US Healthcare System PDF

Week 1: Irrationalities of the US HealthCare System 1. United States Health Policy does not really address health, but health care. The focus is on the organization and financing of medical goods and services. 2. Health is a private choice not a human right in the United States 3. The...

Week 1: Irrationalities of the US HealthCare System 1. United States Health Policy does not really address health, but health care. The focus is on the organization and financing of medical goods and services. 2. Health is a private choice not a human right in the United States 3. There are extremes of excess and deprivation 4. The United States spends the most money on its health care delivery system than any other industrialized (OECD) country. How is health policy developed? The development of Health Policy involves both private and public sectors, including multiple levels of government. Health policies can be developed, transformed and destroyed in one of Four ways: 1. Bill-a written piece of legislation that is being proposed and negotiated in a state or federal legislative body (House, Senate). 2. Proposition-is a referendum placed on a ballot, by the public or government, for vote. 3. Executive Order-As signed, written or published directive by a mayor, governor or a president (executive branch of government). 4. Supreme Court and other judicial decisions Critical Moments in US Health Policy - 1912: President T Rooseveley while campaigning calls for a single national health insurance (NHI) - 1935: Social Security Act - Provides Pensions to Elderly (FDR), NHI proposed by opposed by AMA - 1939: FDR’s 2nd Attempt for NHi but Republicans & Southerns Democrats oppose - 1948: President Truman attempts to pass NHI - AMA blocks it - 1965: President L.B. Johnson Passes Federal Health Insurance Plans: Medicare & Medicaid - 1973: President Nixon encouraged the development of HMOs to control costs - 1986: Emergency Medical Treatment & Labor Act - 1996: Health Insurance Portability & Accountability Act - 1997: Children's Health Insurance Program (title 21 of Social Security Act) - 2003: Medicare Part D - 2022: Inflation Reduction Act (CMS will negotiate drug prices) Reasons why National Health Insurance has failed in the SUS - US did not initiate national health are in the early 20th century (unliked Europe) - Decentralized government system (state vs federal) – related to erosion of trust in big government - Denouncing German “socialized medicine” post WWI; however, socialized doesn't egal single – payer universal healthcare system - Aversion to pay higher taxes for the greater good - American Medical Association has historically opposed national health insurance - Competing interests: Patients vs Health Insurance Companies, Employers, Hospictals, Pharmaceuticals & Technology Companies, Employers, Hospitals, Pharmaceuticals & Technology Companies Market Justice Health is an individual responsibility Benefits based on your purchasing power (what you can afford) Limited obligation to the collective good Emphasis on the individual wellbeing Private solutions to social problems Rationing based on ability to pay Social Justice Health is an collective responsibility Everyone is entitled to a bsci package of benefits (ACA tried) Strong obligation to the collective good Community wellbeing supersedes that of the individual Public solutions to social problems Planned rationing of health care Week 2: - Health: A multidimensional construct of humans’ physical, emotional, mental, spiritual and material well being– not simply the absence of illness or biomedical diagnosis. “Fully realizing one's' human rights” - Illness - our subjective understanding and embodied feeling(s) of health - Disease - is a physical or mental malady determined by an “objective medical evaluation” You can have a disease with no feeling of illness; you can have illness with no formal diagnosis of a disease What is the biomedical approach? - An individual Approach - Health is the absence of disease, pain, defect - The body & mind can be treated separately - Body is treated as an organism or machine - What physicians treat are disease and they alter the biological condition to be in homeostasis - It is imperative to use technology and science in diagnosis and treatment Public Health approaches - The goal of public health is to promote health and prolong life within a population or community using prevention strategies - Prevention: planning for action to prevent or forestall the occurrence of undesirable events (not just about the physical body/absence of disease) - Primary prevention: proactively altering the social and environmental conditions at the population level that cause illness and disease – UPSTREAM APPROACHES - Unlike the biomedical model, public health moves beyond the individual and considers the physical, build and social environment Three Levels of Prevention: Primary - policies, environmental interventions, social action Secondary - screening; early detection; vaccinations; behavior change/med intervention Tertiary; Quarantine - after the fact, when you already have a problem, you try to contain it or reverse the deleterious effects Detriments of Population Health - Genes & health behaviors only account for 25% - Access to medical care, genes & health behaviors total to less than 50% - Most public health research is focused on 3 categories above^  - Over 50% of determinants of health are social/societal characteristics and total ecology - Health is shaped by the larger world around us - Social epidemiology: examines the social distribution of health in populations & social determinants of health - Social Determinants of Health: the features of societal conditions that affect health & their pathways The social construction of health and illness - Social constructionism: assumes that everything is created through meanings and experiences that are shaped by cultural and social systems - Taken for granted meanings & symbols help reduce confusion & become reified - diversity & variation are normal, and social change is possible - Biomedicine is socially constructed - a form of regulation & not absent of social & political context - Approach to health & illness - the subjective experiences of wellbeing & illness need to be documented, desmine a formal medical diagnosis - Medical knowledge about illness & disease are not just nature – they are bound to people's perception & culture Week 3: Access, Cost, Quality - Not just the holy trinity of health policy and management, but laos the way we evaluate the effectiveness of the healthcare delivery system - Our goals are to increase access, reduce costs and improve quality - Access: refers to the ability to obtain personal health services that are needed, affordable, convenient, acceptable and effective - Cost: at the macro level (national) refers to the proportion of the total healthcare expenditures that make up the gross domestic product. Cost as the micro level refers to the cost that people incur to pay for health insurance and receive health case goods and services - Quality: refers to the degree to which health services for individuals and populations increase the likelihood of desired health outcomes (eg no asthma attacks and are consistent with latest professional knowledge Medicare Medicaid Social Security CHIP Policy Amendment to Amendment to Social Security Children's Social Security Social Security Act (F. D. Health Act, 1965 (Title Act, 1965 (Title Roosevelt) Insurance 18*) (L. B. 19) (L. B. Program 1997 Johnson) Johnson) (Title 21) *(W. J. Clinton) Financing Payroll Tax Fed Block Grant Payroll Fed Block 1.45% (>=50% of +Employer Tax Grants (up to states budget) (6.2%*2=12.4%) 85% of states budget) Target Adults 65+ Persons with Retired Persons Children in Population Disable (post-2 incomes at or Disabled homes up to years SSI), below 138% FPL Persons & 200% FPL ESRD & ($16) Dependents Dependents Services Part A - Primary Care Provides a cash Primary Care Hospital Emergency benefit to and Ambulatory Insurance* Care (EMTALA retired & care for Part B - 1986) Hospital disabled children Primary Care Nursing home, persons - hospital  and Outpatient Community persons emergency SVCs* based Services receiving SSI room care Part C - automatically Medicare enrolled in Choice (MCO) Medicare (A+B) Part D - (MMA, - Know the political context leading to as least 2003, G. W. one of these programs Bush) - * not health insurance program but tied to medicare and the parents legislation to Medicare, Medicaid and CHIP Political Context of Medicare & Medicaid: - Later part of the Civil Right Movement - Proposed as an Amendment to the Social Security Act of 1935 (Under FD Roosevelt; no health benefits) - In 1960 Kerr-Mills Act was created to provide states block grants and they decide which patients could receive medical assistance & the federal government would match them *not many states participated* - Social Security Amendment of 1965 is one of Lyndon B. Johnson's Great Society Programs (Medicaid/Medicare) - Great Society programs were LBJ & Democrats’ Platform to eliminate poverty & racial injustice - 2:1 ratio of Democrats in House & Senate + Democratic President == healthcare reform in the US - Bill introduced March 1965 & signed into law on July 30, 1965 - Despite the 5-month wait from bill to law it required 500+ amendments 1. SSA, 1965 Title 18 Medicare Part A&B 2. SSA, 1965 Title 19 Medicaid 3. Children’s Health Insurance is Title 21 of SSA Medicare - Benefits persons 65+, long-term disabled (