Chapter 2_ Historical & Benchmark Developments in American Health Care .pdf

Chapter I Historical Benchmark Developments in American HealthCare BenchmarkDevelopment's in USHealthcare Early1800s190058participation in USmedicinelimitedtopatients physiciansMledicalpracticerelativelysimplePhysicianssetting adjustingestimatesofpatientability to Intimatephysician...

Chapter I Historical Benchmark Developments in American HealthCare BenchmarkDevelopment's in USHealthcare Early1800s190058participation in USmedicinelimitedtopatients physiciansMledicalpracticerelativelysimplePhysicianssetting adjustingestimatesofpatientability to Intimatephysician pay patientrelationship 1915 emergence of compulsoryhealthinsurance to protectworkers against a lossofincomeresultingfromindustrialaccidents 791.7 WWIinterruptedthecampaignforcompulsoryhealthinsurance 447 AMAHouseofDelegatesofficiallycondemned compulsory healthinsurance Mostphysicianoppositionattributed to concern that insurancewoulddecrease ratherthanincreasephysician add totheirnegativeexperience withaccident incomes insurancepaiddoctorsaccordingtoarbitraryfeeschedules TheGreatDepression Birth ofBlueCross 2 1 79298GreatDepressionthreatenedthefinancialsecurity of physicians hospitalsPhysicianincomes hospital admission uldn'tpay out of pocket insurance Effin.tn 1957 26plans Ii n 600,000 members AHAbegan approvingthese plans 1,250publicschoolteacherspaying 50 month guaranteed 21dayshospitalcare 793726 plans600,000 members By Problem w financingmedicalcare moderatemajority of AMA recommendedadoption of grouppractice voluntaryhealth EYEWI fedgov'tboostedprivatehealthinsurance industrybyexcluding healthins benefits fromimage pricecontrols excludeworkers contributionstohealth ins fromtaxable FI ins companiessimplyraised their premiums rather than exerting pressure on Drs hospitals to contain costs 79658proponents ofgov't sponsored ins limited efforts to old people lowincomepopulations PASSMedicare Spen prox142mil on HCannually 8.4 bNoni 4 trill approx78 of GDP DominantInfluence of Government 2.2 Federal government's coverage of health care for special populations played a role in spiraling costs  983 Institutes of Health to support categorical programs forheartdiseasecancer stroke 7,95 s Tai's Fy grantfederal aid to the Iates forpublichealth welfareassistancematernal child health children with disabilities 1964 68 Creative Federalism totalgrantawards to states nearlydoubled 79638HealthProfessions Educational Assistance Act dental nursing Efo ai h Faita t.itFederalism 7970 New rescind thefederalgovernment's directadministration of severalhealthcareprograms shift revenues to state localgovt's via blockgrants Blockgrants Consolidatedgrants of federal funds allocated for specificprograms that a state of localgovernment can use at its discretion Irajor Healthcare concerns23 Cost Quality Access Federalgovernment'simprovements in access to care Iron accompanied by skyrocketingexpenditures issues quality Resulted in healthcaresystem's expansionsbeyond Ifangle actualneed Fundingimprovedaccess to competent appropriate Access ΔQuality medical care formany Alsoresulted inuntold s of unnecessary clinical interventions Efforts at Planning QualityControl PublicHealthService Act 1965 amended to establish the RegionalMedicalProgram Initiative a nationwidenetwork of medicalprograms in designated geographic areas to address heartdiseasecancer Sts egionalmedicalprogramsaddededucational clinical resources but did not improve prevention or cost reductions in target conditions ComprehensiveHealthPlanningAct1796658promote comprehensiveplanning for rationalsystems of healthcarepersonnel facilities in designatedregions Requiredfederal state localpartnerships Failed initiative  Allprograms dominated bymedical hospitalleaders Johnson era11966 69 Medicare Medicaid entrenched the federalgovernment in thebusiness offinancing health care ambitious creativefederalismimproved access but fueledan inflationaryspiralofhealthcare costs Managed CareOrganizations2.4 Health Maintenance Organization HMO Act 1797318 supported the development of HMOsthroughgrants for federaldemonstrationprojects Expected to holddowncosts bychanging the profit incentivefromfee for service to promotinghealthprevention 7990s consumer provider backlash results By in all 50 statesenactingprotections against managed careaccess cost restrictions PreferredProviderOrganizations PPO in 2001derivative of NCOs Organized byphysicians hospitalsto meet theneeds ofprivatethird party selfinsured firms By2022PPOscovered 52 ofcoveredemployees form of employer sponsored T.IEfffar HospitalContainment ProspectiveHospitalReimbursement In 7980Reagan administrationcontinuedefforts to shrink federallysupportprograms Decentralization ofprogramresponsibility to the states throughblockgrants Medicareprospectivepayment in hospitals diagnosis relatedgroups DRG shifted hospital reimbursement from a feefor serviceretrospectivemodeto a prepaid prospectivemodebased onpatientdiagnosis DRGsputhospitals at financial risk for charges that exceededper case DRGlimits Resource based relative valuescales make physician payments equitable across various types of servicesspecialties locations Biomedical Advances 1st half century 2nd half century Preventionor cure of Technologic manyinfectious advances diseases Pa fksm.fr ent P a fffe tissypffm another communicabledisease Influence of InterestGroups Development of fullypartially taxfundedhealthservice proposals initiated waves of lobbying efforts interestgroups for or against the initiatives by 5 majorgroups playkeyroles in debates on tax funded healthservices 1 Providers 2 Insurers 3 Consumers 4Business 5 Labor Physicians usedto be one of the best financed but it isrecognized as not representing thevalues of largenumbers of physicians detached from the AMA InfluenceGroups AMA Founded 7847 largestmedicallobby1224,503members AMAopposed gortprovidedinsurance Onlyreps 25.61 of Drs medstudents Interest Groups InsuranceCompanies Insurers politicalefforts havebeen viewed as self I I Efm eliminatehighriskconsumersfrominsurance pool 1 Frequentpremium rate increases contribute significantly to focus on cost containment plight of the uninsured underinsured Strongrole in debates about Obama's healthcare reformefforts opposeidea of publicoptionwhich would severly limit theirprofits Interest Groups Business Labor Labor unions have a strongpresencewheneverUS Chamber of Commerce are involved Ex AmericanFederationof Labor Congress of Industrial Organizations hastremendousinfluence on nat l healthpolicy 1 Service Employees International Union8 largestunion 82 91819469 Taffyholdprominentplaceon theirnationalagenda Interest Groups8Pharmaceutical Industry Increased its spending on lobbying tactics campaign contributions to unprecedentedlevels I Perscription pricesprofits recordhighindustry correctlyanticipatedpublic congressionalpressure to legislatecontrols on drugprices coverage for older adults on Medicare  Major role in 03 Medicare Part D perscription benefit drug plan Finalplan prohibited Medicare fedgov'tfromusing its enormouspurchasin power to negotiatepricing w drug companies Interest Groups Public HealthFocus onPrevention PH lobbypromoting health disease prevention American PH Association 1872 approx 25,000 members substantial influencethroughorganizedadvocacy educational efforts at fed state local levels HealthInsurancePortability AccountabilityAct HIPPA 1996 HIPPA GHP grouphealth Ensure that workers couldmaintain uninterruptedhealth plan insurancecoverage if theyloseor changedjobs byenabling continuedcoveragethrough their prioremployer's GHP Privacy of personal health information Dept of Health HumanServices HHS 1 Nat l standards for regulations protecting the privacy securityof certainhealthinfo Privacy rule Security rule for all organizations providers w accessto individuals personal health 089 extension of HIPPA'sprivacy security provisions beyondproviders to otherentities handlingelectronichealthinfo ex clearinghouses Balanced Budget Act BBA1997 BBA 7 increased cost sharingamongMedicare beneficiaries 2 extended the prospectivepaymentsystems introduced w DRGS to hospitaloutpatientservices homehealthagencies skilled nursing facilities inpatientrehabfacilities 3 opened Medicareprogram to privateinsurersthrough the Medicare ChoiceProgram Medicare Advantage Immediateimpact annual rate of Medicare spending state faith rain I am CHIP targetinguninsuredchildrenwhosefamilyincome was to high to qualify for Medicaid too low for private health insurance Largestexpansion of children's health insurance in the country CHIP now covers 10billionchildren Death with Dignity Acts Death with DignityAct Oregon199418response to growing concern among medicalprofessionals publicaboutthe  extended painful demeaning nature of terminalmedical care for patients w certainconditions multiplerequirements forDrs to write prescription for lethal medicationcombos patient must be fullyaware of diagnosprognosis risks likelyresultofmeds alt care pain control hospice Covid 19 Early 27 500,000 Coviddeaths American RescuePlan changecourseofpandemic deliverimmediate reliefto families most progressivepiece of legislation to build a bridge to an equitableeconomic recovery won'tknoweffectslong term untilyears later