HSA3111 Test 3 Study Guide PDF

HSA3111 Test 3 Study Guide **Module 10:** [In Class PPT ] - Oak Hammock: an example of continuing care or long-term care continuum - Major LTC Issues - Medicare and private health insurance provide minimal coverage for long-term care - Medicaid ultimately pays for t...

HSA3111 Test 3 Study Guide **Module 10:** [In Class PPT ] - Oak Hammock: an example of continuing care or long-term care continuum - Major LTC Issues - Medicare and private health insurance provide minimal coverage for long-term care - Medicaid ultimately pays for the vast majority of long-term care expenses in this country - To qualify for Medicaid, one basically must be broke - Medicaid, meanwhile, is generally available to people who have no more than \$2,000 in assets and meet strict income tests - Paying for long-term care is Medicaid's single largest expense - A Balanced Budget -\> Bill Clinton - The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act **Module 11** [In Class PPT] - Watch the Prescription Drug Videos again in Ch. 13 - Takeaway: Are these pharmaceutical companies simply turning a blind eye to excessive profit-making at the expense of society -- YES - What are the ultimate goals for learning more about policy, FDA approval process, clinical trials, and government R&D incentives? - READ ARTICLES: - Default Concepts by Gruber - Antitrust Concepts by Wollmann -- a lot of mergers = concerned with monopoly - A close-up of a document Description automatically generated - Companies are finding loopholes; Wollmann is saying there needs to be stronger antitrust enforcements as only larger mergers have to notify their plans so that smaller mergers go unnoticed. - Ex: if 90 million is the threshold to report, companies can structure their mergers to stay just under that limit, like 80 million, and still go unnoticed. -  - Eliason et al. - A close-up of a document Description automatically generated - The Child Caregiver Exemption: allows an older person to transfer their home to a qualified adult child without violating Medicaid's Look Back period. The adult child is qualified if they have lived in the Medicaid applicant's home for at least two years prior to the applicant moving out of the home and into a nursing home or an assisted facility. In addition, the adult child must have also provided a certain level of care for their parent during those two years in order to qualify for the Child Caregiver Exemption. - From the video, we don't want cowboys, we want pit crews. - CDC to look at the Morbidity and Mortality Weekly Report - Health Care's Iron Triangle: cost, quality, and access - Structure, process, outcome **Module 12** [In Class PPT] - Oak Hammock = continuous care - A menu refers to the idea that it is nice to have choices in long term care - Why is it so important to know ADLs and IADLS? - Hoe much help, supervision, and hands-on care does an older person need? - Determines the cost of care at a facility - Whether someone is considered "safe" to live at home - Eligible for certain long-term care services - Ryan White Program - Centers for Disease Control -- Morbidities and Mortality Weekly Report - New Morbidity - Definitions of - GDP - CPI - Inflation - Health Care Inflation - Why was CHIP created? - Reasons for the high cost of healthcare - Third party payment (moral hazard) - Imperfect market - Utilization of health care is driven by need, not demand - The quantity of healthcare produced is usually higher than in competitive markets - Prices are permanently higher than the true cost of production - Growth of technology - Increase in the elderly population - Elderly consume more healthcare at 3.5 times the rate - With increased life expectancy and the aging of the baby boomer generation, there are increases in its elderly population - Medical model of health care delivery - Multiplayer system and administrative costs - Defensive medicine - Waste and abuse - Practice variations (Ex: MRI) - Can you identify imbalanced and excessive profit? - Insulin is an example as they changed the formula and charged more - Narcon - Lobbyists: Lobbyists communicate the views of special interest groups to lawmakers, including members of Congress - "Fox guarding the hen house" - Why is it less profitable to bring a new antibiotic to market than a specialty drug to treat a specific or a drug to treat a chronic condition? - Eradicate vs control: with antibiotics, people get it once they get sick and then they get better; we should focus on preventing chronic conditions as they are used for longer - In 1789, the Bill of Rights was signed - 10^th^ Amendment: if it is not written in the constitution, then the power falls to the people - The US Constitution does not set forth an explicit right to healthcare - Article I, Section 8 of the constitution: the government has the power to: - Spend for the general welfare - Regulate interstate commerce - To tax - Presidents - Harry S. Truman - 33^rd^ president - Power to spend for the general welfare - Hill Burton Act signed into law by him - Lyndon B. Johnson passed Medicare and Medicaid - Richard Nixon passed - Federal support of health maintenance organizations in 1973 - The enactment of the National Health Planning and Resources Development Act of 1974 - Obama passed the ACA - The stars aligned for health care reform - Bush reformed Medicare and added a prescription drug benefit (part D) - Principle features of U.S health policy - Fragmented (states run a lot of it) - Incremental - Piecemeal reform - Pluralistic (interest group) - The decentralized role of the states - Impact of presidential leadership - Policy intervention begins with identifying what markets fail or do not function - 15% vs 1% - small incremental changes can make a large impact - Ex: Helping with End-Stage Renal Disease (Kidney Failure) - Read article: Kidney Dialysis is a Booming Business -- Is it Also a Rigged One? - Video to help with Test 3 Question: Less is More: Structuring Choice for Health Insurance Plans \*\*\*\*\* - Duopoly -- Gaming the System - The dialysis industry is a duopoly as it is largely controlled by two companies: DaVita and Fresenius - Loophole: used to circumvent or otherwise avoid the purpose, implied or explicitly states of a system of policy - Ex: Davita -- buys more which charges the government more because of fee for service - What can you do to close this loophole? -  - Article: Price Transparency in Hospitals -- Current Research and Future Directions - What are the three 3 main ideas? - Pricing transparency - What are some of the issues related to this rule, and from a consumer's perspective what is the greatest overall shortcoming of this government price transparency initiative? - Shortage of geriatric physicians because Gen Z has no interest **Module 13** [In Class PPT] - Donabedian Model: Structure -\> Process -\> Outcome - Usually used to measure quality - Lobbyists worse for industries, not the government **Kahoot Questions** - According to the textbook, what is the primary purpose of certificate of need statutes? - To control capital expenditures by health facilities - Medical cost inflation is influenced by all the following factors except: - Decrease in uninsured - Which response means unwilling to admit or accept what is offered as true? - Incredulous - Signed the act that created the Privacy Rule or national standards for protecting certain health information? - Bill Clinton - The Donabedian Model provides three domains -- outcome, process, and structure to: - Help define and measure quality - Which of these domains is the foundation of health care? - Structure - Which is the key factor contributing to the passage of the ACA? - "The Stars Aligned" - Why does US have the highest health care costs compared to other countries and the cost continues to increase? - The US has two systems: private and public - The \_\_\_ Amendment that the United States Constitution does not set forth an explicit right to healthcare - 10th