in the Bill of Rights emphasize regarding powers not explicitly written in the Constitution?

Such powers belong to the people. Signup and view all the answers

Which president is associated with the signing of the Hill Burton Act?

Harry S. Truman Signup and view all the answers

What are the principal features of U.S health policy?

Fragmented and incremental reform Signup and view all the answers

What significant health legislation did Lyndon B. Johnson pass?

Medicare and Medicaid Signup and view all the answers

Which two companies largely control the dialysis industry?

DaVita and Fresenius Signup and view all the answers

What does the term 'loophole' refer to in the context of policy systems?

An exception that allows for avoidance of a policy's intent. Signup and view all the answers

What main purpose does Article I, Section 8 of the Constitution serve?

To outline Congress's powers to tax and regulate commerce. Signup and view all the answers

What concept describes the idea that small changes can lead to significant improvements in health policy?

Incrementalism Signup and view all the answers

Study Notes

Module 10: Oak Hammock - Long-Term Care

Oak Hammock is an example of a continuing care or long-term care facility.
Major long-term care issues include limited coverage from Medicare and private insurance, with Medicaid covering most long-term care expenses.
Medicaid eligibility requires low income and asset levels.
Long-term care expenses are the largest component of Medicaid expenditures.
Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is mentioned.

Module 11: Prescription Drug Videos & Policy

Pharmaceutical companies' practices are scrutinized for prioritizing profit over societal well-being.
FDA approval process, clinical trials, and government R&D incentives are key topics to understand the policy environment.
Articles on the topics should be read for deeper insight.
Antitrust concerns are raised regarding potential mergers in the pharmaceutical industry, concerned with monopolies.
Antitrust concerns point towards loopholes that may be exploited, indicating a need for stronger antitrust enforcement to avoid consolidation in the pharmaceutical industry, specifically targeting larger mergers.

Module 12: Child Caregiver Exemption & Other Topics

Child Caregiver Exemption allows home transfer to qualified adult children without triggering Medicaid look-back periods.
Qualifying children must have resided with the applicant for two years before the move, and providing care is a significant factor.
CDC Morbidity and Mortality Weekly Report, health care's iron triangle (cost, quality, and access), are discussed.
Structure, process, outcome are discussed in relation to measuring quality of care.

Module 12- Additional: U.S. Health Care Spending and Reforms.

U.S. health care spending is a substantial portion of its GDP.
Projected health spending continues to rise.
The discussion involves incremental steps to control cost via the 1% Steps for Health Care Reform Project
End-stage renal disease (kidney failure) as an example of a medical specialty with particular issues for treatment coverage.
Specific issues concerning dialysis industry are highlighted.
Antitrust considerations of market structure and potential for monopolies in the industry were raised (Wollmann's concern about antitrust issues because only large mergers must be reported).

Module 13: Price Transparency and Donabedian Model

Hospital price transparency is a subject of policy discussion, including concerns about consumer perspectives and shortcomings of existing initiatives.
The main ideas of pricing transparency.
Price transparency initiatives and its issues and consumer shortcoming.
Model for analyzing patient care quality, often used in healthcare contexts (Structure -> Process -> Outcome).
Donabedian Model to evaluate quality of care (Structure -> Process -> Outcome).
The role of lobbyists and their impact on industries and the government.
Need for certificate of need statutes in health care, to regulate capital expenditures in a particular industry.
Cost factors that contribute to medical cost increases (except decrease in the number of uninsured).

Additional Points (Ethics, Law, and Policy of Healthcare)

Issues revolving around lobbyists influencing lawmakers and their role in special interest groups.
The constitutional basis for government intervention in healthcare (Article I, Section 8, which grants the government the power to spend for the general welfare and regulate interstate commerce.).
Historical examples of presidential action related to healthcare policy (Truman, Johnson, and Nixon).
Discussion of the Affordable Care Act.
Examination on the structure, process, outcome of health care and how health care costs affect different parties
Constitutional basis for federal authority (10th Amendment).

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Description

Explore the critical issues related to long-term care facilities, focusing on Medicaid coverage and eligibility. Additionally, understand the implications of pharmaceutical practices, FDA regulations, and antitrust concerns in the prescription drug industry. This quiz covers key policies that impact healthcare access and pharmaceutical development.