Week 3.pdf

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 abil...

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 (