Podcast
Questions and Answers
What primary aspect does US Health Policy focus on?
What primary aspect does US Health Policy focus on?
Which process does NOT contribute to the development of Health Policy?
Which process does NOT contribute to the development of Health Policy?
Which historical event marked President Truman's attempt to pass National Health Insurance (NHI)?
Which historical event marked President Truman's attempt to pass National Health Insurance (NHI)?
Why was the Social Security Act significant in 1935?
Why was the Social Security Act significant in 1935?
Signup and view all the answers
What characterizes the extremes seen in the US healthcare system?
What characterizes the extremes seen in the US healthcare system?
Signup and view all the answers
What is the primary financing source for Medicare?
What is the primary financing source for Medicare?
Signup and view all the answers
Which population group is targeted by the Medicaid program?
Which population group is targeted by the Medicaid program?
Signup and view all the answers
What type of care does Part B of Medicare primarily cover?
What type of care does Part B of Medicare primarily cover?
Signup and view all the answers
The Children's Health Insurance Program (CHIP) is designed to cover children in families with incomes up to what percentage of the Federal Poverty Level?
The Children's Health Insurance Program (CHIP) is designed to cover children in families with incomes up to what percentage of the Federal Poverty Level?
Signup and view all the answers
What is the funding mechanism for Medicaid?
What is the funding mechanism for Medicaid?
Signup and view all the answers
What services are provided by Part A of Medicare?
What services are provided by Part A of Medicare?
Signup and view all the answers
What act established the Social Security program?
What act established the Social Security program?
Signup and view all the answers
What benefit does Medicaid provide primarily?
What benefit does Medicaid provide primarily?
Signup and view all the answers
What significant program was introduced as part of Lyndon B. Johnson's Great Society initiatives to address poverty and racial injustice?
What significant program was introduced as part of Lyndon B. Johnson's Great Society initiatives to address poverty and racial injustice?
Signup and view all the answers
What was the main purpose of the Kerr-Mills Act introduced in 1960?
What was the main purpose of the Kerr-Mills Act introduced in 1960?
Signup and view all the answers
Which title of the Social Security Act was established for Medicaid?
Which title of the Social Security Act was established for Medicaid?
Signup and view all the answers
How many amendments were required to pass the Medicare and Medicaid legislation after the bill was introduced in March 1965?
How many amendments were required to pass the Medicare and Medicaid legislation after the bill was introduced in March 1965?
Signup and view all the answers
What age group does Medicare primarily serve?
What age group does Medicare primarily serve?
Signup and view all the answers
What was a significant health policy initiative introduced in 1997?
What was a significant health policy initiative introduced in 1997?
Signup and view all the answers
Which factor has contributed to the failure of National Health Insurance in the U.S.?
Which factor has contributed to the failure of National Health Insurance in the U.S.?
Signup and view all the answers
What does 'Market Justice' emphasize regarding health?
What does 'Market Justice' emphasize regarding health?
Signup and view all the answers
Which act was passed in 2003 to enhance prescription drug coverage for seniors?
Which act was passed in 2003 to enhance prescription drug coverage for seniors?
Signup and view all the answers
What defines 'illness' as opposed to 'disease'?
What defines 'illness' as opposed to 'disease'?
Signup and view all the answers
What is a key characteristic of the Social Justice perspective on health?
What is a key characteristic of the Social Justice perspective on health?
Signup and view all the answers
Which historical opposition has played a significant role in the U.S. regarding National Health Insurance?
Which historical opposition has played a significant role in the U.S. regarding National Health Insurance?
Signup and view all the answers
What methodology does the phrase 'biomedical approach' imply in health care?
What methodology does the phrase 'biomedical approach' imply in health care?
Signup and view all the answers
What is the primary goal of public health?
What is the primary goal of public health?
Signup and view all the answers
Which level of prevention focuses on policies and environmental interventions?
Which level of prevention focuses on policies and environmental interventions?
Signup and view all the answers
What percentage of determinants of health are accounted for by social factors according to population health research?
What percentage of determinants of health are accounted for by social factors according to population health research?
Signup and view all the answers
In social epidemiology, what is primarily examined?
In social epidemiology, what is primarily examined?
Signup and view all the answers
Which aspect does the biomedical model primarily concentrate on?
Which aspect does the biomedical model primarily concentrate on?
Signup and view all the answers
What does medical knowledge about illness and disease reflect according to social constructionism?
What does medical knowledge about illness and disease reflect according to social constructionism?
Signup and view all the answers
What is an important factor in evaluating the healthcare delivery system?
What is an important factor in evaluating the healthcare delivery system?
Signup and view all the answers
Which type of prevention involves actions taken after a health issue has occurred?
Which type of prevention involves actions taken after a health issue has occurred?
Signup and view all the answers
Access to healthcare services does not consider which of the following?
Access to healthcare services does not consider which of the following?
Signup and view all the answers
What is the ultimate goal of primary prevention strategies?
What is the ultimate goal of primary prevention strategies?
Signup and view all the answers
Study Notes
Cost at Micro & Macro Level
- The cost of health insurance and healthcare goods and services is incurred at the micro level.
- At the macro level, healthcare costs are measured as a proportion of the country's Gross Domestic Product (GDP).
Measuring Healthcare Quality
- Quality is determined by the extent to which healthcare services for individuals and populations improve the likelihood of desired health outcomes, adhering to current professional knowledge.
US Healthcare Policy
- The main focus of the US Healthcare Policy is on the organization and financing of medical goods and services, rather than solely on health.
- Health is considered a private choice, not a human right in the US.
- The US spends more on its healthcare delivery system than any other developed (OECD) country.
Developing US Healthcare Policy
- Healthcare policies are developed through contributions from the private and public sectors, involving multiple government levels.
- Policy development can occur through four pathways:
- Bills - Proposed legislation debated in state or federal legislatures.
- Propositions - Referendums submitted to public vote.
- Executive Orders - Directives issued by mayors, governors, or presidents.
- Judicial decisions - Rulings made by the Supreme Court and other judicial bodies.
Key Moments in US Healthcare Policy History
- 1912: President Theodore Roosevelt advocated for a single national health insurance (NHI) system.
- 1935: The Social Security Act was enacted, providing pensions to the elderly. The American Medical Association (AMA) opposed the inclusion of NHI in the act.
- 1939: President Franklin D. Roosevelt attempted to introduce NHI legislation, but faced opposition from Republicans and Southern Democrats.
- 1948: President Harry Truman also attempted to pass NHI, but was blocked by the AMA.
- 1965: President Lyndon B. Johnson successfully implemented Medicare and Medicaid as federal health insurance programs.
- 1973: President Richard Nixon encouraged the development of Health Maintenance Organizations (HMOs) to help control healthcare costs.
- 1986: The Emergency Medical Treatment and Labor Act (EMTALA) was passed.
- 1996: The Health Insurance Portability and Accountability Act (HIPAA) was enacted.
- 1997: The Children's Health Insurance Program (CHIP) was established.
- 2003: Medicare Part D, a prescription drug benefit, was added to Medicare.
- 2022: The Inflation Reduction Act was passed, giving the Centers for Medicare and Medicaid Services (CMS) the authority to negotiate drug prices.
Reasons for National Health Insurance Failure in the US
- The US did not adopt national healthcare in the early 20th century like many European countries.
- The decentralized government system, with state and federal levels, has contributed to a lack of trust in large government programs.
- Post-World War I, the US condemned German "socialized medicine," despite the fact that "socialized" does not necessarily equate to a single-payer universal healthcare system.
- Americans have been reluctant to pay higher taxes for the greater good.
- The AMA has historically opposed national health insurance.
- Competing interests from patients, health insurance companies, employers, hospitals, pharmaceutical and technology companies, and others have hindered the development of a comprehensive national healthcare system.
Market Justice vs. Social Justice in Healthcare
-
Market Justice:
- Health is viewed as an individual responsibility.
- Access to healthcare is determined by purchasing power.
- Limited obligation to the collective good.
- Emphasis on individual wellbeing.
- Private solutions are preferred for social problems.
- Rationing is based on ability to pay.
-
Social Justice:
- Health is considered a collective responsibility.
- Everyone is entitled to a basic package of healthcare benefits.
- Strong obligation to the collective good.
- Community wellbeing takes precedence over individual wellbeing.
- Public solutions are sought for social problems.
- Planned rationing of healthcare services is advocated.
Understanding Health, Illness, and Disease
- Health: A multidimensional concept encompassing physical, emotional, mental, spiritual, and material well-being, not simply the absence of illness or disease.
- Illness: An individual's subjective understanding and felt experience of health.
- Disease: A physical or mental condition diagnosed by a medical professional based on objective evaluation.
Biomedical Approach to Healthcare
-
Individual Focus:
- Health is defined as the absence of disease, pain, or defects.
- The body and mind are treated as separate entities.
- The body is viewed as a machine or organism.
- Disease is the primary target for treatment.
- Focus on altering biological conditions to achieve homeostasis.
- Reliance on technology and science in diagnosis and treatment.
Public Health Approaches to Healthcare
-
Population Focus:
- Goal is to promote health and prolong life among populations and communities through preventative strategies.
- Prevention is a key concept, focusing on preventing or mitigating undesirable events.
- Primary prevention focuses on altering social and environmental conditions that cause illness and disease at the population level.
- Public health extends beyond the individual, considering the physical, built, and social environment.
Three Levels of Prevention in Public Health
-
Primary Prevention:
- Upstream approaches that implement policies, environmental interventions, and social action to prevent illness and disease.
-
Secondary Prevention:
- Screening, early detection, vaccinations, behavior modification, and medical interventions to address early stages of disease.
-
Tertiary Prevention:
- Interventions employed after a disease has been diagnosed, focusing on containing and reversing the harmful effects of the disease.
Determinants of Population Health
- Genes and health behaviors account for only 25% of determinants of health.
- Access to medical care, genes, and health behaviors account for less than 50% of health determinants.
- Over 50% of health determinants are related to social and societal characteristics and the broader ecological environment.
- Health is shaped by the wider world around us.
- Social epidemiology explores the social distribution of health within populations and investigates the social determinants of health.
Social Determinants of Health
- The features of societal conditions that influence health and their associated pathways.
Social Construction of Health and Illness
- Social Constructionism: Argues that meanings and experiences are shaped by cultural and social systems.
- Taken-for-granted Meanings and Symbols: Reduce confusion and become reified, highlighting the normality of diversity and variation and the potential for social change.
- Biomedicine is Socially Constructed: A form of regulation not devoid of social and political context.
- Approach to Health & Illness: Subjective experiences of well-being and illness require documentation, separate from formal medical diagnoses.
- Medical Knowledge is Socially Bound: Understanding of illness and disease is not solely based on nature but encompasses people's perceptions and cultural interpretations.
The Holy Trinity of Health Policy and Management
- Access, cost, and quality are the key components used to evaluate the effectiveness of healthcare delivery systems.
- The goal is to increase access, reduce costs, and improve quality.
Access to Healthcare
- Refers to the ability to obtain needed, affordable, convenient, acceptable, and effective personal healthcare services.
Political Context of Medicare and Medicaid
- Developed during the Civil Rights Movement.
- Proposed as an amendment to the 1935 Social Security Act (created by Franklin D. Roosevelt, but without health benefits).
- The Kerr-Mills Act (1960) provided states with block grants for medical assistance, but participation was limited.
- The Social Security Amendments of 1965, part of Lyndon B. Johnson's Great Society Programs, established Medicare and Medicaid.
- The Great Society aimed to address poverty and racial injustice.
- Democratic majorities in both the House and Senate, along with a Democratic President, facilitated healthcare reform.
- The Medicare and Medicaid bill was introduced in March 1965 and signed into law in July 1965, after extensive amendments.
Medicare
- Provides benefits to individuals aged 65 and older, individuals with long-term disabilities, people with End Stage Renal Disease (ESRD) and their dependents.
- Financed through payroll taxes (1.45%).
- Includes:
- Part A (Hospital Insurance): Covers hospital stays, skilled nursing facilities, hospice care, and home health services.
- Part B (Medical Insurance): Covers doctor's office visits, outpatient care, preventive services, and durable medical equipment.
- Part C (Medicare Advantage): Private health plans offered by Medicare-approved companies that provide coverage for Part A and Part B services.
- Part D (Prescription Drug Coverage): Covers prescription medications through private insurance plans.
Medicaid
- Provides health coverage to low-income individuals and families.
- Financed through federal block grants to states, with federal matching funds based on state spending.
- Covers:
- Primary and emergency care, hospital services, nursing home care, and community-based services.
Social Security
- Provides cash benefits to retired, disabled, and deceased workers and their families.
- Financed through payroll taxes (6.2% from employees and 6.2% from employers).
CHIP (Children's Health Insurance Program)
- Provides health insurance to children in families with incomes up to 200% of the federal poverty level (FPL).
- Financed through federal block grants to states, with federal matching funds based on state spending.
- Covers:
- Primary and emergency care, hospital services, and prescription medications.
- The program is an expansion of the Social Security Act (Title 21).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz explores the intricacies of US healthcare policy, focusing on healthcare costs at both micro and macro levels. It also delves into the measurement of healthcare quality and the development of healthcare policies through various contributions. Test your understanding of the unique aspects of healthcare in the US and its implications.
