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Questions and Answers
What is the primary focus of tertiary prevention in healthcare?
Which of the following accurately describes 'availability' in the context of the Five A's of Access?
What does the term 'equity' in healthcare imply?
What is a goal of secondary prevention in healthcare?
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Which factor does not contribute to 'acceptability' in the Five A's of Access?
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What is Medicaid designed to provide?
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What key indicator is used to compare health system performance regarding infant mortality?
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Which of the following issues is attributed to the US healthcare system?
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What is one of the principles of the Institute of Medicine's vision of good care?
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What aspect of health does the 'TRIPLE AIM' focus on?
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Why is healthcare considered important for the economy?
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What is a common cause of disparities in healthcare outcomes?
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What type of prevention aims at reducing disease progression?
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What is one potential consequence of the death spiral in insurance?
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Which segment of the population is primarily targeted by the Obama Care individual mandate?
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What is the maximum income threshold to qualify for Medicaid as per the provided information?
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What demographic trend is projected to increase by 2050?
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How do pharmaceutical companies typically lobby regarding drug prices?
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What requirement is placed on companies with more than 50 employees regarding health insurance?
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What is a common misconception regarding health insurance subsidies for low-income individuals?
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Which organization lobbies for malpractice insurance reform?
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What was the first plan to offer health insurance?
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Which country was the first to offer universal healthcare?
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What is a key feature of employer-based insurance for large companies?
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What is the purpose of the Individual Mandate in the Affordable Care Act?
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What is self-insurance in the context of large employers?
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What is a major consequence of the projected shortfall of up to 124,000 physicians by 2034?
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What is the purpose of the Anti-Kickback Statute?
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How does experience rating work in health insurance?
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Which of the following does NOT represent a cost-sharing mechanism in health insurance?
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What does the term 'moral hazard' refer to in the context of healthcare insurance?
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What is a key characteristic that differentiates health insurance from other types of insurance?
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Under adjusted community rating, what factors can insurers use to set premiums?
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What is the purpose of a stop-loss provision in health insurance?
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Study Notes
US Healthcare Overview
- Medicare: Federal program providing free or discounted healthcare insurance for individuals aged 65 and older.
- Medicaid: Free or discounted healthcare insurance for low-income families or individuals.
- Stakeholders in the healthcare system include the public, healthcare providers, facilities, employees, and government.
- US healthcare spending is high, but outcomes do not match financial investment.
Importance of Healthcare
- Essential for all; affects physical, psychological, and social well-being.
- 1 in 10 workers are employed in healthcare, indicating its economic impact.
- Businesses face rising insurance costs, influencing productivity and economic growth.
Health System Performance Indicators
- Infant Mortality Rate (IMR): Measures infant deaths before age one per 1,000 live births.
- Key factors affecting IMR include maternal folic acid intake, nutrition, and ultrasound use.
- Disparities exist based on location, race, and income affecting infant survival rates.
Key Issues in the Healthcare System
- Lack of central governing agency leads to poor integration and coordination.
- Inequities in access to care based on differing insurance and provider costs.
- Focus is primarily on interventions rather than preventative measures.
Institute of Medicine's Vision for Care
- Emphasizes patient safety (“do no harm”) and efficacy of treatments.
- Promotes timely, cost-effective, and equitable care for all individuals.
Triple Aim Objectives
- Aim to enhance population health, improve patient experience, and control healthcare costs.
Disease Progression and Prevention
- Primary Prevention: Target individuals at risk to prevent disease before onset.
- Secondary Prevention: Focus on early detection and management of diagnosed diseases.
- Tertiary Prevention: Address treatment for advanced diseases to minimize disability and prevent complications.
Access to Healthcare: The Five A's
- Availability: Sufficient supply of healthcare professionals and facilities.
- Affordability: Financial capability to pay for services, supported by insurance.
- Accessibility: Proximity of services, including transportation considerations.
- Accommodation: Flexibility of services like telehealth and after-hours care.
- Acceptability: Cultural competence regarding language, gender, and religion.
Equity in Healthcare
- Equity refers to fairness in access and outcomes regardless of demographics.
- Aims for equal access, utilization, and outcomes for individuals with similar needs.
Uninsured Populations
- Primarily composed of part-time workers, non-citizens, low-income households, and young adults.
Death Spiral in Insurance
- Younger, healthier individuals leaving the insurance pool increases costs for remaining members, leading to a cycle of escalating premiums and further exits.
Affordable Care Act (ACA) Key Points
- Introduces individual mandate requiring insurance coverage.
- Allows dependents to stay on parents' plans until age 26.
- Prohibits denial of coverage due to pre-existing conditions.
- Provides tax credits for individuals between 133% and 400% of the federal poverty line.
- Employers of 50+ employees must offer insurance coverage.
Trends in Healthcare
- Aging Population: Predicted 21% of the population will be aged 65 and older by 2050.
- Cultural Diversity: Hispanic population projected to increase from 16% to 30% by 2050.
- Rise of Obesity: Increasing rates of unhealthy behaviors.
- Healthcare Worker Shortage: Anticipated shortfall of up to 124,000 physicians by 2034.
Healthcare Financing
- Health Insurance: Method to protect against significant financial losses due to health issues.
- Fraud Prevention Laws: Includes the Federal False Claims Act and Anti-Kickback Statute to prevent illegal financial activities.
- Types of Health Insurance: Varies from group insurance through employers to self-insurance.
Cost Sharing Mechanisms
- Premiums: Regular payments for insurance coverage.
- Deductibles: Out-of-pocket costs before insurance coverage kicks in.
- Copayment/Q&A: Fixed fees per service accessed.
- Co-Insurance: Percentages paid after reaching deductibles.
- Stop-loss Provision: Limits out-of-pocket expenses after which insurance covers remaining costs.
Historical Context
- First Universal Healthcare: Germany was the first to implement universal healthcare.
- Baylor Plan: Established in 1929 as the first health insurance for hospital services.
- Employer Mandate Requirement: Large employers must offer health insurance.
Affordable Care Act Exam Highlights
- Emphasizes the necessity for universal insurance coverage; penalties for non-compliance.
- Defines coverage prerequisites for individuals aged 65 and older reflecting work history.
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Description
Explore the key components of the US healthcare system, including Medicare, Medicaid, and the stakeholders involved. Understand the economic impact and performance indicators, such as the Infant Mortality Rate, while recognizing disparities in healthcare access and outcomes.
