USHC final exam

What was "Terri's Law"?

Terri's Law, they argued, does not allow the state to intrude into a person's private decision except in instances "when no written advance directive exists, where a family member has disputed the withholding of nutrition and hydration, where a court has found the patient to be in a persistent vegetative state, and where a family member has challenged the withdrawal of nutrition and hydration. This gave Florida Governor Jeb Bush the authority to intervene in the case. Gov. Bush immediately ordered the feeding tube reinserted

What is the difference between macroallocation and microallocation?

macro - amount and distribution of resources within a society, more significant micro- resource constraints at the level of individual physician or institution; more acute; bedside rationing

Who typically makes macroallocation decisions?

medical directors of private insurance companies and leaders of MCR/MA programs

What are pros of a govt financed single payer system?

universal coverage potential cost savings physician choice portability

How can harm be minimized when rationing has to compromise beneficence?

utilize science to determine which treatments will maximize benefit and minimize harm

Which California governor vetoed the single payer plan in 2008?

Arnie

Which president was the first to propose an employment based national health insurance?

Richard Nixon in 1971 -mandate for the employer to purchase private health insurance for their employees

What is the order of surrogacy of family members according to PA act 169?

spouse adult children not of spouse adult children of spouse parent adult sibling adult grandchildren

What is the average annual cost of assisted living?

42,600 dollars -mostly paid out of pocket -housing with a graded intensity of services depending on functional capacity of its residence

What is the cap for high deductible plans per the ACA?

$6600 individual $13,200 family

How much were the tax penalties for not purchasing insurance in 2016?

$695 for individuals 2.5% of household income, up to 2,085$

How was AALL going to be funded?

-Program run by states and financed by payroll tax contribution from employers and employees -small contribution from state govt -payments go to regional funds (NOT private insurance) and funds pay for care -social insurance program

What was Clinton's solution for national health insurance in 1993?

-called for universal health insurance through an employer mandate (then changed this to voluntary) -employers were given tax credits to cover employees voluntarily -this approach has failed to significant'y reduce the number of uninsured

What are benefits of hospice?

-lower cost of care than those not in hospice programs -family members are more satisfied vs families of pts dying in hospitals or nursing homes

What are the two requirements in order to have savings in one area directly benefit another area?

1) a closed system of health care funding (whether govt global budget or a private network of HMOs) 2) a decision making structure with responsibility to allocate budgets to health care interventions in a fair manner

What three things must be balanced if rationing must occur?

1) concerns of health people for illness prevention 2) importance of acutely sick people to obtain diagnosis and treatment 3) obligation to provide care and comfort to those with untreatable chronic illness

When was MCR/MA enacted?

1965

What was the outcome of Nancy Cruzan's case?

1983 placed limits on autonomy requiring that life supporting tx can be withdrawn only when the pt has stated their wishes clearly in advance

When was SCHIP enacted?

1997

When was the ACA passed?

2010

How many patients in the US die each day awaiting organ transplants?

21

What percentage of an elderly person's income goes toward health care costs?

24% (1/5 of it goes to nursing homes) expenditures are worse for poor, minorities, and females direct out of pocket payments by pts finance 15% of LTC in USA

What percentage of medicare's budget is pent on people in their last 6 mo of life?

28%

What percentage of uninsured were employed or were dependents of employed persons in the 1990s?

75%

What was the first national health insurance proposal (in the US)?

American Association for Labor Legislation (AALL) 1915 proposal attempted to provide medical care, sick pay, and funeral expenses to lower paid workers and their dependents AMA reversed its support and proposal failed

T/F: Painful cost control may require rationing.

true limits are placed on medical care that is expected to be beneficial

What did the 1970 Kennedy-Griffiths Health Security act attempt to do?

Broaden MCR and MA system in order to cover the entire population -govt health insurance would replace all public and private plans -govt financing through income tax -AMA and private insurance opposed

T/F: Long term care focuses on only health care.

False LTC includes health, social, house, transportation, and supportive services

T/F: Painless cost control is an example of rationing.

False - NO limitation is placed on medical care that is expected to be beneficial

Which case/dilemma discussed the ethics of caring for conjoined twins?

Lakebergs -separating twins - one will probably die, will the other have a better life than if both lived together?

Which ethical dilemma case promoted the right of pt/their surrogates to withdraw tx even if tx is necessary to sustain life?

Karen Ann Quinlan 1975

Which state implemented the first individual health care mandate?

Massachusettes - governor Mitt Romney -penalties for not having insurance -subsidies to purchase insurance if below 300% of poverty level (not covered by MA) -insurance rates for non-elderly dropped for 14% to 3.7% Con - high degree of cost sharing

Why is On Lok Senior Health Services in San Francisco used as a LTC model?

On Lok = peaceful, happy abode -social health maintenance organization began in 1971 -merged all aspects of LTC into 1 program -multidisciplinary health care team -assume financial risk for frail elderly population *reimbursed via capitation from MCR/MA -cost is no high than traditional MCR/MA covered care, but provides far more comprehensive care!

What are the 4 basic methods for financing health care?

Out of pocket, individual private insurance, employment based private insurance, govt financing NOTE: out of pocket financing would NOT be an option for paying for national health care

What programs provide On Lok "look alikes?"

PACE programs that exist in 32 states -reduced hospitalization rates compared to non PACE programs however MA costs are higher

What does PACE stand for?

Program of All-inclusive Care for the Elderly

What are potential pros/cons of employer mandated natl health insurance?

Pros: extension of current system may make transition easier Cons: economically disastrous, may increase lay offs, high admin costs, not portable, lack of decision making regarding your physician

Differentiate between the 2 categories of national health insurance: social insurance model vs public assistance model.

Social insurance model - only those that have paid into the system are eligible for the benefits (ie MCR) public assistance model - eligibility is based on a means test; those below a certain income may receive assistance (ie MA)

T/F: single payer systems are the most radical proposals for national health care reform.

true - biggest difference from current system - eliminate MA and private insurance - enact a system similar to MCR for everyone

What is UNOS?

United Network fo Organ Sharing -The national organ transplantation act was passed in 1984 -organization matches organs and recipients -medical criteria become the major factor in allocating organs

What bill proposed natl health insurance organized as an expansion of social security system?

Wagner-Murray-Dingell Bill of 1943 -employer and employee contributions paid to the federal social insurance trust fund -trust fund to pay providers -supported by Harry S. Truman but natl health insurance was defeated by the AMA AGAIN

What does MCR part A cover?

hospital care and skilled nursing care

What were the exclusion criteria that Stanford defined in 1980 for organ transplants?

alcoholism, job instability, antisocial behavior, or psychiatric illness social and economic criteria for access raised concerns for distributive justice

How did 1915(c) waivers expand MA coverage of home health services?

authorized in 1981 Home and community based care 1915(c) waivers program attempts to prevent nursing home admissions by allowing MA recipients to receive more home care services

What are the 4 ethical principles of medicine?

beneficence - help those in need nonmaleficance - do no harm autonomy - right of the person to choose and follow his or her own plan justice - treat everyone fairly

What term applies to the allocation of benefits and burdens in a society ie welfare benefits are based on need?

distributive justice

What are the 5 ADLs?

eating, dressing, bathing, toileting, transferring

T/F: In 2009, more elderly people died at home vs the hospital.

false 52% in hospital 34% at home

T/F: the republican controlled House voted 10 times to repeal ACA from 2011-2015.

false 60 times

T/F: Medicare covers a greater percentage of LTC costs than medicaid.

false MA pays 40% MCR pays 21% MCR usually pays for services for a few weeks or months after an acute hospitalization but not for care of a stable chronic condition

T/F: The ACA is costing the federal govt more than it was projected to cost.

false costing 20% less than projected

T/F: individual mandates would have the least effect on existing dollar flows in the health care system.

false - employer mandates (extend rather than replace employment based coverage)

T/F: LTC insurances reimburse charges for nursing homes.

false - pay fixed daily fee rather than reimbursing actual charges -ie pay 150$ per day after 90 day deductible -avg cost of nursing home care was 245$ per day in 2011 -policies may limit coverage to a few years AKA shitty investment

How is medicaid funded?

federal and state taxes public assistance model of govt insurance program is administered by the state

What are cons of a single payer, govt financed system?

govt would have too much power can negate coverage easily to control costs taxes would rise too high to pay for this system

How did the ACA save 82 mil seniors an average of 1,407$ in rx med costs?

gradual closing of MCR part D donut hole

All of these resources are scarce in the US health care system except: Organs health care services Primary care money

health care services health care commodity scarcity is not a reality in the US

What are the 4 main components to reform health care?

individual mandate employer mandate MA eligibility expansion insurance market regulation

What did the Heritage foundation (conservative group) propose for natl health insurance in 1989?

individually purchased national health insurance -individual mandate -similar to mandatory car insurance -employers offer insurance but don't have to contribute $ -tax credits proposed to offset cos of premiums -vouchers for poor individuals -continued coverage as workers changed jobs

What are the 8 IADLs?

laundry, housework, meal prep, grocery shopping, community transportation, financial management, medication management, making phone calls

What percent of elderly had health insurance in 1950?

less than 15% -MCR/social insurance program in response

What percentage of US population over 45yo has private LTC insurance?

only 5% -costs are high and premiums increase with age -most elderly cannot afford this coverage -usually specify the pt must be dependent in 2 or more ADLs before receiving home health services -large deductible for nursing home care

By how much did medicare part B premiums increase from 1966 to 2015?

over $100 $3 to $104.90

What is a common impairment in individuals required long term care?

people utilizing LTC have impairment in ADLs, IADLs

What are pros of an individual mandated ntl health insurance system?

portability, frees employers of the obligation to provide insurance, tax credits available for those who can't afford coverage

What are the 4 basic concepts address in 'The joint principles of a patient centered medical home?'

primary care, patient centered care, new model practice, payment reform idea that primary care would coordinate care for pts with complex needs

What regulations did the ACA place on the insurance market?

private insurance has to cover young adults up to age 26 on parents insurance eliminates caps on total insurance benefits payouts prohibits denial of coverage based on preexisting conditions Limits the extent of experience rating to a max of 3:1 between a plans highest and lowest premium charge for same package

Why did businesses begin to hire more part time workers without health care benefits?

rapidly rising costs made insurance unaffordable in the 1990s

What type of long term care is covered by insurance: skilled care, custodial care, or both?

skilled care only assistance with ADLs, IADLs are not covered

What was the Pepper Commissions recommendation for funding LTC in 1990?

social insurance program -similar to MCR part A -financed by increased compulsory SS contributions -provide coverage for help with ADLs and IADLs

How is MCR financed?

social security payments, federal income taxes, and individual procedures

What act accomplished the following: set standards for nursing homes (ECFs) and mandates surveys to enforce quality standards?

the omnibus budget reconciliation act of 1987

What are the cons of an individual mandated natl health insurance system?

too difficult to enforce, cumbersome system to award tax credits, not affordable for low income families, would encourage bare bones policies

T/F: ACA expanded roles of nurses, pharmacists and other HC professionals.

true

T/F: MCR part A costs have increased from 1% to 2.9% (1966 v 2015).

true

T/F: Organ transplant system is the best model for allocation of resources on an INDIVIDUAL level.

true

T/F: The ACA limits the % of premiums that can be retained by the insurance company as overhead or profit.

true

T/F: for profit nursing homes have more quality problems/deficiencies than nonprofit facility homes.

true common deficiencies include failure to prevent falls, failure to prevent or treat pressure ulcers, and use of restraints - hispanics are more likely to be placed in low quality facilities than whites

T/F: the ACA eliminated the categorical eligibility for MA.

true ie young, parents, pregnant, elderly, disabled

What group of people make up the majority of unpaid LTC providers?

women over 60yo