Health Policy

Explain the significance of Planned Parenthood v Casey (1992) case?

almost overturned Roe v Wade but then affirmed it. The Pennsylvania legislature amended its abortion control law in 1988 and 1989. Among the new provisions, the law required informed consent and a 24 hour waiting period prior to the procedure. A minor seeking an abortion required the consent of one parent (the law allows for a judicial bypass procedure). A married woman seeking an abortion had to indicate that she notified her husband of her intention to abort the fetus. These provisions were challenged by several abortion clinics and physicians. A federal appeals court upheld all the provisions except for the husband notification requirement. The five provisions were 1) The woman had to provide her informed consent, a doctor had to provide her with information about how abortion may impact her health, and she had to wait 24 hours after receiving this information prior to having the procedure 2) Anyone under the age of 18 had to have the consent of at least one parent. 3) If married, she must have consent from her husband 4) It clearly defined what is meant by a medical emergency that is necessary to terminate a later stage pregnancy 5) New reporting outcomes must be maintained by facilities that perform abortions. In the ruling by the Supreme Court, they found that all provisions except the one regarding spousal notice were legal and were allowed under law

Important Political and social events in the 1930's?

Great Depression and New Deal

What is the famous health quote from Rene Dubois?

"To ward off disease or recover health, people as a rule find it easier to depend on the healers than to attempt the more difficult task of living wisely.

Describe the relationship between the 14th amendment and the constitution?

* Denial of a minimal level of healthcare to the poor/disadvantaged could be seen as a violation of the equal protection guarantees of the Constitution o 14th Amendment applies only to states * Right to maintain bodily integrity...can relate to health o Similar principles in the Due Process Clause of the 5th Amendment (applies to federal government)

Describe the refugee act of 1980

* Refugee Act of 1980 created The Federal Refugee Resettlement Program to provide for the effective resettlement of refugees and to assist them to achieve economic self-sufficiency as quickly as possible after arrival in the United States. Set refugee quota at 50,000

How is a refugee defined?

* Refugee status is a form of protection that may be granted to people who meet the definition of refugee, are of special humanitarian concern to the USA, and are typically outside their country and unable or unwilling to return home because they fear serious harm.

How does the US handle healthcare for refugees?

* Refugees are considered lawfully present immigrants and are eligible for the same protections under the ACA as US citizens. * Refugees are exempt from the 5 year wait period to receive Medicaid and CHIP

Federal funding for refugee health care?

* Refugees with minor children are eligible for State-Federal programs that support families in need (Temporary Assistance for Needy Families - TANF and Medicaid). * Refugees who do not qualify for those programs are eligible for Refugee Cash Assistance (RCA) and Refugee Medical Assistance (RMA) for the first 8 months in the US. (these programs are 100% federally supported) * With RMA, the refugee gets the same benefit package as a Medicaid recipient in that state. When the RMA expires (8 months), the refugee is treated the same as other low-income persons in the state for eligibility for medical insurance assistance.

Is there a medical exam for US entry for refugees?

* The Immigration and Nationality Act (INA) and the Public Health Service Act regulations outline the requirements of medical examination of those seeking refugee status. * The purpose of the medical exam is to identify refugees with inadmissible health-related conditions. o Communicable disease of public health significance o Failure to present documentation of vaccination for vaccine-preventable diseases o Physical or mental disorder with associated harmful behavior o Drug abusers/addicts * Waivers may be granted in certain cases

Describe the Patient Protection and Affordable Care Act as it relates to refugees?

* They are granted the same protections and benefits under the ACA * Eligible to purchase insurance through the exchanges * Many will qualify for premium tax credits to purchase coverage * Health plans are prohibited from denying coverage to children under 19, including refugee children due to pre-existing conditions * Plans cannot deny coverage to those who were uninsured or had preexisting conditions (many may be coming from countries with poor health care/access) * No lifetime dollar limits on care * No charging higher premiums based on health status * States must extend Medicaid coverage up to age 26 for adults who have aged out of the foster care system, including those in the Unaccompanied Refugee Minors program

What does The WHO recommend for health care for undocumented immigrants/refugees?

* WHO does not recommend mandatory screening as there is a lack of evidence for its benefit or cost-effectiveness and it only adds increased anxiety (recommends voluntary health checks) * WHO suggests all migrants should have access to hospitals, prevention (vaccination) and high quality care (when needed) without discrimination * WHO supports policies to provide health care services to migrants/refugees regardless of their legal status as part of universal health coverage

Describe the components of abandonment?

1. Duty of care must be established - refusal to see a patient in the first place is not abandonment (duty of care must be established)

What are the main components of the ACA?

1. Elimination of lifetime limit on benefits and unreasonable annual limits on benefits 2. Prohibit insurance companies from kicking you off plans. 3. "Elimination of pre-existing condition insurance rule. Insurers will be prohibited from denying coverage or setting rates based on health status, medical condition, claims experience, genetic information, evidence of domestic violence, or other health-related factors" 4. Require coverage of preventive services and immunizations 5. Extend dependent coverage up to age 26 6. Each state will establish an Exchange to help individuals and small employers obtain coverage 7. New, refundable tax credits will be available for Americans with incomes between 100 and 400 percent of the federal poverty line (FPL)" 8. Health care mandate: Health care is now mandated in that a financial "shared responsibility" penalty will be assessed if someone chooses not to obtain healthcare 9. Employer mandate that employers must provide insurance if employees are full time and if they have at least 50 full time employees.

What are the main provisions of the ACA?

1. Extends dependent coverage to children under age 26, 2. children under age 19 cannot be denied insurance and benefits based on preexisting health conditions. 3. Major medical plans can no longer impose any annual or lifetime dollar limits on essential health benefits, 4. Plans must cover preventive care with no cost-sharing, and they cannot rescind cover- age, except in cases of fraud. 5. States are expected to establish health insurance marketplaces that provide access to private health insurance plans 6. The Secretary of Health and Human Services (HHS) will establish marketplaces in states that do not create their own approved marketplace. 7. Premium credits and cost-sharing subsidies will be available to individuals who enroll in marketplace plans, provided their income is generally at or above 100 percent and does not exceed 400 percent of the federal poverty level (FPL) and they meet certain other requirements. 8. Also beginning in 2014, most individuals will be required to have insurance or pay a penalty (an individual mandate) 9. Certain employers with more than 50 employees who do not offer health insurance may be subject to penalties. 10. ACA's market reforms are further expanded in 2014, with no annual dollar limits allowed on essential health benefits, and no coverage exclusions for preexisting conditions allowed regardless of age. 11. Additionally, plans must sell and renew policies to all individuals and may not discriminate based on health status. 12. In addition to the expanding private health insurance coverage, ACA, as enacted, requires state Medicaid programs to expand coverage to all eli- gible non-pregnant, non-elderly legal residents with incomes up to 133 percent of the FPL, or risk losing their federal Medicaid matching funds ○ This was found to be unconstitutional in the case of a National Federation of Independent business vs Sebelius ○ e Court found that the states were being "coerced" in violation of the Tenth Amendment into administering this new program. 13. ACA creates the Center for Medicare and Medicaid Innovation (CMMI) to pilot payment and service delivery models, primarily for Medicare and Medicaid beneficiaries. 14. The law also establishes new pay-for-reporting and pay-for-performance programs within Medicare that will pay providers based on the reporting of, or performance on, selected quality measures. 15. ACA also creates a variety of new commissions and advisory bodies, some with substantial decision-making authority

What were the two major cases against the ACA?

1. National federation of independent business v. Sebelius 2. King v. Burwell

When does a healthcare practicioner have a duty to care till?

1. Problem resolved 2. Pt discontinues services 3. Provider gives pt amble opportunity to seek other care

What are the three different acts pertaining to vaccinations?

1. Public health Service Act of 1944 2. National childhood vaccine injury act of 1986 3. 2010 ACA:

What are the elements of contracts?

1.offer and acceptance by a competent person having the legal capacity to make such an agreement 2. The second element in a contract is that there must be an exchange consideration 3. mutuality of obligation: both parties must be bound to perform their obligations or the law will treat the agreement as if neither party is bound to perform 4.

Describe the amendments of the constitution pertaining to abortion?

10th - if a power is not granted to the federal government, and it is not prohibited to the States, it is a State authority. The United States Constitution, including all of the amendments, does not expressively discuss abortion or medical services. 14th - Right to privacy has been used to uphold abortion. The 14th amendment gives freedom of choice of a woman for an abortion. It does NOT however imply a funding obligation for the government to pay for women's abortions.

Describe comstock laws?

1873 - Comstock law in (1873) made it a federal crime to have an abortion as it was lumped into anti-obscenity laws, except in the case of it being detrimental to the health of the mother

What is the current legal status of medical marijuana?

29 states have legal medical marijuana 8 states have legalized recreational marijuana

List the appropriate case laws for immunizations?

1905 Jacobson 1922 Zucht 1944 Prince 1973 Roe 1979 Brown

Describe the 1905 jacobson v. Massachusetts case?

1905 jacobson v. Massachusetts - Compulsory vaccination is an appropriate use of state police power to protect the health and welfare of it's citizens

Describe the 1922 Zucht case?

1922 Zucht - upheld that states can withhold admission to school based on immunization

Describe the 1944 Prince case?

1944 Prince v.Mass Massachusetts, which involved child labor under an asserted right of religious freedom, the U.S. Supreme Court summarized the doctrine, noting that: Neither rights of religion nor rights of parenthood are beyond limitation. religious freedom"does not include liberty to expose the community or the child to communicable disease

Describe 2016 - Whole Woman's Health v. Hellerstedt,(2016)?

2016 - Whole Woman's Health v. Hellerstedt,(2016) ○ The Court ruled 5-3 that Texas cannot place restrictions on the delivery of abortion services that create an undue burden for women seeking an abortion

Describe title 29 of the social security act?

1965 Healthcare for the poor and disabled Each state establishes eligibility standards, scope of services, develops rates, and administers program under minimum national federal guidelines

Describe the 1970: Family Planning Services and Population Research Act Title X of 1970:?

1970: Family Planning Services and Population Research Act Title X of 1970: Prohibits federal funds from being utilized for abortion services. Nixon described the premise of Title 10 as "no American woman should be denied access to family planning assistance because of her economic condition."

Describe 1973 Roe v. Wade?

1973 - Roe v Wade (1973): Supreme court upheld that "person" under the 14th amendment does not include the unborn... fetus not given protected constitutional rights. Under 9th amendment, person has right to medical decisions (based on right to privacy) so the mother's choice must be upheld. This ruling established the trimester notion and that women can have an abortion in the 1st trimester and there were limitations in the 2nd and 3rd trimesters

Health care reimbursement in 1980s

1980 - Fee for Service (FFS) 1983 - Diagnosis related group (DRG)

Describe Barber v. Superior court?

1983 - Barber v. Superior Court Right to Die case. A severely brain-damaged patient with poor prognosis was removed from a ventilator and later from a nasogastric tube with the agreement of his family and physicians. Another caregiver alleged that the withdrawal of both treatments was part of a conspiracy to kill the patient to hide malpractice; a California appeals court ruled that the physicians had no duty to continue to provide life sustaining treatment in light of their prognosis and his surrogate's agreement that he would prefer not to be so sustained.

1986- EMTALA: Emergency Medical Treatment and Labor Act

1986- EMTALA: Emergency Medical and Treatment Labor Act - forbids denial of care due to lack of ability to pay, prohibits the unnecessary transfer while care is being administered, and prohibits the suspension of care once it is initiated until the situation is stabilized

Describe planned parenthood v. Casey?

1992 - Planned Parenthood v Casey (1992) - • there were five stipulations that theoretically attempted to make the decision about abortion more of a group decision rather than an individual one made by the woman. The five provisions were • 1) The woman had to provide her informed consent, a doctor had to provide her with information about how abortion may impact her health, and she had to wait 24 hours after receiving this information prior to having the procedure • 2) Anyone under the age of 18 had to have the consent of at least one parent. • 3) If married, she must have consent from her husband • 4) It clearly defined what is meant by a medical emergency that is necessary to terminate a later stage pregnancy • 5) New reporting outcomes must be maintained by facilities that perform abortions. In the ruling by the Supreme Court, they found that all provisions except the one regarding spousal notice were legal and were allowed under law § Under this ruling states are allowed to restrict abortion, within limits, and they are not allowed to make it an undue burden to restrict a woman's right to have an abortion

Explain what is legal in the decision to remove life support?

1993 - role of court in life support decisions: court order is not necessary to remove life support if physician, hospital, or nursing home ethics committee, and legal guardian or next of kin all agree and they document the patient wishes, no liability if facts carefully documents but can be liable if facts do not exist to support the action taken Court involvement when: family members disagree, physicians disagree on prognosis, patient's wishes are not know as he or she was always incompetent, evidence exists of wrongful motives or malpractice, no family member can serve as guardian.

Describe 1994 the Vaccines for Children (VFC) program b

1994 the Vaccines for Children (VFC) program began, under which all Medicaid-eligible children, all children who are uninsured, all American Indian and Alaska Native children, and insured children whose coverage does not include vaccinations (with limitations on the locations where this last group can receive VFC vaccine) qualify to receive routine childhood vaccines at no cost for the vaccine. The VFC program operates in both public health clinics and private provider offices.

What are the components go HIPPA?

1996 Provides the ability to transfer and continue health insurance coverage when there is a change of employment or loss of a job; diminishes health care fraud and abuse; mandates industry-wide standards for health care information on electronic billing and other procedures; and requires the protection and confidential handling of protected health information

Describe 1997 Washington v Glucksberg & Vacco v. Quill.?

1997 Washington v Glucksberg & Vacco v. Quill. Found that there is no RIGHT to commit suicide. Both of these cases were the plaintiff arguing that states laws that ban physician assisted suicide are uncostitutional. This was found NOT to be so. Prohibition of physician assisted suicide by a state does not violate the equal protection clause of the 14th amendment. • The Court found that there was no constitutional right to have a physician assist in a suicide, so that the states were free to prohibit physicians from participating in suicides. The Court found that converse was also true: there was nothing to prevent the states from allowing both assisted suicide and physician participation in assisted suicide, so long as Congress does not preempt their authority by passing a law banning physician- assisted suicide nationally

Describe how the different constitutional amendments apply to vaccination?

1st amendment - Freedom of religion 5th & 14th - Federal and state governments cannot restrict, life, liberty, or property without due process of law 9th - Right to privacy. Upheld by Quinlan in 1976 and Cruzan vs state medical director in 1990) 10th - States are given all of the powers not designated by the constitution for the federal government • Courts must use strict scrutiny when arguing protected rights of the constitution Commerce clause: Government can regulate vaccinations sold in states Supremacy clause

Describe 2007 - Gonzales v Carhart?

2007 - Gonzales v Carhart : Upheld 2003 partial birth abortion ban upheld in 2007 by SCOTUS.

What is the rate of hospital born infections compared between England and the US?

3x more hospital born infections in England compared to US. .002 per capita in US and .006 per capita in England.

Which amendments pertain to the opioid epidemic?

5th 9th 10th 14th Commerce clause of constitution

What are the important amendments relating to illegal immigration?

5th: Right to due process federal 9th: Right to privacy. Rights retained by people. Travel is an enumerated irhgt. 10th: State rights. Police powers of state. 14th: Right to due process state. Equal protection by the state. All those who are born in the US are citizens

What is the definition of an administrative agency?

Administrative agencies Administrative agencies, whether created by the federal Constitution, Congress, or a state legislature, are official governmental bodies authorized and empowered to implement laws.

Explain the significance of Webster vs reproductive health services 1989 case?

Abortion case. In 1986, the state of Missouri enacted legislation that placed a number of restrictions on abortions. The statute's preamble indicated that "[t]he life of each human being begins at conception," and the law codified the following restrictions: public employees and public facilities were not to be used in performing or assisting abortions unnecessary to save the mother's life; encouragement and counseling to have abortions was prohibited; and physicians were to perform viability tests upon women in their twentieth (or more) week of pregnancy. Lower courts struck down the restrictions. Supreme Court overturned the lower courts decision.

Describe the importance of the Whole Woman's Health v. Hellerstedt,(2016) case?

Abortion case. Supreme Court ruled that The Court ruled 5-3 that Texas cannot place restrictions on the delivery of abortion services that create an undue burden for women seeking an abortion

Describe the acts pertaining to end of life issues?

Acts 1990 - Patient Self Determination Act: facilities receiving federal funds must inform all patients about advanced directives and that they can make their own health decisions 1998 - Oregon Death and Dignity Act: only for Oregon but has been frequently referenced law. Supreme Court has upheld that physician assisted suicide is not a constitutional right so that the states may control whether or not it is legal legally allow a physician to issue medication that would lead to death but not to administer it. The act requires proof that the person has less than 6 months to live and that the decision is not based on depression; requires 2 physicians confirm and waiting periods · Death with dignity act mandates pharmacists report sale of lethal drugs..like physicians, they can not be held liable as long as they follow the rules · CDC provides guidelines for proper disposal of these medications but that is all I could find

Describe laws on advanced directives?

Advanced Directive: State laws very slightly_ In the case of lack of AD and an incompetent patient. Some states make the physician the decision maker, Some states appoint the physician to determine next of kin, some have a hierarchy of family members that can make decisions and some appoint a court appointed proxy.

What would be the agencies involved in vaccinations?

Agencies like Dept HHS (NIH, CDC, FDA) and EPA Infectious Disease Society of America (IDSA) notes substantial scientific evidence supports use and they work to enforce vaccination and minimize exemptions CDC has an Advisory Committee on Immunization Practices that provideds suggested guidelines Other supporters include: AMA, pediatric infectious disease society, nursing association, American academy pediatrics, Pharmaceutical companies—BIG surprise! FDA is involved with vaccine and NIH with research here

What are important case laws relating to immigration?

Aliessa v. Novello (2001) - NY State court of appeals determined NY State funds must provide Medicaid to undocumented immigrants.

What is the actual wording of the 14th amendment?

All persons born or naturalized in the United States and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

What kind of allocative and regulatory decisions need to be made regarding Zika?

Allocative/distributive or regulatory; in the current case with Zika, allocative decisions/policies must be made to fund Zika research into a vaccine, testing, and public vaccination and treatment efforts as well as social regulation to prevent the spread of Zika and for mandatory reporting of a communicable disease.

What are the amendments of the constitution that deal with rights?

Amendments • Article 1 of constitution: Congress has the power to tax and spend to provide for the general welfare of the citizens • 5th - Equal protection from federal through due process clause • 8th Amendment - Prisoners have a right to food, clothing, shelter, and medical care. • 9th- Right to make medical decisions, right to life, right to privacy 14th - Provides equal protection under the law and someone cannot be discriminated against through due process clause. Right to privacy

Which amendments pertain to Zika?

Amendments 5th: Right to due process federal 9th: Right to privacy. Rights retained by people. Travel is an enumerated irhgt. 10th: State rights. Police powers of state. 14th: Right to due process state. Equal protection by the state. All those who are born in the US are citizens o But through constitution, all people (not just citizens) in the US (whether legally or illegally) have rights through 5th and 14th Amendments - "due process of law" and "equal protection under the law" § So entitled to fair hearing prior to deportation, can apply for asylum (Dye text) o HOWEVER - SCOTUS has decided that even illegal immigrants cannot be excluded from public education (Dye) - this federal policy heavily affects state and local resources o Grounds for immigrant deportation = falsified documents used to gain entry to US, committing felony once a resident, failure to register a change of address, aiding another to enter US illegally, marriage fraud, threaten national security, voting unlawfully; and failing to update the government with a residential address every three months o Government must provide clear and convincing evidence that entry gained through fraudulent means; deportee must then rebut with a preponderance of evidence that admission would have been granted even without the fraudulent material.

What are the amendments that apply to end of life issues?

Amendments 9th: right to make medical decisions regarding life To make medical decisions 10th: States rights to dictate health decisions in state. So, PAS left up to the states. 14th : right to due process. US citizen can not lose life, liberty or property without notice and opportunity to be heard. (physician would be tried with due process)

Which amendments apply to refugees?

Amendments · 5th - due process (federal). No deprivation of life, liberty or property · 10th - Anything not specified for federal govt by constitution is retained by the states and people · 14th - Equal rights/protection. Denial of minimal care can be seen as going against equal protection clause. Due process (state) No state may deprive life, liberty or property. Citizen if born here. The Fourteenth Amendment provides for equal protection under the law for all people ("people" not just "citizens") within the jurisdiction of the U.S. The Supreme Court interpreted that everyone has equal rights despite their, "legal status, color, or religion" and all the children regardless of their immigration status

Describe legislation to protect the rights of disabled individuals?

Americans with Disabilities Act (ADA)- Do people have a right for accommodations if they cannot go to school now because they ae not immunized Section 504 of the civil rights law - ensures that the child with a disability has equal access to an education. The child may receive accommodations and modifications. Individuals with disabilities Act (IDEA) - require a public school to provide an individualized educational program (IEP) that is designed to meet a child's unique needs and provide the child with educational benefit.

Describe the process for how a bill starts?

Anyone can draft a bill and this means special interest groups, lobbying bodies, or other individuals can draft a bill. According to Dye's model, it is the process of identifying a problem and setting an agenda that can lead to policy formulation. Longest notes this agenda setting including identification of problems, solutions and the political/social circumstances needs to happen at just the right time to move through the 'window of opportunity' and move toward true policy formulation and development of legislation. Referred to a committee The policy for covering immigrants in health care expenses would likely be referred to Ways and Means committee of the house and/or the health, education, labor and Pensions committee of the Senate.

Define assault?

Assault - mental threat (battery must be possible, and person must be aware of threat and fear it)

What are the 7 ethical theories?

Authority based Consequentialism Utilitarianism Egoist Virtue ethics Natural law Deontological

What are the 6 ethical principles?

Autonomy Beneficence Nonmaleficence Justice Procedural & distributive Fidelity Verocity

What is the background/timeline on the opioid epidemic?

Background • Opioids are natural or synthetic drugs that are used to fight pain. • They include prescription drugs such as Fentanyl, Morphine, OxyContin, Hydrocodone, Percocet, and Vicodin, as well as the non-prescription drug Heroin • Among these drugs, Fentanyl, can be absorbed through the skin and eyes is 100 times more potent than morphine, and 50% stronger than Heroin and .5 gram can be fatal. 1990's - Pain was being described as the fifth vital sign. There was a push to manage pain better. The number of painkiller prescriptions increased in the US from 2 million to 3 million each year. 1995 - 1996 - painkiller prescriptions increased to 8 million, according to a National Institute Drug Abuse study. 1996 - OxyContin was introduced by Purdue Pharma. 1998 - Purdue Pharma created a video promotion entitled 'I got my life back' which was shown in waiting rooms of doctor's offices. In this video six people with chronic back pain and were treated with OxyContin. The doctor featured on this video stated that this drug should be used much more than it is to treat pain. 2007 - Purdue Pharma along with three executives were charged with misbranding its drug and downplaying the possibility of addiction. The executives pleaded guilty and settled with the government for $625 million. • 2014 - Over 28,000 deaths due to Opioids overdose in the US, about ½ from prescription drugs. Heroin-related deaths tripled from 2010 and in 2014 10,500 people died of Heroin overdoses. More people died from drug overdose than any time recorded. More than 240 million prescriptions were written for opioids, and four out of five heroin users started out using prescription opioids. • The use of Fentanyl has increased 80% in the US this last year. On the east coast of the US its found in powder form, whereas the on the west coast its found in pill form. • Deaths from an overdose of Fentanyl increased from 92 to 514 in Ohio, 185 to 397 in Florida, and 58 to 185 in Maryland in a year's time. March 2016 - The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are taking steps to address the epidemic. CDC has developed guidelines for the physicians who prescribe Opioids for chronic pain. The FDA for the immediate -release Opioids will now carry a "black box" warning about the risk of abuse, addiction, overdose, and death.

Where did medicare part C come from?

Balanced budget act of 1997

Define battery?

Battery - physical touch without consent

What is beyond all reasonable doubt?

Beyond reasonable doubt: This is the highest standard used as the burden of proof in Anglo-American jurisprudence and typically only applies in criminal proceedings

List the bills/acts which apply to abortion?

Bills 1873 - Comstock law in (1873) made it a federal crime to have an abortion as it was lumped into anti-obscenity laws, except in the case of it being detrimental to the health of the mother  1970: Family Planning Services and Population Research Act Title X of 1970: Prohibits federal funds from being utilized for abortion services. Nixon described the premise of Title 10 as "no American woman should be denied access to family planning assistance because of her economic condition." Hyde Amendment: disallows federal funding for abortion unless the pregnancy results from rape or incest, or if it is life-endangering. Planned Parenthood gets claims that the federal funding is utilized for services other than abortion services. Title 42 Federal law was amended to allow federal funding of transplantation research, it prohibited a physician from altering the timing, method or procedures used to terminate a pregnancy solely for the purpose of obtaining tissue. In addition clear consent must be made by the woman donating the tissue that the tissue can be utilized for research and that she has not been informed regarding the identity of the researchers. Title 42 Federal law prohibits any person "to knowingly acquire, receive, or otherwise transfer any human fetal tissue for valuable consideration if the transfer affects interstate commerce." Human fetal tissue includes all "tissue or cells obtained from a dead human embryo or fetus after a spontaneous or induced abortion, or after a stillbirth." However, "valuable consideration does not include reasonable payments associated with the transportation, implantation, processing, preservation, quality control or storage of human fetal tissue." 2015 • 2015 : Defund Planned Parenthood Act 2015 (See my analysis paper for a full reading) o Inflammatory videos from a prolife group appeared to show employees of PP looking to profit from the sale of body parts of aborted fetuses o This lead to the above stated law which looked to eliminate funding to all PP clinics that performed abortions, unless the health of the mother was concerned § In this case they did not look to eliminate abortion rights, but instead went after the largest provider of abortions § The law did not make it out of congress to the president's desk

What are the pertinent bills relating to refugees?

Bills 1944: PUBLIC HEALTH SERVICE ACT 1944: HHS PREVENT ENTRY AND SPREAD OF COMM DISEASES BUT STATES ALSO HAVE AUTH WITHIN 1952: Immigration and nationality Act- removed race based quotas and set nationality-based quotas. started the Immigration and Naturalization Service (INS) 1964 Civil Rights Act · Healthcare and related services must be provided in a language and manner that the refugee can understand (Title VI of the 1964 Civil Rights Act, requires federal agencies to implement systems to help those with limited English proficiency). 1965 Immigration and Naturalization Act: states if President finds entry of aliens to US would be detrimental to interest of US he may for the period deemed necessary suspend entry They may also decide to do screenings of people entering the country. · Refugee Act 1980 - regulates this policy; must prove fear of persecution is real if return to homeland to gain refugee status · Under international law, the Geneva Convention, or the laws of the United States, foreign citizens who have become disillusioned with their homeland cannot take temporary refuge within the United States. · The President retains the ultimate decision making authority when determining the number of refugees to allow into the country during a given year. · 2010 - ACA Refugees and the ACA · They are granted the same protections and benefits under the ACA · Eligible to purchase insurance through the exchanges · Many will qualify for premium tax credits to purchase coverage · Health plans are prohibited from denying coverage to children under 19, including refugee children due to pre-existing conditions · Plans cannot deny coverage to those who were uninsured or had preexisting conditions (many may be coming from countries with poor health care/access) · No lifetime dollar limits on care · No charging higher premiums based on health status · States must extend Medicaid coverage up to age 26 for adults who have aged out of the foster care system, including those in the Unaccompanied Refugee Minors program Amendments · 5th - due process (federal). No deprivation of life, liberty or property · 10th - Anything not specified for federal govt by constitution is retained by the states and people · 14th - Equal rights/protection. Denial of minimal care can be seen as going against equal protection clause. Due process (state) No state may deprive life, liberty or property. Citizen if born here. The Fourteenth Amendment provides for equal protection under the law for all people ("people" not just "citizens") within the jurisdiction of the U.S. The Supreme Court interpreted that everyone has equal rights despite their, "legal status, color, or religion" and all the children regardless of their immigration status

What are the bills pertaining to medical marijuana?

Bills 1970 Controlled Substances Act (1970): Allows for the classification of drugs to be established including schedule 1 drugs (highly addictive and have no accepted medical use). This law also allows the federal govt to prosecute individuals and businesses who participate in the consumption, growth or distribution of these drugs. In addition, this law prohibits a physician from prescribing a medication that is considered a schedule 1 drug, therefore MM must be a recommendation or referral. 1990 Patient Self Determination Act of 1990: Patients have the right to be informed of their medical rights and to execute an advanced directive. Also ensured their right to refuse/choose their medical treatment. In addition the law mandates the admitting hospitals inform the family or default surrogate that they have the right to make medical decisions

Define breach of contract?

Breach of Contract · A valid contract was executed · The plaintiff performed as specified in the contract · The defendant failed to perform as specified in the contract The plaintiff suffered an economic loss as a result of the defendant's breach of contract

Describe breach of warranty?

Breach of Warranty · A warranty is a guarantee concerning goods or services · Express warranty includes specific promises or affirmations made · Implied warranty is a guarantee of a product's quality that is not expressed in a purchase contract; assumes the item sold can perform the function for which it was designed Strict Liability · Defendant must have manufactured the product · Product must have been defective at the time of the sale · Plaintiff must have been injured by the product The defective product must have been the cause of the injury

What is the burden of proof with negligence cases?

Burden of proof based on a preponderance of evidence (plaintiff's evidence outweighs the defendant's evidence).

What is the burden of proof level for most vaccination cases?

Burden of proof is preponderance of evidence

What level of burden of proof is necessary in end of life cases?

Burden of proof level for a court case: Clear and convincing evidence

Describe the different levels of burden of proof?

Burden of proof refers most generally to the obligation of a party to prove its allegations at trial Reasonable suspicion is a low standard of proof in the U.S. to determine whether a brief investigative stop or search by a police officer or any government agent is warranted. Probable cause is a relatively low standard of evidence, which is used in the United States to determine whether a search, or an arrest, is warranted Some credible evidence: One of the least reliable standards of proof, this assessment is often used in admistrative law, and often in Child Protective Services Substantial evidence is "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion."[4] Preponderance of the evidence, also known as balance of probabilities is the standard required in most civil cases Clear and convincing evidence is a higher level of burden of persuasion than a "Preponderance of the Evidence. This standard is used in many types of equity cases, including paternity, PINS, juvenile delinquency, child custody, the probate of both wills and living wills, petitions to remove a person from life support ("right to die" cases),[7] and many similar cases. Beyond reasonable doubt: This is the highest standard used as the burden of proof in Anglo-American jurisprudence and typically only applies in criminal proceedings

What were some of the health care cost containment issues of the 1990s?

Bye bye fee-for-service Dramatic increase in cost containment measures such as managed care

Define a contract?

Contract: a special kind of agreement, written or oral, that involves legally binding obligations between two or more parties.

Describe the CDC stance on vaccinations

CDC's National Immunization Program: As of 2000, the CDC purchased over half the childhood vaccine administered in the United States through two federally overseen, state-administered programs. The CDC produces vaccine information materials for mandatory distribution by providers to patients or parents before administration of VICP-covered vaccines. Through these materials, called Vaccine Information Statements, parents are informed about the schedules for administration of the vaccines, are alerted to contraindications that dictate against administration to particular individuals, and are informed about potential adverse reactions to look for to encourage timely medical intervention, as needed.

What is the position of the CDC/WHO on medical marijuana?

CDC/WHO Primary responsibility of both is to disseminate information and support research that achieves increased information pertinent to health and well being of individuals CDC investigates and collects data, warns the public of threats (side effects and addictions), educates HC providers and provides recommendations to patients. The CDC must follow the guidelines of the federal govt, which maintains the use of marijuana for any purpose is illegal, however, the do not post a position on this topic. WHO was founded to address the global issues of health and disease- provides guidance in current research, dissemination of information, leadership on global issues, and technical support. Again there is no public position of the WHO, however, they will work with the CDC to address any global issues such as effects of international travel to obtain the drug. Most countries maintain that the use of marijuana for recreational purposes is illegal however several countries have legalized MM: Austria, Canada, Germany and Spain.

Describe how the National childhood vaccine injury act of 1986 applies to vaccinations?

Can get federal money if injured by a vaccine significantly limited tort against provider and drug manufactuers An excise tax on each dose of covered vaccine funds the compensation program. Individuals alleging vaccine injury must go through the VICP before filing any tort actions against the administering health-care provider or the vaccine manufacturer. If the judgment of the court is accepted, further actions against the provider and manufacturer are barred. Even if the judgment is declined, the NCVIA significantly narrows the scope of any tort action against the manufacturer. Since the inception of the VICP, few individuals have chosen to reject the judgment of the court and file suit against the provider or manufacturer Department of Health and Human Services to coordinate and oversee all activities within the U.S. government related to vaccine research and development, vaccine-safety monitoring, and vaccination activities

Describe Canterbury (1972): Canterbury v Spence

Canterbury (1972): Canterbury v Spence Led to informed consent law, employs "reasonable man" standard Courts have ruled that anyone in the border of the US (even illegal immigrants) are granted the same fundamental, undeniable constitutional rights (except right to vote and have firearms) - comes from 14 Amendment but upheld within courts

Describe relevant case law for the opioid epidemic?

Case Law • In 2007 Purdue Pharma, along with three executives were charged with misbranding its drug and downplaying the possibility of addiction. The executives pleaded guilty and settled with the government for $625 million. • In December 2015 Perdue Pharma was ordered to pay the state of Kentucky $24 million over an eight-year period. Kentucky accused Perdue Pharma of misleading the public about the addictiveness of the drug. • Some states, including Ohio and Missouri, have recently sued pharmaceutical companies over their role in the opioid epidemic. • MDs in multiple sates have been convicted of manslaughter secondary to perscribing opiods and their patients overdosing when they were not medically necessary.

What is the relevant case law for ZIKA?

Case Law 1905 Jacobson vs MA imposed mandatory immunization for protection of public health. Now that we know Zika can be spread through sexual contact, perhaps the greater good is to provide herd immunity.[bc1] 1922: School mandates for immunization is 1922 Zucht case. This relates back to the 10th amendment also as the US supreme court federal rulings for mandatory vaccination could only be applied if there was a significant public health need [bc1]Can the vaccination be similar to the HPV that is recommended for males and females?

Describe the relevant case law pertaining to abortion?

Case Law 1965 US Supreme Court struck down state laws prohibiting use of birth control by married couples • 1965 Griswold v Connecticut SCOTUS ruled in favor of the "right to privacy" and this set the stage for Roe v Wade. Supreme Court ruled that a state's ban on the use of contraceptives violated the right to marital privacy. The case concerned a Connecticut law that criminalized the encouragement or use of birth control. • 1973 - Roe v Wade (1973): Supreme court upheld that "person" under the 14th amendment does not include the unborn... fetus not given protected constitutional rights. Under 9th amendment, person has right to medical decisions (based on right to privacy) so the mother's choice must be upheld. This ruling established the trimester notion and that women can have an abortion in the 1st trimester and there were limitations in the 2nd and 3rd trimesters • 1989 - Webster v. Reproductive health services (1989) • 1992 - Planned Parenthood v Casey (1992) - • there were five stipulations that theoretically attempted to make the decision about abortion more of a group decision rather than an individual one made by the woman. The five provisions were • 1) The woman had to provide her informed consent, a doctor had to provide her with information about how abortion may impact her health, and she had to wait 24 hours after receiving this information prior to having the procedure • 2) Anyone under the age of 18 had to have the consent of at least one parent. • 3) If married, she must have consent from her husband • 4) It clearly defined what is meant by a medical emergency that is necessary to terminate a later stage pregnancy • 5) New reporting outcomes must be maintained by facilities that perform abortions. In the ruling by the Supreme Court, they found that all provisions except the one regarding spousal notice were legal and were allowed under law § Under this ruling states are allowed to restrict abortion, within limits, and they are not allowed to make it an undue burden to restrict a woman's right to have an abortion • Planned Parenthood v. ACLA (2001 - The American Coalition of Life Activists (ACLA) released a flier and "Wanted" posters with complete personal information about doctors who performed abortions. A civil jury and the Ninth Circuit Court of Appeals both found that the material was indeed "true threats" and not protected speech. • 2003 - Partial birth abortion ban (2003): a ruling that prohibited the procedure known as intact dilation and extraction. • 2006 Ayotte v. Planned Parenthood of Northern New England (2006). Planned Parenthood et al. challenged the constitutionality of a New Hampshire parental notification law related to access to abortion. New Hampshire ended up repealing the statute via the legislative process. • 2007 - Gonzales v Carhart : Upheld 2003 partial birth abortion ban upheld in 2007 by SCOTUS. • 2016 - Whole Woman's Health v. Hellerstedt,(2016) ○ The Court ruled 5-3 that Texas cannot place restrictions on the delivery of abortion services that create an undue burden for women seeking an abortion • Maher v. Roe & Harris v. McRae: Supreme court ruled that the medicaid program could refuse to pay for a woman's abortions •

What is the relevant case law with medical marijuana?

Case Law 2002 - Conant vs Walters(2002) Supreme court ruled that physicians may discuss and recommend the use of MM however they could not assist them in obtaining it.

Report on King v. Burwell?

Case challenging the ability of congress to give subsidies to all individuals regardless if they bought their insurance from a state exchange

What is the case law pertaining to end of life issues?

Case law • 1973 - Roe V Wade: right to privacy in medical decisions (US Supreme Ct) • 1976 - Quinlin(1976) - Karen Quinlin's father sued to be able remove respirator tube, supported use of other's substituted justified in right to refuse life supporting medical care • 1983 - Barber v. Superior Court Right to Die case. A severely brain-damaged patient with poor prognosis was removed from a ventilator and later from a nasogastric tube with the agreement of his family and physicians. Another caregiver alleged that the withdrawal of both treatments was part of a conspiracy to kill the patient to hide malpractice; a California appeals court ruled that the physicians had no duty to continue to provide life sustaining treatment in light of their prognosis and his surrogate's agreement that he would prefer not to be so sustained. • • 1990 - Cruzan (1990) - Cruzan's parents sued to be able to remove feeding tube, court supported their right to do on appeal. Reflected pt's right to refuse medical treatment. • 1993 - role of court in life support decisions: court order is not necessary to remove life support if physician, hospital, or nursing home ethics committee, and legal guardian or next of kin all agree and they document the patient wishes, no liability if facts carefully documents but can be liable if facts do not exist to support the action taken · 1997 Vacco V Quill: Landmark decsion by US Supreme Court that a fundamental right to commit suicide doesn't exist and a NY Ban on PAS was constitutional ; while equal protection under 14th amendment does allow competent persons to remove life support it doesn't allow PAS/euthanasia. US Supreme Court "made a legal distinction between refusal of treatment and" physician assisted suicide. • 1997 Washington v Glucksberg & Vacco v. Quill. Found that there is no RIGHT to commit suicide. Both of these cases were the plaintiff argiong that states laws that ban physician assisted suicide are uncostitutional. This was found NOT to be so. Prohibition of physician assisted suicide by a state does not violate the equal protection clause of the 14th amendment. • The Court found that there was no constitutional right to have a physician assist in a suicide, so that the states were free to prohibit physicians from participating in suicides. The Court found that converse was also true: there was nothing to prevent the states from allowing both assisted suicide and physician participation in assisted suicide, so long as Congress does not preempt their authority by passing a law banning physician- assisted suicide nationally

Who is responsible for the implementation of medicare?

Centers for Medicare & Medicaid Services (CMS; www.cms.gov), the agency responsible for implementing the Medicare and Medicaid programs as well as many aspects of the ACA, m

What are some different world views on abortion?

Chile is forbidden with all abortions, even medically necessary. Ireland is forbidden with abortion unless it's medically necessary (Rape, Incest, Save a woman's life). Abortions in Canada is avail to all women without restrictions. Of note: across the board. Abortion is NOT to be encouraged as part of "family planning?

Describe the Civil Rights Act of 1964

Civil Rights Act of 1964 which prohibits discrimination under federally funded programs

Important legal cases related to patient rights?

Civil Rights Act of 1964 which prohibits discrimination under federally funded programs 14th Amendment - citizenship if born here Ethics consideration: Access to health care should not be contingent upon the fact that undocumented immigrants have violated a law. Because the denial of health care to undocumented immigrants may also negatively affect the society by leading the increase in untreated communicable diseases (such as TB, Malaria, etc). 14th Amendment - citizenship if born here undocumented immigrants living and often working in the U.S have some rights and protection under the U.S constitution. The Fourteenth Amendment provides for equal protection under the law for all people ("people" not just "citizens") within the jurisdiction of the U.S. The Supreme Court interpreted that everyone has equal rights despite their, "legal status, color, or religion" and all the children regardless of their immigration status are entitled to free public education as mandated by Fourteenth Amendment.12 The courts have ruled that if the undocumented immigrants are within the borders of the U.S, they are granted the same fundamental, undeniable constitutional rights granted to all Americans except right to vote or possess fire 9th & 14th amendments - Right to privacy. Right to make decisions for your children because they are not competent 9th: The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people. Ie..The government needs a real good reason to limit your rights 14th: States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws. arms

Describe the civil rights act of 1964?

Civil rights act of 1964 ○ Prohibits discrimination with any federally funded program

Explain the two main types of damages and how they are awarded?

Comparative - both responsible (damages can be split ie 80/20) Contributory - if one contributed to the problem cannot get damages from the other

Explain comparative vs contributory damages?

Comparative - both responsible (example 20/80) Contributory - if plaintiff's negligence contributed to the outcome, they cannot collect money.

Explain the types of damages awarded for negligence?

Compensatory damages awarded to return the plaintiff to their prior financial state. Punitive damages can be awarded for pain and suffering

What is the actual wording of the 1st amendment?

Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

How is medical consent for treatment different for minors?

Consent for minors does not exist. It is more assent. Assent differs from consent in that while the willingness of a minor to accept treatment is an important consideration, it is just a consideration . Parental permission may trump assent.

Explain the importance of the 14th amendment?

Courts have ruled that anyone in the border of the US (even illegal immigrants) are granted the same fundamental, undeniable constitutional rights (except right to vote and have firearms) - comes from 14 Amendment but upheld within courts

Define criminal law?

Criminal law is society's expression of the limits of acceptable human and institutional behavior.

Describe he different levels of criminal law?

Criminal law is society's expression of the limits of acceptable human and institutional behavior. Misdemeanor is an offense punishable by less than 1 year in jail and/or a fine. Felony is a more serious crime and is punishable by imprisonment in state/federal penitentiary for more than 1 year. Kickbacks Fraud Criminal negligence is the reckless disregard for the safety of others; a willful indifference to an injury that could follow an act. Manslaughter is the unlawful killing of another person without malice of forethought. • Voluntary manslaughter: intentional killing of another person caused by a provocation • Involuntary manslaughter: death is a result of a reckless act (reckless driving) Murder is the unlawful killing of another that requires malice of forethought and the premeditated intent to kill another person. • 1st degree murder: deliberate and premeditated killing with malice of forethought • 2nd degree murder: not deliberate or premeditated, but does have malice of forethought

Define criminal negligence?

Criminal negligence is the reckless disregard for the safety of another.

Define criminal negligence?

Criminal negligence is the reckless disregard for the safety of others; a willful indifference to an injury that could follow an act.

Explain the importance of the Cruzan (1990) case?

Cruzan's parents sued to be able to remove feeding tube, court supported their right to do

Describe the current situation with end of life issues?

Current situtation/status · AMA code of ethics states "preferences of the patient should prevail" when the person is competent · States that have Death with Dignity Act or some equivalent form: Oregon (1994), Washington (2008), Montana (2009), Vermont (2013), California (2016) (www.deathwithdignity.org).... Class notes also included New Mexico and it was legal there in 2014, but there was a court of appeals reversal that made it illegal in Sept of 2015..likely to move to NM Supreme Court (this from healthcare.findlaw.com)

Describe the ADA of 1990?

DA (Americans with Disabilities Act of 1990) ○ Prohibits discrimination against individuals with disabilities

What are the divisions of the HHS?

DIVISIONS of health and human services: NIH (research), CDC (global health and with WHO looks at healthcare as a global right; helps promote WHO mission), FDA (vaccinations, enforces public health service act, condoms and control of disease

Describe different types of damages in breach of contract?

Damages Liquidated - set at time of contract Nominal - minimal so more symbolic Compensatory - restitution, reliance, expectancy Punitive: damages can be awarded for pain and suffering

Define defamation of character?

Defamation of Character: slander = oral, libel = written

What is the definition of health from The WHO?

Definition of health from the WHO: An often cited definition of "health" from the World Health Organization describes health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity."

Describe the proposed bill for the defund planned parenthood act of 2015?

Defund planned parenthood act of 2015 • Passed house on September 18th • The bill passed by the HR puts a 1 year moratorium on federal funding of Planned Parenthood, unless a clinic agrees not to perform any abortions or provide funding to other entities that provide abortions. The bill does allow exceptions for pregnancy due to rape, incest or a danger to the woman's health • The bill died in the senate and did not get passsed.

What are the two different degrees of negligence?

Degrees of Negligence: · Ordinary: failure to do, under the circumstances, what a reasonably prudent person would or would not do · Gross: intentional or wanton omission of care that would be proper to provide, or the doing of that which would be improper to do so

What can the fear of deportation do to illegals?

Deportation — and even the fear of it — can cause emotional distress and depression as well as distrust of healthcare providers, Dr Riley said. That distrust can lead individuals to delay or forgo medical care, which is a formula for disaster if they have highly infectious diseases such as tuberculosis and severe acute respiratory syndrome. Illegal immigrants would be especially reluctant to see physicians if those in publicly funded healthcare facilities were ever required to report the immigration status of their patients to authorities, an idea kicking around in some states, according to Dr Riley.

What is misfeasance?

Doing act incorrectly

What is malfeasance?

Doing unlawful or improper act

Describe the importance of the 14th amendment

Due Process Clause of the Fourteenth Amendment provides constitutional protection for certain rights or "liberty interests" related to privacy. Legislative enactments that implicate the right to privacy have been reviewed under the heightened strict scrutiny standard of review. Thus, the right to privacy has been held to include the right to procreate, use contraception, have an abortion, and maintain bodily integrity. Actual Law No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws 4th Amendment - citizenship if born here Ethics consideration: Access to health care should not be contingent upon the fact that undocumented immigrants have violated a law. Because the denial of health care to undocumented immigrants may also negatively affect the society by leading the increase in untreated communicable diseases (such as TB, Malaria, etc). 14th Amendment - citizenship if born here undocumented immigrants living and often working in the U.S have some rights and protection under the U.S constitution. The Fourteenth Amendment provides for equal protection under the law for all people ("people" not just "citizens") within the jurisdiction of the U.S. The Supreme Court interpreted that everyone has equal rights despite their, "legal status, color, or religion" and all the children regardless of their immigration status are entitled to free public education as mandated by Fourteenth Amendment.12 The courts have ruled that if the undocumented immigrants are within the borders of the U.S, they are granted the same fundamental, undeniable constitutional rights granted to all Americans except right to vote or possess fire arms

Describe the EMTLA act of 1996?

EMTLA (Emergency medical and treatment labor act) of 1996 ○ Forbids denial of emergency care secondary to payer source ○ Health care provider must stabilize the patient before care is stopped

Describe the case law pertaining to employee responsibility?

Employee responsibility Darling v Charleston Community Memorial Hospital 1965: Found that hospital is liable for employees actions

Where did medicare part D come from and when?

Established as part of the Medicare modernization Act of 2003 (MMA)

Describe the executive branch and its role?

Executive Branch • Implements law (Signs laws or vetoes laws passed by congress) • Enforces laws through department regulations • Establishes rules and regulations to implement law • Appoints the director of the Department of Health and Human Services (HHS) • Contained within HHS is the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) • Also makes decisions based largely on political outcome • State of the economy is often blamed more on executive than legislature • Due to this, greater consideration of the budget and policy effect on the economy usually takes place at the executive branch • Can present a united front unlike the legislative branch which is heterogeneous in it's representation

What is nonfeasance?

Failure to act

Define false imprisonment?

False Imprisonment - unlawful restraint of a person's liberty (excessive force to restrain a patient may fall under this and battery)

Describe the role of the Federal - State - Local (Government levels) on health policy?

Federalism means responsibility for health policy is shared between the federal government and the states. And, to a lesser degree, the local governments.

Define felony?

Felony is a more serious crime and is punishable by imprisonment in state/federal penitentiary for more than 1 year.

Where does funding come from for health related research?

Funding for health related research • Federally, through budget of NIH (80% going to competitive grants, 10% to its own research - Longest text) • Also through private investment R&D/pharmaceutical companies FDA also must approve the drugs since it is agency responsible for safety of medications, biological products, food, cosmetics, radiation emitting products (longest)

explain the concept of Parens Patriae as applied to vaccinations?

Further authority to compel vaccination of children comes under the doctrine of parens patriae in which the state asserts authority over child welfare. In the 1944 case of Prince v. Massachusetts, which involved child labor under an asserted right of religious freedom, the U.S. Supreme Court summarized the doctrine, noting that: Neither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth's well being, the state as parens patriae may restrict the parent's control by requiring school attendance, regulating or prohibiting the child's labor, and in many other ways. Its authority is not nullified merely because the parent grounds his claim to control the child's course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death

Describe Parens Patriae when applied to vaccinations.

Further authority to compel vaccination of children comes under the doctrine of parens patriae in which the state asserts authority over child welfare. In the 1944 case of Prince v. Massachusetts, which involved child labor under an asserted right of religious freedom, the U.S. Supreme Court summarized the doctrine, noting that: Neither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth's well being, the state as parens patriae may restrict the parent's control by requiring school attendance, regulating or prohibiting the child's labor, and in many other ways. Its authority is not nullified merely because the parent grounds his claim to control the child's course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death. U.S. at 166-7, 64 S.Ct. at 442)

What is the world view on the opioid epidemic?

Global · Afghanistan (heroin 6.9% per capita) is the world's largest producer of poppy opium. Surveys from 2009 - 2012 gave shown at least 350,000 Afghans are addicted. · There is up to 50% of opium-using parents also give it to their children. · An estimated 1 million Afghans are addicted to heroin, which amounts to approximately 8% of the population. · The Afghans have limited access to treatment, many years of war, and resulting trauma.

1930's themes

Great Depression

What groups are eligible for medicare?

Groups eligible for Medicare: • People over the age of 65 • most persons with end-stage renal disease (ESRD) • persons with Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) are allowed to waive the 24-month waiting period. • Medicare eligibility could also apply to individuals in other areas who are diagnosed with a medical condition caused by exposure to a public health hazard for which a future public health emergency declaration is made under the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (Public Law 96-510).

What are state governments role in healthcare?

Guardians of publics health • Enact state laws to protect public's welfare • Promote healthy behaviors • Disease control • Natural disaster prep and response Purchasers of Healthcare Services • Medicaid funding • State employees Regulators • License and regulate health professionals • License and regulate health related organizations • Regulation of health insurance industry Safety net providers • Support of community based providers and charity care • Support of clinics that serve low income Education • Subsidize medical education • Fund public health education programs Experiments with new laws Experiments with laws before they reach the federal level · Monitor, investigate, inform/empower, mobilize community, develop and enforce policies/laws, link people to services, ensure competent HC workforce · Only certain infectious disease are reportable (those that can spread quickly or are dangerous) o Usually sexually transmitted diseases, childhood diseases, bioterrorism-related infections, and "unusual cluster of disease" (the "other" category) o Get reported to state public health departments then forwarded to national (CDC)

Define health?

Health Defined by the WHO (1946) as the "state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity)

What is the history of the zika problem?

History • The Zika virus is spread by the Aedes mosquito. The Zika virus was identified in the late '40s and early 1950s in South Africa. • Zika spread from Africa to french polynesia to south america and then to north America. • By the fall of 2015, the potential association between a Zika infection in pregnancy and microcephaly was confirmed. Microcephaly and other neurological conditions associated with Zika have now been identified as being transmitted both sexually by males exposed by Zika as well as by mosquito vector, which makes Zika somewhat unique. • Research of Zika virus has led to fund transfers within the DHHS to take 1% of funding from other important NIH funded projects, including Cancer and Ebola research to fund Zika virus research. Opponents of this say that while Zika virus is growing, the funding for this project should come from other countries including South America where the Zika virus outbreak is most impacted, as well as the US is approaching the winter season. In addition, illegal immigration, and the long term carrier in the male sperm has the potential for infecting American citizens, spreading the disease and causing birth defects within the US, leading to a quest for temporary stoppage and travel from Zika infested countries. Proponents say that although the amount of infected is still small in the US, it will continue to grow.

Explain the importance of the Darling (1965): Darling v Charleston Community Memorial Hospital case?

Hospital is liable for negligence of employees - Corporate Responsibility Doctrine

What are the house committees that may be involved in healthcare?

House subcommittee on Environment the Economy and Energy Subcommittee on Health House Democratic Steering and Policy Committee

Potential committee for vaccination bills?

House ways and means committee House Committee on Energy and Commerce and then to their subcommitte on health

Describe the Hyde amendment?

Hyde Amendment: disallows federal funding for abortion unless the pregnancy results from rape or incest, or if it is life-endangering. Planned Parenthood gets claims that the federal funding is utilized for services other than abortion services.

Describe the importance of the Aliessa v. Novello (2001) case?

Illegal immigrant case. NY State court of appeals determined NY State funds must provide Medicaid to undocumented immigrants.

Explain the importance of cruzan v. Harmon case (1987)?

In 1983 a 25 year old Missouri woman was injured in a car accident and suffered permanent brain damage. After 4 years her parents asked for artificial nutrition and hydration to be withdrawn, citing her statements to friends that if she were brain-injured she would not want to be kept alive. [=substituted judgment] A lower court approved the request; the state appealed to the state supreme court, which overturned the lower court judge's opinion. The family appealed it to the US Supreme Court. The Supreme Court ruled that yes, surrogates could withdraw life-supporting treatments; yes, artificial nutrition and hydration are on a par with other medical treatments in this respect; but that each state was allowed to set standards for what would count as evidence of the patient's prior wishes [and Missouri's standards didn't allow verbal testimony]. Missouri withdrew their objections to the withdrawal; Nancy Cruzan died 6 months after the supreme court decision and 13 days after the withdrawal of nutrition and hydration. (Annas discusses in SAL, 388) Important things about this case: she was diagnosed as in PVS (=permanent/persistent vegetative state, but not brain-dead); the treatment removed was not only ventilator support, but nutrition and hydration as well; states are allowed to set their own standards for what counts as evidence. Only two states, New York and Missouri, require a higher standard of evidence of the patient's preference than prior verbal statements.

Describe the 1990 the Patient Self Determination Act

In 1990 the Patient Self Determination Act was passed by the United States (US) Congress, this Act stated that competent people could make their wishes known regarding what they wanted in their end of life experience, when they were possibly not competent. Also included in this Act is the durable power of attorney, which designates a competent person to assist in making end-of-life decisions when the individual was no longer competent.

Describe the importance of the defund planned parenthood Act of 2015?

Inflammatory videos from a prolife group appeared to show employees of PP looking to profit from the sale of body parts of aborted fetuses o This lead to the above stated law which looked to eliminate funding to all PP clinics that performed abortions, unless the health of the mother was concerned In this case they did not look to eliminate abortion rights, but instead went after the largest provider of abortions The law did not make it out of congress to the president's desk

Explain the importance of the Superintendent of Belchertown State School v. Saikowitz (1977) case?

Incompetent person care case. Saikewicz was a 67 year old with an IQ of 10. He couldn't talk or communicate. He was diagnosed with AMM leukemia which was 100% fatal. Chemotherapy offered a 50% chance of partial remission. The court was asked to decide whether he should be treated or not. The court articulated the doctrine of 'substitute judgment:' If the person cannot make a choice, a surrogate should be appointed to choose on h/h behalf, either judging as that person would judge, or judging so as to concord with that person's best interest. "Incompetent persons must have the same panoply of rights and choices as competent persons, because they have the same dignity and worth." A guardian was appointed by the court and a hearing, was held, in which the decision was made that he should not be treated. This decision was appealed to the state Supreme Court for definitive policy, and they affirmed it. The case remains controversial.

Describe interest groups methods to influence health policy?

Individuals or organizations that present a unified position to a policymaker on a preference regarding a specific problem or solution. Easy to respond to or address a group with a unified position. Groups may seek to stimulate new policies that benefit their members or block policies that do not serve their member's best interests. · Methods Lobbying: communication methods to persuade policymakers to support choices that are in their best interest Electioneering: using resources to help policymakers obtain or keep political office, so they will vote in the groups interests. Litigation: challenge existing policies or alter policy implementation through litigation in state or federal courts. Influencing public opinion: media and public campaign to convince public opinion to support or challenge a policy.

Describe case law applying to informed consent?

Informed Consent • 1957 Salgo v. Leland Stanford ○ Led to AMA relook at requirement to provide for pt autonomy through education - start of informed consent • 1960 Nantanson v. Kline case • 1964 must be in native language - title VI of civil rights act of 1964 • 1972 canterbury v. spence - must be understandable by the "reasonable man" • must provide benefits and risks without coersion assent of minors - consideration, but parents have final consent

Explain the significance of the Cobbs v. Grant case?

Informed consent case. Cobbs had a duodenal ulcer. In the course of the operation, his spleen was nicked, and he had to have another operation. Then he developed a gastric ulcer. Cobbs felt he had not been sufficiently warned of possible risks of his initial operation. The court agreed and changed the standard of disclosure from physician-based ("what do doctors normally disclose") to patient-based ("what would a competent patient need to know to make a rational decision")

Explain the significance of the natansan v. Kline case?

Informed consent case. In a Kansas case a woman sued for damage in the form of radiation burns from cobalt radiation therapy following her masectomy. She brought a malpractice suit. The doctor conceded that she had consented, but had not been adequately informed of the risks.

What are the different levels of scrutiny? Highest to lowest?

It is part of the hierarchy of standards that courts use to weigh the government's interest against a constitutional right or principle • Strict: highest level - U.S. courts apply the strict scrutiny standard in two contexts, when a fundamental constitutional right is infringed,[1] particularly those found in the Bill of Rights and those the court has deemed a fundamental right protected by the Due Process Clause or "liberty clause" of the 14th Amendment, or when a government action applies to a "suspect classification" such as race or, sometimes, national origin. It must be justified by a compelling governmental interest. Examples include national security, preserving the lives of multiple individuals, and not violating explicit constitutional protections. Must be narrowly tailored and designed in the least restrictive way possible. • Intermediate scrutiny: middle level - it must be shown that the law or policy being challenged furthers an important government interest in a way that is substantially related to that interest • Rationally-based: lowest level - The rational basis review tests whether a governmental action is a reasonable means to an end that may be legitimately pursued by the government. This test requires that the governmental action be "rationally related" to a "legitimate" government interest

Describe Jacobson (1905)

Jacobson (1905) - against MA regarding imposing of immunizations, court support that state could impose mandatory law in support of public health ...(need for individual immunizations makes personal autonomy and states interest at conflict)

important legal cases in regards to immunizations?

Jacobson (1905) - against MA regarding imposing of immunizations, court support that state could impose mandatory law in support of public health ...(need for individual immunizations makes personal autonomy and states interest at conflict) 14th amendment Zucht (1922) - upheld that states can withhold admission to school based on immunization First Amendment Little recent case law directly addresses the existence of a First Amendment free exercise right to a religious exemption from mandatory vaccination because 48 states have provided by statute for religious exemptions to school vaccination laws. 10th Amendment /Police Power: Under the Tenth Amendment to the United States Constitution, the powers not specifically delegated to the Federal Government are reserved to the states or to the people. This implies that the Federal Government does not possess all possible powers, because some of these are reserved to the State governments, and others are reserved to the people. The first state law mandating vaccination was enacted in Massachusetts in 1809; in 1855, Massachusetts became the first state to enact a school vaccination requirement. The constitutional basis of vaccination requirements rests in the police power of the state. Nearly 100 years ago, the U.S. Supreme Court issued its landmark ruling in Jacobson v. Massachusetts, upholding the right of states to compel vaccination. The Court held that a health regulation requiring small pox vaccination was a reasonable exercise of the state's police power that did not violate the liberty rights of individuals under the Fourteenth Amendment to the U.S. Constitution. The police power is the authority reserved to the states by the Constitution and embraces "such reasonable regulations established directly by legislative enactment as will protect the public health and the public safety"

Define misdemeanor?

Misdemeanor is an offense punishable by less than 1 year in jail and/or a fine.

Describe the judicial branch and its role?

Judicial Branch • Nominated by president and confirmed by senate • Life tenure but can be impeached by congress • Interpret the law and determine constitutionality of the law • Inferior courts must apply Supreme Court's interpretation of law • Parties must petition Supreme court to hear case • Supreme court must grant certiorari • Supreme court usually only hears cases where there is a new or important legal principle, or when two or more federal appellate courts have ruled against each other. • Can nullify the rules and regulations given by the executive branch • Can declare federal and state laws unconstitutional Health policy making is far more common in state courts and lower courts than in Supreme court Judicial The courts have 3 roles in health policy (Referee, meaning giver, rights protector) 1. Judicial review. Deciding disputes in regards to the extent of authority enjoyed by each of the three branches. 1. Has a branch of government acted within the constitution or overstep it's role as defined. 2. Interpreting laws when there is dispute about a laws meaning. Clarify the meaning of laws. Vindicating or rejecting the rights of parties who come to court and claim their rights have been violated.

Explain the importance of the Quinlin(1976) case?

Karen Quinlin's father sued to be able remove respirator tube, supported use of other's substituted justified in right to refuse life supporting medical care

What are some key health issues facing refugees?

Key Health Issues facing Refugees/Migrants · Physical or traumatic injuries related to travel or lack of control of chronic medical issues · Forced displacement leads to loss of access to medication/medical supplies for acute or chronic conditions, lack of access to health services, disruption to treatment · Poor living conditions contribute to added physical and psychological strain Interruption of care due to destruction of health care facilities in their country, inability to access providers (who are killed or injured), disruption in supply delivery, power failure leads to issues with safe water/sanitation

What are the 4 types of health policies?

Laws Rules and regulations Other implements decisions Judicial decisions

Describe Salgo (1957): Salgo v Leland Stanford

Led to AMA relook at requirement to provide for pt autonomy through education - start of informed consent

Explain the importance of the Salgo (1957): Salgo v Leland Stanford case?

Led to AMA relook at requirement to provide for pt autonomy through education - start of informed consent Patient was paralyzed from a new diagnostic treatment and argued that the doctor had been negligent in not warning him that there was a risk of paralysis.

Explain the importance of the Canterbury (1972): Canterbury v Spence case?

Led to informed consent law, employs "reasonable man" standard. The patient underwent a laminectomy for back pain. After the operation he fell out of bed and was paralyzed. He claimed to have been insufficiently warned of the dangers of the operation. Another very influential informed consent case.

Describe the legislative branch and its role?

Legislative Branch • Congress (Senate and house of representatives) • Writes laws (Makes new laws or amends existing laws) • Bill is introduced in congress - bill referred to appropriate subcommittee for review - if approved it is moved on to full committee - if approved, the bill is moved to the floor of the house or senate (the majority party leadership decides on when to put it on the calendar) - when a bill passes one chamber of congress it is sent to the other chamber for approval - if approved by both chambers of congress it is sent to the president - president vetoes or signs bill - Congress can override a veto with 2/3 vote from each chamber - the bill becomes law. • Establishes the annual federal budget • Controls government accountability office which audits and generates reports on every aspect of government. • Legislators often act on a continuum of either public interest of self interest to base their policy making decisions • Policies typically create winners and losers. Legislators seek to have the highest political gain to please the most people and to make the least amount displeased.

What are the roles of the 3 branches of government on making policy?

Legislative branch formulates policy by enacting laws Executive branch implements policy by implementing laws and proposing policy Judicial branch interprets policy, preserves rights, resolves disputes1

What are the Sources of power in policy making?

Legitimate • Given power by one's position Reward • The ability of one entity to reward another entity based on decisions and actions • Usually takes the form of favors in policy making. Storing influence for later use. Coercive power • Ability to withhold or prevent someone from obtaining desired result to motivate them. Expert power • Possessing expertise valued in policy markets Referent power/charismatic power Ability of some individuals or organizations to engender loyalty or emulation.

Explain advanced directives?

Living Will - A written document that allows a patient to give explicit instructions about medical treatment to be administered when the patient is terminally ill or permanently unconscious; Durable Power of Attorney - you give another person legal authority to act on your behalf.

Define malpractice?

Malpractice is negligence or carelessness of a professional

Define manslaughter?

Manslaughter is the unlawful killing of another person without malice of forethought.

What is the CDC/WHO position on the opioid epidemic?

March 2016 - The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are taking steps to address the epidemic. CDC has developed guidelines for the physicians who prescribe Opioids for chronic pain. The FDA for the immediate -release Opioids will now carry a "black box" warning about the risk of abuse, addiction, overdose, and death. · Develop black box warnings to make consumers aware of risks of (e.g.) addiction from certain drugs · Prescription drug monitoring programs - which MDs should check to see if pt seeking prescriptions from multiple providers DEA - working in conjunction with above to reduce illegal drug use/abuse, tracks arrests, make recommendations about penalties for breaking law The CDC and WHO have both called opiods a public health threat · CDC released its Guidelines for Prescribing Opioids for Chronic Pain · CDC awarded over $30 million to 29 states to improve prescribing practices by enhancing Prescription Drug Monitoring Systems (PDMPs) through its Prescription Drug Overdose (PDO) grants. CDC plans to expand to 50 states in 2016 · The Centers for Medicare and Medicaid Services (CMS) released an Information Bulletin on Medicaid best practices for addressing prescription drug overdoses, misuse, and addiction. · More than 60 medical schools, 191 nursing schools have committed to requiring their students to take some form of prescriber education. The President issued a memorandum requiring all federal health care professionals who prescribe opioids to be appropriately · FDA - part of DHHS, rules and regs involved with monitoring drug development and approving drugs as safe for consumption in US after reviewing research. Works together with DEA on determining Scheduled drugs (what's on the list)

What are the five basic types of health regulatory policies?

Market entry restrictions Rate or price setting controls on health service providers Quality controls on the provision of health services' Market preserving controls Social regulation

Describe the process for medical examination for refugee entry?

Medical Examination for US entry · The Immigration and Nationality Act (INA) and the Public Health Service Act regulations outline the requirements of medical examination of those seeking refugee status. · The purpose of the medical exam is to identify refugees with inadmissible health-related conditions. o Communicable disease of public health significance o Failure to present documentation of vaccination for vaccine-preventable diseases o Physical or mental disorder with associated harmful behavior o Drug abusers/addicts

Describe the medical examination process for US entry?

Medical Examination for US entry · The Immigration and Nationality Act (INA) and the Public Health Service Act regulations outline the requirements of medical examination of those seeking refugee status. · The purpose of the medical exam is to identify refugees with inadmissible health-related conditions. o Communicable disease of public health significance o Failure to present documentation of vaccination for vaccine-preventable diseases o Physical or mental disorder with associated harmful behavior o Drug abusers/addicts Waivers may be granted in certain cases

Describe Medicare part A?

Medicare Part A (Payed for with taxes) • Free of premiums to most eligible • Hospital Insurance • SNF ○ Covered if admitted within 30 days of hospital admission 3 days or greater • Hospice ○ Covered if life expectancy less than 6 months • Home health ○ Covered after hospital admission

Describe medicare part C?

Medicare Part C • Also known as Medicare advantage • was established as the Medicare+Choice program by the Balanced Budget Act of 1997 Advantage program expands beneficiaries' options for participation in private-sector health care plans.

Describe medicare part D?

Medicare Part D • Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 • help pay for prescription drugs not otherwise covered by Part A or Part B. In 2006 and later, Part D provides subsi- dized access to prescription drug insurance coverage on a voluntary basis for all beneficiaries upon payment of a premium, with premium and cost-sharing subsidies for low-income enrollees.

Describe Medicare Part B

Medicare part B (Paid by general treasury and premiums) • Supplementary medical insurance • Physician, outpatient, or other services • Subject to co-payment • Must pay monthly premium

Describe Medicare part D?

Medicare part D (Paid by general treasury and premiums) Prescription drug coverage

Define assault?

Mental threat (battery must be possible, and person must be aware of threat and fear it)

Describe the legal case relating to MEASLES EPIDEMIC in Maricopa County, Arizona.

More recently, in the face of a MEASLES EPIDEMIC in Maricopa County, Arizona, the Arizona Court of Appeals rejected the argument that an individual's right to education would trump the state's need to protect against the spread of infectious diseases short of confirmed cases of measles in the particular school. Given the nature of the spread of measles and the lag time in getting laboratory confirmation of cases, the court in Maricopa County Health Department v. Harmon was satisfied that it is prudent to take action to combat disease by excluding unvaccinated children from school when there is a reasonably perceived, but unconfirmed, risk for the spread of measles. Although the court considered the right to education under Arizona's constitution, the decision is instructive in showing the reach of the police power to ensure the public health. The court in Maricopa specifically noted that Jacobson did not require that epidemic conditions exist to compel vaccination.

Define murder?

Murder is the unlawful killing of another that requires malice of forethought and the premeditated intent to kill another person.

Explain the concept of negligence and define the three different types of negligence?

Negligence Commission or omission of an act that a reasonably prudent person would or would not do Malpractice - professional negligence (related to standards of practice) Criminal negligence - reckless disregard for safety of another Types Malfeasance - bad act Misfeasance - wrong act/ acting improperly Nonfeasance - failure to act

What is the current opioid situation?

On an average day in the US: • More than 650,000 opioid prescriptions dispensed1 • 3,900 people initiate nonmedical use of prescription opioids2 • 580 people initiate heroin use2 78 people die from an opioid-related overdose3

What is the actual wording of the 5th amendment?

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

What is the current refugee quota?

President Obama has set the refugee quota for 2017 to 110,000. President trump recently cut this amount back to the refugee act of 1980 level of 50,000.

What are the 4 requirements of a contract?

Offer and acceptance by a competent person Must be an exchange Must be mutuality of obligation Must be legal

Describe the implications to immigration of the trump travel ban.

On Jan 27th, 2017, Trump signed an executive order that bans all immigrants and visa holders from seven majority-Muslim countries from entering the US for 90 days. The pordert also bans all refugee admissions for 120 days — and bans Syrian refugees indefinitely

How do European countries handle illegal immigration in reference to healthcare?

Other countries • European Union has recognized healthcare as a right but there is a huge variance in level of care for illegals • 20 EU countries allow access to only emergency care • 4 allow access to some care services beyond emergency care • 5 allow illegals full coverage if they meet certain conditions. Vision and dental is usually excluded from all countries

Describe the legal right to take someone, other it kid or adult, away from an abusive relationship.

Parens patriae - Parens patriae is Latin for "parent of the nation." In law, it refers to the public policy power of the state to intervene against an abusive or negligent parent, legal guardian or informal caretaker, and to act as the parent of any child or individual who is in need of protection.

Describe the case law pertaining to patient safety?

Patient safety • Tarasoff (1976) - court held that mental health professionals have a duty to protect individuals who are being threatened with bodily harm by a patient

Describe the Patient self determination act of 1990?

Patient self-determination Act of 1990 ○ Patient has a right to make end of life decisions

Describe the legal concept of abandonment in healthcare.

Patient would be injured by the action of not continuing the care once the patient-clinician relationship has been formed refusal to see a patient in the first place is not abandonment (duty of care must be established) legal obligation to the patient to provide care until the problem that initiated the relationship is resolved; the patient discontinues services; or the provider gives the patient ample opportunity to seek other medical care, such as a referral to another provider or enough time for the patient to find another practitioner who is willing to continue care

Describe the outline for evaluating health policy?

Policy Evaluation Outline 1. Problem statement/background info 1. Discuss the issues leading to and surrounding the legislation 2. What is the legislation intended to do? 2. Alternative legislation 1. What are the potential or proposed alternatives? 3. Longest model analysis 1. Include all inputs and influences 4. Assessment Discuss the societal and professional impacts of the policy. Describe the outcome.

What are the main components of the Longest model?

Policy Formulation Policy Implementation Policy Implementation Inputs/interest groujps

Describe the policy modification phase?

Policy Modification · Allows for all prior decisions made within the process to be revisited and possible changed. · Feedback loop that can influence all phases of policy formulation (agenda setting and legislation development) or implementation (rulemaking and operations). · Feedback provided by individuals, organizations, interest groups. · Policies can be modified through amendments in the creation of legislation, or through judicial decisions relating to the legality and enforcement of the legislation.

What is the purpose of health policy analysis?

Policy analysis is finding out what governments do, and why they do it, and what difference, if any, it makes. (Dye)

Give more details about the policy implementation phase?

Policy implementation - process moves from legislative branch of govt to administrative branch (with legislative oversight) · Rules and regs - gets assigned to appropriate department in govt and agency (drug laws most likely to DHHS and DOJ due to DEA/FDA/CDC/NIH/SAMHSA involvement) o Once regs reviewed in draft form they are opened for public comment § Administrative Services Act - need to have procedure and comment period by law o After comment period there needs to be a response to comments and creation of final rules § All are published in Federal Register · Operations - actual implementation of rules/regs o Day to day running of program Budget involved here and if not specified in

Describe the legal concept of precedent?

Precedent • There is general judicial adherence to the principle of stare decis. (To stand by a decision) • This basically stays that a court should rule similarly to how a court either at the same level or at a superior level has ruled in the past. • Example: A federal court would in principle follow precedent given by other federal courts, the federal court of appeals, and the Supreme Court. Precedent is NOT absolute however.

What are the possible inputs into policy formulation/implementation?

Preferences of individuals, organizations, and special interest groups · Biological, cultural demographic, ecological, economic, ethical, legal, psychological, social, and technological inputs.

Explain good Samaritan laws?

Present in most states - relieve health care professional (and sometimes lay person) from liability in emergency situation

What are some of the pros/cons for covering illegal immigrant healthcare?

Pro for covering Illegal immigrant Healthcare • Decreased chance of cross infection in citizens • Healthcare is a right • Illegals are a vulnerable population They have the same rights as citizens according to the 14th amendment Cons against healthcare for Illegals • People taking advantage of system • "Magnet" &" free rider" concern • Reduced access to citizens • Increased health care costs • They have violated the law Healthcare is not a right

What is malpractice?

Professional commission or omission of an act that a reasonably prudent professional would or would not do

Describe the legal issues with patient abandonment?

Pt would be injured by the action of not continuing care once the patient-client relationship has been formed. Professional has obligation until: 1. Problem resolved 2. Pt discontinues services 3. Provider gives pt amble opportunity to seek other care (PT need to educate pt that they can pay out of pocket and not just dc when insurance ends)

Explain the health related concept of abandonment?

Pt would be injured by the action of not continuing care once the patient-client relationship has been formed. Professional has obligation until: 1. Problem resolved 2. Pt discontinues services 3. Provider gives pt amble opportunity to seek other care (PT need to educate pt that they can pay out of pocket and not just dc when insurance ends)

Define Public sector policy?

Public sector policy Authoritative decisions regarding health or the pursuit of health made by any of the 3 branches of government to influence the actions or decisions of citizens. Health policy is set up to influence one or more of the determinants of health which, in turn, determines the health of the nation's citizens.

What is criminal negligence?

Reckless disregard for safety of another

What is parens patrie?

Refers to the public policy power of the state to intervene against an abusive or negligent parent, legal guardian, or informal caretaker and to act as the parent of any child or individual who is in need of protection.

Explain the importance of the Quilan case 1975?

Right to die case. In 1975 a 21 year old New Jersey woman, Karen Ann Quinlan, suffered severe brain damage after an alcohol/drug overdose. She was diagnosed as in a permanent vegetative state and was ventilator dependent. Her father asked the court to be appointed guardian so he could remove the ventilator. Her physicians resisted, appealing to the then current 'standard of care.' The lower court refused the father's request but the state supreme court agreed. She was weaned from the ventilator but since her parents did not ask for medical nutrition and hydration to be withdrawn, she lived for another 9 years.

How does the ACA deal with refugees?

Refugees and the ACA · They are granted the same protections and benefits under the ACA · Eligible to purchase insurance through the exchanges · Many will qualify for premium tax credits to purchase coverage · Health plans are prohibited from denying coverage to children under 19, including refugee children due to pre-existing conditions · Plans cannot deny coverage to those who were uninsured or had preexisting conditions (many may be coming from countries with poor health care/access) · No lifetime dollar limits on care · No charging higher premiums based on health status · States must extend Medicaid coverage up to age 26 for adults who have aged out of the foster care system, including those in the Unaccompanied Refugee Minors program

Describe acts for accomidations in schools?

Rehabilitation Act on 1973 • Section 504 of the Rehabilitation Act states that each student must be allowed reasonable accommodation and assistance as necessary IDEA Individuals with disabilities education improvement Act of 2004)

Describe the 1979 Brown v. Stone case?

Religious v. philosophical exemptions. 1979 Brown v Stone : Mississippi's Supreme Court ruled that such a distinction violated the U.S. Constitution's Equal Protection Clause by favoring religious over philosophical objectors

What are the 4 requirements of a contract?

Requirements of a contract: Offer and acceptance by a competent person • Must be an exchange for something of value by both parties • Must be mutuality of acceptance and obligation Must be legal

What are the requirements to be a US citizen?

Requirements to aply to be a US citizen U.S. Citizenship and Naturalization Most people become US citizens through one of the following ways: • Born in the United States or its territories; • Born outside the US but to US citizen parent(s); • Naturalization (see a live example of N-400 application process) Eligibility Requirements for Naturalization To become a naturalized US citizen, you must meet several general requirements including age, residence, presence, moral character, English language, U.S. history, etc. Below is a list of basic requirements for naturalization, for more details please download USCIS Guide to Naturalization(03/2012 edition): • You are a lawful permanent resident (green card holder); • You must be 18 years of age or older; • You have resided in the US as a LPR for at least 5 years, with no single absence from the US of more than one year. Absence of more than 6 months may restart the clock of counting Continuous Residence (Note that "resided" means "retained legal residence," which is different than "physically present" in the following requirement); • You have been physically present in the US for at least half of the last 5 years (30 months) ("physically present" means you are actually in the U.S.); • You have resided within a state or district for at least 3 months; • You must be a person of good moral character (certain crimes such as aggravated felony, drug related, gambling offenses, prostitution, etc. will most likely disqualify an applicant); • You can read, write, speak and understand basic English; • You have a basic knowledge of US history and government (see test questions); • You must show attachment to the principles of the Constitution; • You may also apply for citizenship if 1. you have been a lawful permanent resident for 3 years if you obtained LPR status based on a marriage to a U.S. citizen, and you have been married to and living with the same citizen for the past three years (Note that the 3-year period starts with the date your green card is approved, even if it is a conditional green card); or, 2. you have served in the U.S. Armed Forces; or, 3. you belong to one of several groups eligible for naturalization (e.g. people who are nationals but not citizens).

Who are the responsible parties in ZIKA?

Responsible Parties · Public health preparedness (Teitelbaum, Ch 12) - radically changed after 9/11 and anthrax letter threats where need to detect and quickly respond became very clear - resulted in largest reorganization of federal gov't since WWII. · Office of Homeland Security developed 2001, then Homeland Security Act 2002 created Department of Homeland Security (DHS) - many other agencies moved to this department o Within DHS, Office of Health Affairs is main agency for health preparedness - its Intl Affairs and Global Health Security office coordinates information sharing with global partners (FEMA also part of DHS) · Department of Health and Human Services (DHHS) - under which the CDC falls o Office of Public Health Preparedness and Response - assists with state and local preparedness; stockpiles medication and supplies for public health emergencies · National Institutes of Health (NIH) - with FDA approving drugs, facilitating delivery of countermeasures, and working to coordinate emergency and crisis response · Depending on health threat - involved parties also include EPA, Departments of State, Defense, Justice, Transportation, Commerce, Energy, and Treasury - getting coordination efforts also from National Security Staff of White House

Explain importance of Barber v. Superior Court case (1983)?

Right to die case. A severely brain-damaged patient with poor prognosis was removed from a ventilator and later from a nasogastric tube with the agreement of his family and physicians. Another caregiver alleged that the withdrawal of both treatments was part of a conspiracy to kill the patient to hide malpractice; a California appeals court ruled that the physicians had no duty to continue to provide life sustaining treatment in light of their prognosis and his surrogate's agreement that he would prefer not to be so sustained.

Explain the importance of the sun Hudson case?

Right to refuse treatment case. Ms. Hudson gave birth to a son with an unknown father (she is said to believe his father was the Sun) on September 25, 2004, at St. Luke's Episcopal Hospital in Houston, Texas, with thanatophoric dysplasia, a typically fatal form of congenital dwarfism. She was informed that the infant was most likely unable to survive, and should have his breathing tube removed pursuant to Chapter 166 of the Texas Health & Safety Code, the Advance Directives Act. [Under this act, a doctor's recommendations to withdraw medical treatment can be followed, after they have been reviewed by the hospital's ethics committee and after 10 days' notice is given to the patient or guardian.] Hudson was given 10 days from written notice to find a new facility to accommodate the infant, but was unable to do so. Texas Children's Hospital states that it attempted to contact 40 facilities without finding a willing one. A judge ruled that the removal of the tube did not require Hudson's agreement.

Describe the 1973 Roe v. Wade case as it applies to vaccination?

Roe v. Wade 1973- right to privacy in medical decisions

Important legal cases relating to autonomy.

Salgo (1957): Salgo v Leland Stanford Led to AMA relook at requirement to provide for pt autonomy through education - start of informed consent

Explain the concept of scrutiny and explain the three levels of scrutiny?

Scrutiny is the different levels of restriction on the government to apply it's wishes to an individual. strict scrutiny - When the government wishes to infringe on the rights of an individual such as those established in the bill of rights. Government has to prove it has a compelling reason for this. Intermediate scrutiny - it must be shown that the law or policy being challenged furthers an important government interest in a way that is substantially related to that interest Rationally-based: lowest level - The rational basis review tests whether a governmental action is a reasonable means to an end that may be legitimately pursued by the government. This test requires that the governmental action be "rationally related" to a "legitimate" government interest

Differentiate between sexual misconduct and sexual harassment?

Sexual Misconduct - any inappropriate touching, emotional, or verbal acts of a sexual nature Sexual Harassment - any inappropriate touching, emotional, or verbal acts of a sexual nature when submission to or rejection of explicitly or implicitly affects an individual's employment

What is the main difference between sexual misconduct and sexual harassment?

Sexual harassment specifically has to do with employment. when submission to or rejection of explicitly or implicitly affects an individual's employment

What is the life expectancy compared between England and the US?

The 2015 life expectancy in the USA from birth is 79.68 years old The 2015 life expectancy in England from birth is 80.54 years old.

What is some credible evidence?

Some credible evidence: One of the least reliable standards of proof, this assessment is often used in admistrative law, and often in Child Protective Services

What are the levels of proof necessary for civil and criminal cases?

Standard of Proof Criminal: Higher proof with beyond a reasonable doubt evidence Consequences are incarceration so high scrutiny Civil: Low level of proof Negligence, Malpractice, Breech Middle level of proof: clear convincing evidence: spouse, parent, best friend

Describe breach of contract

State laws which require certain contracts in writing are called statutes of frauds A breach of a contract occurs when one of the parties to the contract fails to perform his or her obligations under the contract resulting in injury or loss to the other party defendant may also defend a breach through the following defenses: (1) unconscionability; (2) mistake; (3) fraud; (4) undue influence; and (5) duress

What is a potential problem about the way schools monitor compliance with vaccinations?

States do not punish schools who allow parents to enroll children with the intent to get them vaccinated and then never do.

Describe how the ACA relates to vaccination?

States health plans must cover vaccination

What are the two important clauses of the constitution which come up a lot in healthcare discussions?

Supremacy clause - Federal laws overrule state laws on the same subject due to the supremacy clause of the constitution. Commerce Clause - An enumerated power of the federal government established by the Constitution. Allows federal regulation of economic activity (including healthcare).

Explain the importance of Roe v Wade (1973) case?

Supreme court upheld that "person" under the 14th amendment does not include the unborn... fetus not given protected constitutional rights. Under 9th amendment, person has right to medical decisions (based on right to privacy) so the mother's choice must be upheld. However, states given some ability due to need to protect prenatal life and protecting women's health- leading to trimester rules.

What do you have to take into accounting when considering the influence son health policy?

Take into account • Preferences of current voters • Favor policies that provide immediate benefits to constituents to get re-elected • Consider mostly immediate costs • Individuals • Organizations (health systems, health plans, technology suppliers) • Special interest groups ○ American nurses association ○ APTA ○ American association of retired persons (AARP) ○ Pharmaceutical Research and Manufacturers of America (PRMA) • In 2013, special interest or lobbyist groups s[ent $360 million seeking to influence health policy Do not take into account • Well being of future generations • Do not really consider long term costs All of this generates a lot of policies with immediate benefits but burdensome future costs.

What is the obesity rate compared between England and the US?

The 2008 obesity rate in the USA was 33% of the adults nationwide. ( The 2008 obesity rate in England was 26.90% of the adults nationwide. Japan has the lowest obesity rate of an industrialized nation I could find at 5%.

What is the WHO/CDC recommendations regarding vaccination?

The CDC and WHO support mandatory vaccinations but WHO has no official policy WHO received endorsement from all member states in May 2012 for it's Global Vaccine Action Plan (GVAP) focusing on efforts to increase global vaccination...Access is a big problem here CDC's National Immunization Program: As of 2000, the CDC purchased over half the childhood vaccine administered in the United States through two federally overseen, state-administered programs. The CDC produces vaccine information materials for mandatory distribution by providers to patients or parents before administration of VICP-covered vaccines. Through these materials, called Vaccine Information Statements, parents are informed about the schedules for administration of the vaccines, are alerted to contraindications that dictate against administration to particular individuals, and are informed about potential adverse reactions to look for to encourage timely medical intervention, as needed.

What is the infant mortality rate compared between England and the US?

The CIA puts the 2015 infant mortality rate in the USA at 5.87 per 1,000 live births. The CIA cites the 2015 infant mortality rate of England to be 4.38 per 1,000 live births. It is of interest that the countries of Monaco, Japan, and Iceland are ranked as having the lowest infant mortality rates around 2 per 1,000 live births

What is the level of healthcare spending in the US per person compared to England?

The Economist reports that the level of spending on healthcare in the USA is $8,508 per capita annually while England spends $3,405 per capita annually.

Describe the concept of the Iron Triangle?

The Iron triangle model • The iron triangle is a model that sometimes existed among individuals, organizations, and groups in the policy market. • Each individual or group has some stake in the domain and thus seeks to influence policy. • Two groups ○ Suppliers § Legislative branch to create policy § Executive branch to implement policy ○ Demanders § Private interest groups • Theory is that market is most efficient and stable when all three sides are in agreement. • In healthcare, the iron triangle was sound until the induction of medicare policy and even worse the induction of medicaid policy. • The loss of concordance amongst the special interest groups and fracturing of the large special interest groups has caused the special interest groups to have diminished power.

Explain importance of Linares Case (1988)?

The Linares Case (1988) Right to die case. 8 month old Samuel Linares swallowed a balloon and showed no vital signs for 20 minutes. He was intubated and admitted to a pediatric intensive care unit with severe brain damage. After several months his parents intervened to ask that the ventilator be removed. The hospital attorney took the position that while Illinois law did clearly permit hospitals to withdraw life support from brain dead patients, there was no precedent for withdrawing a ventilator from a person with minimal brain function. After 8 months of hospital refusal the parents were advised to seek a court order authorizing the removal of the ventilator; but on the day they made an appointment with a lawyer the hospital announced that they were transferring Samuel to a long term care facility. Mr. Linares entered the ICU with a pistol, and held caretakers at bay while he unplugged his child's respirator and held him while he died. He was charged with murder, but the judge in the criminal court dismissed the charge.

Describe 1922 Zucht vs King

The Supreme Court in 1922 addressed the constitutionality of childhood vaccination requirements in Zucht v. King. The Court denied a due process Fourteenth Amendment challenge to the constitutionality of city ordinances that excluded children from school attendance for failure to present a certificate of vaccination holding that "these ordinances confer not arbitrary power, but only that broad discretion required for the protection of the public health"

What are the 4 strategies The Who promotes for delving with refugees?

The WHO has adapted 4 strategies to address vulnerabilities and healthcare needs of migrants. The WHO notes that advocacy and policy development is crucial to ensure migrants have equal access to health services. It is necessary for trends to be assessed in migrant health by improving country health information systems, which can identify the gaps in service delivery. In addition, training policy makers on migrant health issues and establishing a minimum health care standard for all vulnerable migrant groups can improve service delivery and reinforce migrant-friendly public health services. In addition, the WHO supports policies that provide health care services to migrants regardless of their legal status as part of universal health coverage.

Describe The Who stance on vaccinations

The WHO has the Department of Immunization, Vaccines and Biologicals. Within this department is the Strategic Advisory Group of Exerts on Immunization (SAGE). The overall focus is to monitor and assess the impact of strategies for reducing mortality of vaccine-preventable diseases. Collection, analyisis and interpretation of surveillance data is the guide to vaccination policies and programmes. On such program is The Global Vaccine Action Plan 2011-2020, which is a framework to prevent millions of deaths through more equitable access to existing vaccines for people in all communities. The WHO coordinates international efforts to provide vaccines to developing countries. Recent efforts over the last 25 years have lead to the September 25, 2015 announcement that Nigeria was removed from the polio endemic list. In addition on September 25, the WHO provided recommendations to reduce pain and anxiety during vaccination.

What is the CDC/WHO opinion abortions?

The WHO works to provide and promote family planning services worldwide. This includes contraception and safe abortions (along with post-abortion care and trained providers). The WHO is supportive of the family planning aspects and the preventative care services offered by Planned Parenthood. The CDC supports many public health initiatives, including those for family planning, STD testing, vaccination and preventative care and screening tests. Both the CDC and Planned Parenthood work together to promote a program called GYT (Get Yourself Tested), a STD testing initiative for young individuals. Some Planned Parenthood centers participate in the CDC's National Breast and Cervical Cancer Early Detection Program.

Describe the process a bill ends to go through to become law?

The balance of power in the US means power is shared between the executive, legislative and judicial branches of government. Anyone can draft a bill and this means special interest groups, lobbying bodies, or other individuals can draft a bill. According to Dye's model, it is the process of identifying a problem and setting an agenda that can lead to policy formulation. Longest notes this agenda setting including identification of problems, solutions and the political/social circumstances needs to happen at just the right time to move through the 'window of opportunity' and move toward true policy formulation and development of legislation. Bills introduced will be given to Congress to in the House, Senate, or both. It is then referred to a committee for review. The policy for covering immigrants in health care expenses would likely be referred to Ways and Means committee of the house and/or the health, education, labor and Pensions committee of the Senate. These committees then send bills to subcommittees on things like health and trade. . If a subcommittee accepts or amends and then accepts a bill, it is moved back to the full committee for approval; it will then be sent to the floor of the house or senate. Once approved there, it will be moved to the other part of the legislative branch as it needs to be approved in both the house and the senate before moving the President for approval, veto or revision. If and when formal enactment of legislation occurs, that legislation creates the bridge to the next step of the Longest model which is the policy implementation phase. All 3 branches of government share responsibility for implementation. Judicial decisions about the application of the law feed into the implementation as well. This implementation phase is composed of 4 steps including designing, rulemaking, operating, and evaluating. Dye refers to these processes as legitimization and implementation. The final step is referred to as Evaluation (Dye) or Modification (Longest). Feedback from individuals, organizations or other interest groups can impact current policy through policy modification or generate a push or opportunity for further policy development/formulation. The loop from formulation, implementation and modification continues and not necessarily in a linear fashion. Outside influence of political, social, economic factors and the dynamic nature of the external environment continue to ignite movement within this loop.

What was a substantial part of the recent ruling in maricopa county?

The court in Maricopa specifically noted that Jacobson did not require that epidemic conditions exist to compel vaccination.

What is the actual wording of the 9th amendment?

The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

Describe the important cases related to infectious diseases.

The federal government derives its authority for isolation and quarantine from the Commerce Clause of the U.S. Constitution. Under section 361 of the Public Health Service Act (42 U.S. Code § 264), the U.S. Secretary of Health and Human Services is authorized to take measures to prevent the entry and spread of communicable diseases from foreign countries into the United States and between states. States have police power functions to protect the health, safety, and welfare of persons within their borders. To control the spread of disease within their borders, states have laws to enforce the use of isolation and quarantine. Jacobson (1905) - against MA regarding imposing of immunizations, court support that state could impose mandatory law in support of public health ...(need for individual immunizations makes personal autonomy and states interest at conflict) 1905 Jacobson vs Massachusetts U.S. Supreme Court rejected a claim that a Massachusetts vaccination mandate not linked to school entry violated the constitutional right to due process of law. Pastor Jacobson. 1922 Zucht vs King Court upheld Jacobson case when applied to compulsatory vaccinations for schools. 1944 Prince vs Massaecheusits Parental authority is not absolute and can be permissibly restricted if doing so is in the interests of a child's welfare. Had to do with child labor laws and Jehovahs witnesses.

Describe the Immigration and Nationality Act of 1965

The new law maintained the per-country limits, but it also created preference visa categories that focused on immigrants' skills and family relationships with citizens or U.S. residents. The bill set numerical restrictions on visas at 170,000 per year, with a per-country-of-origin quota. However, immediate relatives of U.S. citizens and "special immigrants" had no restrictions.[1]

What are the two main perspectives on interest groups?

The pluralist perspective and the elitist perspective.

What is the actual wording of the 10th amendment?

The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

Describe the tripartite system of government?

The three branches of government function in a tripartite system. • Legislative branch formulates policy ○ Enacts laws ○ Creates and funds health programs • Executive branch implements policy ○ Implements laws ○ Proposes legislation ○ Approves or vetoes legislation ○ Disseminates rules and regulations • Judicial branch interprets policy • Interprets constitutional and statutory laws • Develops body of case law • Preserves rights Resolves disputes

What are the states where PAD is legal?

There are currently 6 states in the US where physician assisted suicide is legal. California, montana, DC, Colorado, Vermont, washington

How do undocumented immigrants fit into the flint water crisis?

This area has a huge number of undocumented immigrants who were still drinking the water for much longer than residents o 1st due to misunderstandings, they thought that boiling it would remove the lead, they didn't know that boiling it would concentrate it. o 2nd: when the free water was being handed out, they were asking for ID to ensure that they were really flint residents. Most immigrants under illegal status were too afraid to show id's or any papers for fears of export. So they went without bottled water. § So now here comes major healthcare issues..... We cannot turn them away if they show up to the hospital. No health insurance and seriously ill with lead poisoning. The cost to society. § Most flint residents fall under government plans as well. When thinking ethically on society.... And even from health policy Perspective. Congress has allotted 300 million (in tax payer money assist to flint) taxpayers are also paying for medical care through government insurance and illegal immigrant hospital stays. Huge crisis.

What are some thought son PAD/suicide?

Thoughts on the topic of suicide depend greatly on your culture, religion, and background. ). Those advocating in support of PAD do so on the grounds of dignity, autonomy and self-determination "the social commitment of the physician is to sustain life and relieve suffering. Where the performance of one duty conflicts with the other, the preferences of the patient should

Describe title 42 as it applies to abortion?

Title 42 Federal law was amended to allow federal funding of transplantation research, it prohibited a physician from altering the timing, method or procedures used to terminate a pregnancy solely for the purpose of obtaining tissue. In addition clear consent must be made by the woman donating the tissue that the tissue can be utilized for research and that she has not been informed regarding the identity of the researchers. Title 42 Federal law prohibits any person "to knowingly acquire, receive, or otherwise transfer any human fetal tissue for valuable consideration if the transfer affects interstate commerce." Human fetal tissue includes all "tissue or cells obtained from a dead human embryo or fetus after a spontaneous or induced abortion, or after a stillbirth." However, "valuable consideration does not include reasonable payments associated with the transportation, implantation, processing, preservation, quality control or storage of human fetal tissue."

Describe the two types of health policy?

Two types of policy: allocative and regulatory Allocative/ distributive: provide net benefits to some distinctive group or organization at the expense of others to meet public objectives. Allocative policies are intended to help individuals gain access to needed services. For example, subsidies have been used to ensure certain people have access to health services ie Medicare and Medicaid, migrant health. Provisions in the American Recovery and Reinvestment Act of 2009 provide examples of allocative policy_ Continuation of health insurance coverage for unemployed workers, Health Resources and Services Administration ($2.5 Billion for construction, equipment and HIT) , and increased funding for Medicare, Medicaid and wellness programs. Regulatory: Influence the decisions of others by directive. There are 5 main categories of regulatory policies_ social regulations, Market controls on the provision of health services, Market-entry decisions, Rate or price setting controls on health service providers and Market- preserving controls.

Describe how the Public health Service Act of 1944 relates to vaccination?

Under this US Secretary of HHS can take measures to prevent entry and spread communicable disease, states also have authority within their boundaries based on Police Powers

Describe the importance of the Zucht 1922 case?

Upheld that states can withhold admission to school based on immunization

What standard does the federal government typically set for health care?

Usually, federal rights set the minimum standards for the states. Health care cases are reviewed on a rational basis Health care legislation will generally be upheld so long as the government can show a legitimate purpose and a rational basis for carrying out the program

Describe the importance of the 1905 Jacobson vs Massachusetts?

Vaccination case. Compulsory vaccination is an appropriate use of state police power to protect the health and welfare of it's citizens

Who regulates vaccines in the US?

Vaccines are subject to licensure in the United States by the Food and Drug Administration (FDA) following studies that address safety and efficacy.

Describe the 1986 National Childhood Vaccine Injury Act (NCVIA).

Vaccines are subject to licensure in the United States by the Food and Drug Administration (FDA) following studies that address safety and efficacy. 1986 National Childhood Vaccine Injury Act (NCVIA) This comprehensive law established the National Vaccine Program within the U.S Department of Health and Human Services to coordinate and oversee all activities within the U.S. government related to vaccine research and development, vaccine-safety monitoring, and vaccination activities. In addition, the Act estab-lished the National Vaccine Injury Compensation Program (VICP) to compensate for injuries associated with routinely administered childhood vaccines 1st amendment - Right to religious freedom Even though there is right to religious freedom, it does not give individuals the right to expose a child or the community to a communicable disease

What is The WHO opinion on illegal immigration?

WHO · WHO does not recommend mandatory screening as there is a lack of evidence for its benefit or cost-effectiveness and it only adds increased anxiety (recommends voluntary health checks) · WHO suggests all migrants should have access to hospitals, prevention (vaccination) and high quality care (when needed) without discrimination WHO supports policies to provide health care services to migrants/refugees regardless of their legal status as part of universal health coverage

What is The Who/CDC stance on safe drinking water?

WHO/CDC • Access to safe drinking-water is essential to health, a basic human right and a component of effective policy for health protection. WHO acknowledges that most developing nations will not be able to meet these drinking water standards. To assist developing nations that may not be able to afford modern treatment technologies, WHO suggests these countries use the standards as guidelines to provide direction about simple filtration and disinfection

Define vicarious liability?

When one is responsible for the negligent act of another

Define Vicarious liability?

When one is responsible for the negligent act of another Responsibility of the superior for the acts of their subordinate or, in a broader sense, the responsibility of any third party that had the "right, ability or duty to control" the activities of a violator.

Describe Zucht (1922)

Zucht (1922) - upheld that states can withhold admission to school based on immunization

Define Health Policy

as authoritative decisions regarding health or the pursuit of health made in the legislative, executive, or judicial branches of government that are intended to direct or influence the actions, behaviors, or decisions of others.

Describe the topic of abandonment when applied to pro bono work and PT.

can be even in pro bono care if not agreed upon up front and withdrawn without time to get care from another (good Samaritan laws in some state preclude duty to care so would not be the case) it is important that we educate the patient that we can still continue providing care for them if they would like to pay out of pocket. If this education is not performed correctly, or not at all, the patient may be discharged and leave under the assumption that the PT is abandoning them.

What is negligence?

commission or omission of an act that a reasonably prudent person would or would not do

What are the 6 ways to try and defend breach of contract?

contract Breach of Contract can try and defend against a breach by arguing 1. Unconsciounability, 2. Mistake of fact 3. Fraud, 4., undue influence, or 5. Duress 6. Impossibility

Which important acts pertain to the opioid epidemic?

cts o 1914 - The Harrison Narcotic Tax Act imposed a tax on those making, importing, or selling any derivative of opium. o 1924 - Heroin becomes illegal 1970. - is a Scheduled drug and use/prescription/abuse/sale are monitored by DEA part of Dept of Justic o 1990: Pt Self-Determination Act - pt have right to determine what is done with their body/healthcare o 2010 - ACA passed. : Substance abuse treatment becomes an essential benefit under thee law and insurance companies are required to pay for it. o 2016 - Comprehensive Addiction and Recovery Act: This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic, encompassing all six pillars necessary for such a coordinated response - prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal.

Describe the immigration reform and control act of 1986

equired employers to attest to their employees' immigration status; made it illegal to hire or recruit illegal immigrants knowingly; legalized certain seasonal agricultural illegal immigrants, and; legalized illegal immigrants who entered the United States before January 1, 1982 and had resided there continuously with the penalty of a fine, back taxes due, and admission of guilt; candidates were required to prove that they were not guilty of crimes, that they were in the country before January 1, 1982, and that they possessed minimal knowledge about U.S. history, government, and the English language.

What are the 3 phases of the public policymaking process?

formulation Implementation Modification

What are the important acts relating to illegal immigration?

o 1795 requirement that person live in US for 5 years before applying for citizenship and this requirement still stands today. 1924: Immigration act of 1924: Set quotas on number of immigrants allowed into country each year 1944: PUBLIC HEALTH SERVICE ACT 1944: HHS PREVENT ENTRY AND SPREAD OF COMM DISEASES BUT STATES ALSO HAVE AUTH WITHIN 1952: Immigration and nationality Act- removed race based quotas and set nationality-based quotas. started the Immigration and Naturalization Service (INS) 1965 Immigration and Naturalization Act: states if President finds entry of aliens to US would be detrimental to interest of US he may for the period deemed necessary suspend entry They may also decide to do screenings of people entering the country. o Refugee Act 1980 - regulates this policy; must prove fear of persecution is real if return to homeland to gain refugee status o Under international law, the Geneva Convention, or the laws of the United States, foreign citizens who have become disillusioned with their homeland cannot take temporary refuge within the United States. o The President retains the ultimate decision making authority when determining the number of refugees to allow into the country during a given year. 1986: Immigration reform and control act (IRCA). The IRCA toughened criminal sanctions for employers who hired illegal aliens, denied illegal aliens federally funded welfare benefits, and legitimized some aliens through an amnesty program • • EMTLA (Emergency medical and treatment labor act) of 1996 ○ Forbids denial of emergency care secondary to payer source ○ Health care provider must stabilize the patient before care is stopped ○ The CMS (Centers for medicare and medicaid services) can fine hospitals $25,000 to $50,000 per violation of EMTLA and terminate their Medicare provider agreement and the individual physician may receive fine up to $50,000. • ACA • The PPACA of 2010 prohibits undocumented immigrants from purchasing private health insurance with their own money through the new insurance exchanges leaving 11.2 million individuals without health insurance in the US • Deferred action is an administrative relief from deportation; DHS temporarily authorizes non-U.S. citizens to remain in the U.S. o This is what Obama did for children who entered illegally (because they had no control over that action as children) - deferred action for childhood arrivals (DACA) and then also deferred action for parents of Americans (DAPA) (for total of +/- 4-5 million people) These executive orders on hold due to SCOTUS case - US vs Texas 2016

Which ACTS pertain to ZIKA?

o 1795 requirement that person live in US for 5 years before applying for citizenship and this requirement still stands today. 1924: Immigration act of 1924: Set quotas on number of immigrants allowed into country each year 1944: PUBLIC HEALTH SERVICE ACT 1944: HHS PREVENT ENTRY AND SPREAD OF COMM DISEASES BUT STATES ALSO HAVE AUTH WITHIN BOUNDARIES; QUARANTINE. Authority for quarantine rests with CDC. List of communicable diseases that can be quarantined is developed by Executive Order from President (in consultation with Surgeon General and DHHS) - US Legal Code re: Public Health also gives power to: 1952: Immigration and nationality Act- removed race based quotas and set nationality-based quotas. started the Immigration and Naturalization Service (INS) 1965 Immigration and Naturalization Act: states if President finds entry of aliens to US would be detrimental to interest of US he may for the period deemed necessary suspend entry They may also decide to do screenings of people entering the country. o Refugee Act 1980 - regulates this policy; must prove fear of persecution is real if return to homeland to gain refugee status o Under international law, the Geneva Convention, or the laws of the United States, foreign citizens who have become disillusioned with their homeland cannot take temporary refuge within the United States. o The President retains the ultimate decision making authority when determining the number of refugees to allow into the country during a given year. 1986: Immigration reform and control act (IRCA). The IRCA toughened criminal sanctions for employers who hired illegal aliens, denied illegal aliens federally funded welfare benefits, and legitimized some aliens through an amnesty program 2000: PUBLIC HEALTH IMPROVEMENT ACT 2000: Authorizes Secretary of DHHS to take appropriate response actions during public health emergency2003: (result of 9/11) Department of Homeland Security replaces the INS with 3 agencies (efficient, huh?!) o U.S. Customs and Border Enforcement (CBE), handles the INS's border patrol duties, o U.S. Citizenship and Immigration Services (USCIS), the USCIS handles the INS's naturalization, asylum, and permanent residence functions, o U.S. Immigration and Customs Enforcement (ICE) handles the INS's deportation, intelligence, and investigatory functions. o Deferred action is an administrative relief from deportation; DHS temporarily authorizes non-U.S. citizens to remain in the U.S. o This is what Obama did for children who entered illegally (because they had no control over that action as children) - deferred action for childhood arrivals (DACA) and then also deferred action for parents of Americans (DAPA) (for total of +/- 4-5 million people) o These executive orders on hold due to SCOTUS case - US vs Texas 2016 2006: PANDEMIC AND ALL HAZARDS PREPAREDNESS ACT 2006: HHS RESPONSIBLE FOR PUBLIC HEALTH AND MEDICAL RESPONSES TO EMERGENCIES The Federal government does have a right to impose large scale quarantine and this was last used in 1918-1919 during the Spanish Flu pandemic .

What are the terms of the 1951 United Nations Refugee Convention

o Anyone who delivers a missing American POW or MIA soldier receives refugee status from the United States. o For refugees who have "firmly resettled" in another country, the United States will deny a request for refugee admission. The government considers refugees "firmly resettled" if the refugees have received an offer of citizenship, permanent residency, or some other permanent status from a foreign country. * Under international law, the Geneva Convention, or the laws of the United States, foreign citizens who have become disillusioned with their homeland cannot take temporary refuge within the United States. * The President retains the ultimate decision making authority when determining the number of refugees to allow into the country during a given year.

What are some possible solutions for the opioid epidemic?

o Possible solutions § Stricter guidelines for prescribing § Strengthen prescription drug monitoring programs so that MDs can more easily access them and data can be gathered about drug seeking behavior § More mental health resources to treat addiction § Education to MDs about EBP in prescription as well as with addiction treatment programs, to first responders for use of Naloxone for overdose response, to public about risks of opioid drug use § Research about treatment responses, develop better evidence about best practices

What are the possible committees for ZIKA?

ossible Committees • House ways and means committee for approving fund allocation • Committee on energy and commerce (Has a health subcomittee) • The committee on health, education, labor and pensions

Define battery?

physical touch without consent

What level of proof would be necessary for ZIKA?

proof would depend if the case was criminal (beyond a reasonable doubt), Civil (preponderance of evidence) or civil fraud (clear and convincing—higher level of scrutiny than preponderance).

Describe the refugee issues in Europe?

ssues in Europe · Undocumented migrants, asylum seekers and vulnerable populations are finding it more difficult to obtain health care in Europe due to government policies or an inability to pay 100% of the costs. · In the EU there are issues with financial barriers to healthcare, discrimination, police harassment, fear of being reported/deported result in people not seeking medical care · Swedish law does not permit healthcare to undocumented migrants, except emergency services, which they must pay full price for. · Spain limited coverage for undocumented to emergency, prenatal, postnatal, child care...this also applies to refugees

What did Longest estimate about the growth of healthcare expenditures?

t is estimated that National Health Expenditures could exceed $5 trillion by 2023 which would put it at 20% of our GDP. (Longest)

Describe the 2003 - Partial birth abortion ban (2003)?

• 2003 - Partial birth abortion ban (2003): a ruling that prohibited the procedure known as intact dilation and extraction.

What are the two recent historic events that played into health care policy for vaccinations?

· 1900: Smallpox outbreak in 1900 affected US and 11 states enacted mandatory vaccination · 2013: Measles outbreak in California causes enactment of stricter California vaccination laws. This removed the personal belief exemption and only left the medically necessary exemption.

Difference between 1st degree and 2nd degree murder?

· 1st degree murder: deliberate and premeditated killing with malice of forethought 2nd degree murder: not deliberate or premeditated, but does have malice of forethought. The person has some idea of the consequences of their actions.

Define negligence?

· A tort, a civil or personal wrong · Unintentional commission or omission of an act that a reasonable prudent person would or would not do under given circumstances.

Describe the details of the policy implementation phase?

· Activities guided by rulemaking that guide the implementation of policies and the operationalization of those policies. · Includes the management of human resources, financial resources and other resources to facilitate achievement of the goals and objectives of the legislation. · Rulemaking o Establishment of formal rules or regulations, development of the detailed specifications of the legislation. · Operation o Involves the actual running of the programs or processes embedded in the legislation.

Describe the details of the policy formulation phase?

· Activities that set the policy agenda and the development of the legislation. · Agenda Setting o Problems (Important & Urgent) ○ Legislators like it the most when salience (public interest) is high and conflict is low. (Conflict in the issue and special interests public interest) o Possible Solutions o Political Circumstances · Legislation Development o Bill is proposed by HR or Senate (interest groups may help draft initial legislation) o Sent to a Committee for a hearing and discussion o Bill is considered by the entire HR or Senate, may be amended. o If passes, bill is sent to the HR or Senate and the procedure is repeated. o If there are amendments, it is sent back to the HR or Senate for changes to be approved. o Both houses accept the bill, it is sent to the governor/president o Can be signed into law, becomes law by default (not signed in 10 days if Congress is in session), is vetoed (2/3 vote can override). Policy Implementation

Describe the background of the flint water crisis?

· City officials in a last minute effort to save money from a going under financially city, switched water lines from Lake Huron to the flint river . · Situation came to light in Flint in April 2014. Issue with aging pipes leaching lead into water supply - · worsened when Flint did not put in corrosion inhibitors after switched to Flint River from prior source (Lake Huron and Detroit River). · Declared state of emergency by state and later the president in early 2016. With declaration of federal state of emergency, FEMA and Dept of Homeland Security authorized to provide help o Of note this was done with a state appointed emergency manager in place. · The city of flint as well as state of Michigan have been flooded with lawsuits and class action suits. o Most cases are dealing with the children. Neurological disorders, seizures, language and learning deficits. o Key officials at the City, State MDEQ (Mi Dept of Env Qual) and EPA resigned or fired over mishandling of crisis. o Problems: 1st need to prove causation. Yes the lead levels in the children have doubled and tripled but can you "prove" that nothing else caused it? Toys, paint chips, soil, dust?? o Problem:2nd could prove negligence on behalf of the government.... But... Government has sovereign immunity which shields most state and federal governments from lawsuits. The government could show that it is a core government function to provide water and that's what they did. o When looking at possible compensation.... Monetary is hardly likely. The government won't pay.... Sovereign immunity. The cit pay of flint however could be liable but has no money! Which is why they did what they did in the first place.

What are the 4 elements necessary for negligence?

· Duty to care: there must be an obligation to conform to a recognized standard of care · Breach of duty: deviation from the recognized standard of care; failure to adhere to an obligation · Injury: damages must be established; if no injury, then no monetary damages are due · Causation: departure from the standard of care must cause the injury; injury must be foreseeable All 4 are presented = prima facie case of negligence

Describe the current refugee crisis?

· In 2015, about 350,000 refugees and migrants have reached various European countries, and nearly 2 million have taken shelter in Turkey · There is little documentation of a link of infectious disease and migrants...the link is with poverty · Refugees are exposed mainly to the infectious diseases common in Europe, independent of migration · Exotic infections (Ebola, MERS-CoV) are very low risk and more likely to impact regular travelers or healthcare workers · Healthcare needs are diverse o Gender or sexual based violence o Forced prostitution o Reproductive, mother, child health issues o Diabetes, cardiovascular diseases o Mental health concerns o Emergency care o Vaccine prevention

What are the three main forms of negligence?

· Malfeasance: performance of an unlawful or improper act · Misfeasance: improper performance of an act that results in injury to another Nonfeasance: failure to act when there is a duty to act as a reasonably prudent person would do in similar circumstances

What are the main components of the dye model?

· Problem identification · Agenda setting · Policy Formulation · Policy Legitimization · Policy Implementation Policy Evaluation

What is the background for the refugee situation in the US?

· Refugee status is a form of protection that may be granted to people who meet the definition of refugee, are of special humanitarian concern to the USA, and are typically outside their country and unable or unwilling to return home because they fear serious · Under international law, the Geneva Convention, or the laws of the United States, foreign citizens who have become disillusioned with their homeland cannot take temporary refuge within the United States. · The President retains the ultimate decision making authority when determining the number of refugees to allow into the country during a given year. · Refugees are considered lawfully present immigrants and are eligible for the same protections under the ACA as US citizens. · Refugees are exempt from the 5 year wait period to receive Medicaid and CHIP ·

Define voluntary and involuntary manslaughter?

· Voluntary manslaughter: intentional killing of another person caused by a provocation. (Heat of passion killing) No premeditation Involuntary manslaughter: death is a result of a reckless act (reckless driving)

What is The Who/CDC position on refugees?

· WHO does not recommend mandatory screening as there is a lack of evidence for its benefit or cost-effectiveness and it only adds increased anxiety (recommends voluntary health checks) · WHO suggests all migrants should have access to hospitals, prevention (vaccination) and high quality care (when needed) without discrimination · WHO supports policies to provide health care services to migrants/refugees regardless of their legal status as part of universal health coverage

List the 8 safety acts designed to keep our air, water, etc safe?

• 1965 Clean Air Act Amendment • 1967 Air Quality Act • 1970 Clean Air Amendments • 1969 Federal Coal Mine Health & Safety Act • 1972 Federal Coal Mine Health & Safety Act • 1970 Water Quality Improvement Act • 1974 Safe Drinking Water Act • 1970 Lead Paint Poisoning Prevention Act

Describe 965 Griswold v Connecticut?

• 1965 Griswold v Connecticut SCOTUS ruled in favor of the "right to privacy" and this set the stage for Roe v Wade. Supreme Court ruled that a state's ban on the use of contraceptives violated the right to marital privacy. The case concerned a Connecticut law that criminalized the encouragement or use of birth control.

What are the bills pertaining to the flint water crisis?

• 1970 Water Quality Improvement Act 1974 Safe Drinking Water Act 2016 On January 6, 2017, Snyder signed a bill that accelerates the public notice requirement for lead in drinking water to three business days, from the previous time of 30 days.

Describe • 1976 - Quinlin(1976)?

• 1976 - Quinlin(1976) - Karen Quinlin's father sued to be able remove respirator tube, supported use of other's substituted justified in right to refuse life supporting medical care

Describe • 1990 - Cruzan (1990)?

• 1990 - Cruzan (1990) - Cruzan's parents sued to be able to remove feeding tube, court supported their right to do on appeal. Reflected pt's right to refuse medical treatment.

What are the important amendments to the constitution which could apply to health policy?

• 1st - freedom of religion, speech, press, assembly 5th - due process (federal). No deprivation of life, liberty or property • 9th - The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people. Federal government cannot deny rights that are not listed in the constitution. • 10th - Anything not specified for federal govt by constitution is retained by the states and people • 14th - Equal rights/protection. Denial of minimal care can be seen as going against equal protection clause. Due process (state) No state may deprive life, liberty or property. Citizen if born here. The Fourteenth Amendment provides for equal protection under the law for all people ("people" not just "citizens") within the jurisdiction of the U.S. The Supreme Court interpreted that everyone has equal rights despite their, "legal status, color, or religion" and all the children regardless of their immigration status Include the freedom to travel, freedom from incarceration, freedom from physical violence and forced medical procedures, and freedom to live with and raise children."

What is the economic impact of opioid addiction?

• 55 billion in health and social costs related to prescription opioid abuse each year1 • 20 billion in emergency department and inpatient care for opioid poisonings2

What are the common special interest groups pertaining to healthcare policy?

• AMA (American medical association) • APTA (American Physical Therapy association) • AHA. (American hospital association • ACP. (American college of physicians) American academy of family physicians

Describe discrimination in healthcare?

• African Americans and people of Hispanic Origin are disproportionately underserved for health services and underrepresented in all health professions. They experience discrimination that affects their health and sets them up for illness and death. • . African Americans, Hispanics, and Native Americans, who are disproportionately represented below the poverty line, experience worse health than the white majority (National center for health statistics 2013) Impoverished children, on average, have lower birth weights and more conditions that limit school activity compared with other children. These children are more likely to become ill and to have more serious illnesses than other children because of increased exposure to harmful environments, inadequate preventive services, and limited access to health services.

Describe the different exemption levels for vaccination by different states?

• All states allow for medical exemptions • 17 states allow for personal belief exemptions Only 3 do NOT allow for religious exemptions. (Mississipi, west virginia, and california) California just passed a law to forbid religious exemptions.

Describe some social assessment on the defund planned parenthood act of 2015?

• Because of the breadth and depth of the services provided by Planned Parenthood, the passing of the proposed HR 3134 legislation could have significant impacts. While Planned Parenthood does have financial support outside of the federal government, an estimated 70% ($500 million) comes from Medicaid. Since 79% of those who use Planned Parenthood are below the 150% poverty level, many will qualify for Medicaid services. • Planned Parenthood provides critical preventative care services beyond abortion and contraception. If these centers do not have adequate funding, they will not be able to provide the same quality and volume of services. Many of these programs are the only resources available to patients (regardless of income level) in rural communities. = • Additionally, the number of abortions being done for those who do not have access to high quality and affordable care is not likely to change, just because the federal government decides it is not going to fund the Planned Parenthood Program. Instead, these individuals will seek out abortions and inexpensive care from other sources, some of which may not be safe or reliable providers of care. This may increase complications and mortality during abortions. Patients may also not be able to access preventative care measures, including vaccinations, health screenings and educational programs. This all has the potential to contribute to worsening health conditions for a part of the population who is already at high risk for chronic disease, secondary conditions and medical complications.

What are the 6 main determinants of health?

• Biology • Behaviors • Social environment • Physical environment • Health services Public and private health programs and interventions

What are the different bills dealing with patient rights?

• Civil rights act of 1964 ○ Prohibits discrimination with any federally funded program • ADA (Americans with Disabilities Act of 1990) ○ Prohibits discrimination against individuals with disabilities • Patient self-determination Act of 1990 ○ Patient has a right to make end of life decisions • EMTLA (Emergency medical and treatment labor act) of 1996 ○ Forbids denial of emergency care secondary to payer source ○ Health care provider must stabilize the patient before care is stopped • HIPPA (Health Insurance Portability and Accountability Act of 1996) ○ Protects people and their health coverage when they leave or change jobs and requires health industry to be more efficient with records. Also can't deny coverage based on pre-existing conditions if you had insurance for 18 months prior.

Describe the elitist perspective on special interest groups?

• Elitist perspective ○ Real political power in the united states is concentrated in the hands of a small proportion of the population that controls the nation's key institutions and organizations. ○ This perspective says that the special interest groups are biased to certain ones that are the most powerful ○ Policies put forth represent the values, ideologies, and preferences of this governing elite. ○ The only policy alternatives considered are those that fall within the shared consensus of the elite. ○ The large number of special interest groups is meaningless because the power differentials among them is so great. ○ Other groups may win battles over minor issues but the war is always won by the elite over significant policy issues. . ○ Members of the power elite have a strong preference for incremental changes to not disrupt the status quo. ○ Non-elites only move into elite status if they accept the elites consensus values.

Describe the HIIPA act of 1996?

• HIPPA (Health Insurance Portability and Accountability Act of 1996) ○ Protects people and their health coverage when they leave or change jobs and requires health industry to be more efficient with records. Also can't deny coverage based on pre-existing conditions if you had insurance for 18 months prior.

Where does the funding come from for medicare?

• Individual trust funds for Part A and Part B/D (B and D have separate trusts) • Part A - payroll taxes specified by SSA and other miscellaneous taxes • Part B - taken from general Treasury and by premiums paid by beneficiaries • Part D - receives general Treasury funds, premiums, and contributions from states • Provider benefits • Up to 1983 - hospital paid based on reasonable cost • Up to 1992 - physicians paid on reasonable charge • CMS (HHS) has responsibility for administration

Describe Maher v. Roe & Harris v. McRae:?

• Maher v. Roe & Harris v. McRae: Supreme court ruled that the medicaid program could refuse to pay for a woman's abortions

Report on National Federation of Independent Business v. Sebelius?

• National federation of Independent business v. Sebelius ○ Upheld the provision in the ACA that individuals have health insurance or pay a penalty. (Individual mandate) ○ Case challenging the individual mandate of the ACA. ○ The challengers to the law said that congress did not have the right to punish people who did not purchase insurance by issuing them a fine. ○ Defenders of the law said it is supported under the commerce clause of the constitution. ○ The Supreme Court however, did not go with either side's arguments. Instead it said the mandate was legal given congress's right to tax people under the constitution. It said that the law was not meant to be a penalty. (Even though it is written in the law "to penalize". ○ Supreme court struck down the provision in the law to penalize states for not expanding their medicaid programs to cover more people. Court ruled this was coercsion. "While the commerce clause does allow congress to regulate economic activity, it does not allow congress to compel individuals to enter into that activity.

• Planned Parenthood v. ACLA (2001

• Planned Parenthood v. ACLA (2001 - The American Coalition of Life Activists (ACLA) released a flier and "Wanted" posters with complete personal information about doctors who performed abortions. A civil jury and the Ninth Circuit Court of Appeals both found that the material was indeed "true threats" and not protected speech.

Describe the pluralist perspective on special interest groups?

• Pluralist perspective ○ Special interest groups are positive because with so many operating, every individuals own interests are represented by one or more of the special interest groups. ○ Do not consider that some groups are more powerful than others. ○ Provide an essential link between individuals and their government ○ The nature of competition will ensure no interest group becomes too powerful. ○ The competition amongst interest groups is essentially fair Critics argue that special interest groups have become too powerful and that policy is often written to satisfy the special interest group instead of the nation as a whole.

What are the different burden of proof levels? Lowest to highest?

• Reasonable suspicion is a low standard of proof in the U.S. to determine whether a brief investigative stop or search by a police officer or any government agent is warranted. • Probable cause is a relatively low standard of evidence, which is used in the United States to determine whether a search, or an arrest, is warranted • Some credible evidence: One of the least reliable standards of proof, this assessment is often used in admistrative law, and often in Child Protective Services • Substantial evidence is "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion."[4] • Preponderance of the evidence, also known as balance of probabilities is the standard required in most civil cases • Clear and convincing evidence is a higher level of burden of persuasion than a "Preponderance of the Evidence. This standard is used in many types of equity cases, including paternity, PINS, juvenile delinquency, child custody, the probate of both wills and living wills, petitions to remove a person from life support ("right to die" cases),[7] and many similar cases. • Beyond reasonable doubt: This is the highest standard used as the burden of proof in Anglo-American jurisprudence and typically only applies in criminal proceedings

What is the CDC/WHO stance on end of life issues?

• The CDC and WHO recognize the end of life issues as a global issue and concern as life expectancy has increased and therefore most individuals die of chronic disease. • Their primary roles have become to focus awareness and education regarding end of life options and legal documentation needed to protect oneself from end of life controversy. • The CDC does not take a stance on right to withdraw care but provides education on AD. The WHO functions similarly to the CDC on end of life decisions but on a more global front. The WHO works to educate nations and provide global programs that support end of life decisions including the development of the World Wide Palliative Care Alliance. The alliance works to distribute information regarding palliative care across national agencies. The WHO also has a primary role in developing a common language and provide information about systems in other countries, The CDC and WHO work to support research and develop education programs. WHO did take a stand to decrease the burden of suicide in 2000 (WHO document online) but they do not take a stance for or against PAS

Describe the inputs of special interest groups pertaining to the defund planned parenthood act of 2015?

• There have been several inputs throughout this process that have an impact on this proposed legislation. The initial agenda was likely stirred by special interest and lobby groups who oppose abortion and contraception and have an interest in eliminating the funding of those services. • There is also partisan influence on supporting (or not) the legislation with the upcoming elections (with Republicans typically supporting the bill and the anti-abortion sentiment, while Democrats have a tendency to favor the pro-choice stance). The politicians who are up for re-election are more likely to vote based on the viewpoint of the majority of their constituents. • The negative media and press related to the "selling" of fetal tissue (the specifics of whether it actually was for profit or was only for cost reimbursement will likely be overlooked by the media) opens a window-of-opportunity for special interest groups and lobbyists to push for the defunding of the program. This may be due to their personal or religious beliefs or their interest in siphoning that funding into another area of interest. • Private donors who have been supporting Planned Parenthood may have an interest in continuing the legislative support for Planned Parenthood and may take action in blocking the efforts to defund the program...past donors to the program have included the Gates Foundation, Buffett Foundation, Ford Foundation and Turner Foundation. Global interest in the promotion of women's rights and health care for the underserved and undocumented populations may also have an impact on social support against the defunding of Planned Parenthood. In contrast, religious groups may gain support and momentum in pushing for the program to be defunded. With a President who has supported federal program to provide needed health care services, including preventative care, to the underserved and disadvantaged, it is likely to be challenging to gain complete support for the HR bill that is now in the Senate.

What do all torts need to go through for vaccinations?

• VICP - Vaccine Injury compensation Program (1986)

Describe the background of the defund planned parenthood act?

• Video evidence was released which suggested that Planned Parenthood was selling fetal tissue harvested from abortions performed at their health centers. There is debate surrounding the videos and whether they correctly depict the situation (Planned Parenthood states that parts of the videos were edited out and that they were only recouping the cost of transporting those tissues, which is considered legal, and that there were not making a profit from the sale of the fetal tissue. • Planned Parenthood provides comprehensive health services relating to family planning, sexual health, STD prevention, abortion, emergency contraception, contraception and education to both women and men Planned Parenthood states that about 79% of their patients are below the 150% of the federal poverty line. The reduction or elimination of these programs would disproportionally impact those with limited access and limited resources for preventative health care services.

What is The Who/CDC position on ZIKA?

• WHO identified Zika as an international public health emergency - Zika can spread rapidly in current society, with international travel, globalization and urbanization and in the right physical environments (like Puerto Rico where the first locally acquired cases of Zika virus infection were noted in the US (Dec 2015)). • The CDC released preliminary guidelines regarding sexual transmission of Zika on Feb 11. • WHO, with CDC following suit, advised pregnant women to avoid travel to areas where active Zika transmission was identified. • April the CDC met with more than 300 local, state and federal officials to coordinate Zika response, focusing on mosquito control programs. • By May 2016, CDC recommends urine testing for Zika (but with few testing kits readily available) and in July the CDC confirms the first locally transmitted cases of Zika on the mainland US (Miami). • CDC has also issued contraceptive guidance to prevent unintended pregnancy for healthcare providers to follow. FDA • Called for testing of all blood donated in the US for ZIKA

What are some health policy issues relating to Zika?

• ` • Funding for health related research (per Longest, health policy = tax policy) • Immigration and travel • Public health role of US government and foreign/WHO • Federal vs state role in public health ?quarantine?/travel restrictions

Describe Article 28 of the social security ACT?

•1965 Health insurance provided by the government for the aged and disabled Medicare Part A (Payed for with taxes) Medicare part B (Paid by general treasury and premiums)

Define assault?

•A deliberate threat, coupled with the apparent present ability to do physical harm to another. • No actual contact or damage is necessary • Deliberate attempt to injure or attempt harm without consent • Requirements o Ability to commit the battery (physical contact) o Individual threatened must be aware of the immediate threat of battery and must fear it

Define battery?

•Intentional touching of another person in a socially impermissible manner without consent

Define fraud?

•The willful and intentional misrepresentation that could cause harm or loss to a person or property • Requirements o An untrue statement known to be untrue by the party making it and made with the intent to deceive o Justifiable reliance by the victim on the truth of the statement o Damages as a result of that reliance

Define false imprisonment?

•Unlawful restraint of an individual person's liberty or the unlawful restrain or confinement of an individual • Requirements (3) o Awareness of the restraint o No reasonable means of escape o No damages need to be demonstrated • Criminals, mentally ill, children retained for disciplinary reasons at school are justifiable due to other laws. Contagious diseases: state health codes provide guidelines describing the circumstances that permit detainment for certain diseases that pose a public health risk.

Describe the policy formulation stage of the longest model

* Activities that set the policy agenda and the development of the legislation. * Agenda Setting o Problems o Possible Solutions o Political Circumstances * Legislation Development o Bill is proposed by HR or Senate (interest groups may help draft initial legislation) o Sent to a Committee for a hearing and discussion o Bill is considered by the entire HR or Senate, may be amended. o If passes, bill is sent to the HR or Senate and the procedure is repeated. o If there are amendments, it is sent back to the HR or Senate for changes to be approved. o Both houses accept the bill, it is sent to the governor/president o Can be signed into law, becomes law by default (not signed in 10 days if Congress is in session), is vetoed (2/3 vote can override).

Policies & developments in healthcare during the 1840's

1846: First publicized use of anesthesia 1848: Import drug Act - Initiates drug regulation

Policies & developments in healthcare during the 1860's

1865 Antiseptic surgery used

Policies & developments in healthcare during the 1870's - 1890's

1870 Medical Practice Act: Established state licensing oh physician practice 1870s: Discovery the bacteria causes many illnesses 1880s: First hospitals established 1890s: Xrays Discovered

Important Political and social events in the 1900's?

1900 - 1920. Progressive Era. Characterized by support for social reform

Policies & developments in healthcare during the 1910s - 1920's

1918-1919: Pandemic flu kills over 600,000 in US 1921 The Sweet Act: Establishes the VA 1920: The AMA passes resolution against compulsory healthcare 1929: Blue Cross establishes its first hospital insurance plan at Baylor university 1929: Chronic illness replaces infectious diseases as most significant health threat

Policies & developments in healthcare during the 1930s

1930 National Institutes of health established 1933: Federal Emergency relief Administration: Provides limited medical services for the medically indigent 1935: Social Security Act: Provides federal grants to states to prove and maintain their health services

Health policy: Important events in 1929 - 1941 Great Depression

1930's: Veterans Administration and Veterans Health Care System started Healthcare costs continued to rise Private health insurance growing (covered hospitals and physician visits) Fee for service was implemented Hospitals began offering their own insurance plans which started Blue Cross and Blue Shield Idea of compulsory health insurance resurfaced due to people losing jobs and unable to pay for medical care. Social Security Bill of 1935 by FDR as part of New Deal Initially contained compulsory insurance but out of fear this would sink the New Deal due to lobbying efforts of AMA, compulsory insurance was taken out. Federal grants to states for public health programs was included. National Health Act of 1939 FDR's second attempt at national health insurance Didn't gain much traction due to conservative majority and eventually WWII

Health Policy: Important events in the 1940's

1940s, Congress passed legislation that supported 3rd party insurers. This in conjunction with hospital plans laid foundation for today's concept of health insurance Wage Stabilization Policy (1943) Pay had to stay the same, unless you went through a war board to get a raise. Fringe benefits weren't capped so people started bartering health care. Health care benefits were tax exempt. Wagner - Murray - Dingell (WMD) Introduced bill in 1943 adding health insurance measures to Social Security Act. Failed. 1944 - Public Health Service Act: Many other "acts" are amendments under this including HIPAA and PPACA Under this US Secretary of HHS can take measures to prevent entry and spread communicable disease, states also have authority within their boundaries based on Police Powers WMD 2 (1945)(Truman) Title I focused on public health services & maternal and child health care Title II established national health insurance This was debated for 5 years and failed 1946Hospital Survey and Construction Act (Hill-Burton Act) First federal law intervening in medical delivery system Provided federal grants and guaranteed loans to states to improve health facilities and build new hospitals The Hill-Burton facilities were not allowed to discriminate, had to provide reasonable amount of free care to those who could not afford it and were to provide uncompensated care initially for 20 years after funds were received 1947Army-Navy Nurses Act Established Women's Medical Specialist Corps giving military status to PTs. PT profession grew in 40s and 50s due to WWII and polio

Policies & developments in healthcare during the 1940s

1941 Manham Act: Funds wartime emergency building of hospitals 1945: Penecilin developed 1946: The communicable DISEASE CENTER or CDC opens 1949 Trumans National health policy proposal is defeated

Policies & developments in healthcare during the 1950s

1953 Polio vaccine created 1954 First organ transplant performed 1954: IRS declares that employers can pay health insurance premiums for employees with pretax dollars 1954: Brown vs Board of Education: Racial segragation in public school is deemed unconstitutional 1956: Social security act is amended to include social security disability insurance 1959: Simkins vs Moses Cane Memorial hospital: Racial segregation in public hospitals violates the constitution

Policies & developments in healthcare during the 1960s

1964: Civil rights Act passed 1965: Medicare and Medicaid programs created through social security 1965: Griswold vs Conneticut: he Supreme Court ruled that a state's ban on the use of contraceptives violated the right to marital privacy. The case concerned a Connecticut law that criminalized the encouragement or use of birth control. 1967: First heart transplant

Timeline of healthcare expenditures to GDP in US

1965: Just under 6% before medicare is created Hospital costs made up biggest percentage of amount 1983: 10% Hospital costs decrease in amount due to introduction of DRGs in 1983. However, outpatient services go up as people are not kept in the hospital as long. 2000: 14% 2010: 19%

Bills of the 1960s

1965: Social Security Act Medicare created from Title XVIII of Social Security Act of 1965. Medicare is the health insurance for the aged and disabled. Established as a complement to Title II which provided disability, survivor, and retirement benefits for aged. Implemented in 1966 with insurance coverage for age 65+. Consisted of two parts, Part A (hospital, SNF, and hospice insurance and was an entitlement program with free premiums to most eligible) and Part B (physician, outpatient, home health and voluntary. Subject to deductible and copayments, must pay monthly premium and fee for service plan). CMS (HHS) has responsibility for administration 1967 Soc Sec Act Amended- Medicare expanded coverage (DME, podiatry, and PT), increased # inpatient days, and increased pay to some providers

Bills of 1970s

1970 - Kennedy-Griffiths Health Security program - Single payor. AMA opposed 1971 - Nixon's plan - employer mandated insurance 1974 - Momentum for both plans collapsed 1973 - Health Maintenance Organization Act 1973 - Rehab Act 1974 - Congressional Budget and Impoundment Control Act (created CBO) 1974 - National Health Planning & Resource Development Act - Consolidated acts to control costs and improve quality 1974 - Employee Retirement Income Security Act (ERISA) 1975 - Privacy Act 1975 - Individuals with Disabilities Educational Act (IDEA) 1976 & 1978 - HMO Amendments 1977 Medicare -Medicaid Antifraud & Abuse Amendments 1978 Medicare ESRD Amendment

Bills of 1980s

1980 Omnibus Budget Reconciliation Act (OBRA)changed coverage provisions to address rising costs (expanded home health care) 1980 - Mental Health System Act ($800 million to mental health over 4 years 1980 - Child welfare Act (adoption assistance; strengthened foster care program) 1981 - Omnibus Budget Reconciliation Act (rescinded MHSA and transferred responsibility back to states) 1984 - National Organ Transplant Act (created national registry for organ transplants; establishes standards for organ procurement) 1984 - Deficit Reduction Act (Freezes physician and hospital reimbursement to 1984 levels to promote efficiency 1986 - Consolidated Omnibus Budget Reconciliation Act (COBRA) - allows individuals to stay on former employer's health insurance for 18 months 1986 - Emergency Medical Treatment and Active Labor Act (EMTALA) - Anti-patient dumping 1986 - Immigration and Reform Act (amnesty for 3 million immigrants) 1988 - McKinney-Vento Act (provided 15 programs for homeless)

Policies & developments in healthcare during the 1980s

1980: WHO declares small pox eradicated. 1983: Medicare institutes prospetiva payment system for reimbursing hospitals 1986: EMTALA: Ensures access to emergency services in hospitals which recieve medicare funds regardless if the patient is able to pay. 1986: COBRA: The establishment of provisions to allow individuals to continue on personal insurance plan once leaving an employer 1987: JACAHO created. Joint commission on the accreditation of hospitals

Health bills in 1990s

1990 - American with Disabilities Act (1st civil rights law for individuals with disabilities and prohibits discrimination for employment, public services, public, and telecommunications) 1990 - Ryan White AIDS Act 1990 - Safe Medical Device Act (must report if any injuries occurred) 1992 - Mammography Quality Standards Act (quality inspection of mammography facilities) 1993 - Family an d Medical Leave Act (FMLA) - Allows 12 weeks in a 12 month period for leave while maintaining position and benefits accrued 1994 - Health Securities Act (universal coverage; failed due to opposition of Republicans, lobbyists and insurance industry). As a result, more utilization of HMOs and PPOs 1996 - Health Insurance Portability and Accountability Act (HIPAA) - Protects people and their health coverage when they leave or change jobs and requires health industry to be more efficient with records. Also can't deny coverage based on pre-existing conditions if you had insurance for 18 months prior. 1997 - Balanced Budget Act (BBA) - Designed to balance federal budget in 5 years. Primarily impacted Medicare, Medicaid, and CHIP. Medicare patients had to pay more for insurance, higher co-pays, and providers received 10% less money. $1500 cap on OP rehab with hospital OP exempt. Also expanded Prospective Payment System (PPS) 1997 - Children's Health Insurance Program (CHIP) - for families whose income is too high for Medicaid but can't afford private insurance for their children. Administered by states with federal matching funds. 1997 - Taxpayer Relief Act - Major tax reductions in several areas while increasing air transportation tax and cigarette tax 1999 - Medicare, Medicaid, Chip Balance Budget Refinement Act - fixed things from 1997

Policies & developments in healthcare during the 1990s

1990: Americans with Disabilities Act created: he Americans with Disabilities Act of 1990 is a US labor law that prohibits unjustified discrimination based on disability 1990: Run White Care Act: and is the largest federally funded program in the United States for people living with HIV/AIDS. 1990: Cruzan vs Missouri department of health.: An individual can refuse treatment if they are mentally competent President Clinton's proposed health security act is defeated 1992: Rehabilitation Act was amended to include increased protections for individuals with disability to encourage gainful employment. 1994: Oregon health rations medicaid services to the public 1993: FMLA. Grants employees up to 12 weeks of protected unpaid medical leave Comprehensive Childhood Immunization Act - 1993 $$ to provide vaccines to children eligible for Medicaid, without insurance, and Native American children 1994. Health Security Act. Clinton set up a task force to look into a single payer system. This fell through. 1996: HIPPA : Ensures patient privacy rules for protected health information. Grants access to healthcare if become unemployed or leave job. 1997: Balanced Budget Act: Add medicare part C. Creates state Children's Health Insurance Program. (CHIP). provides health coverage to uninsured children whose families earn too much to qualify for Medicaid, but too little to afford private health coverage. Elderly population over the age of 85 starts to creep up in percentage of overall population.

Media impact during the 1990s

1991 - Magic Johnson announces he has HIV Also in "mainstream" from TV show The Real World 1992 - Rodney King verdict/riots 1993 - Internet becomes available publicly and the world wide web is born 50% households have a computer by 2001 Increased access to information - 63% of internet users sought health information (2000) 1995 - OJ Simpson trial issues like DNA are talked about in the general public 1997 - FDA relaxes rules on mass media advertising of prescription drugs Consumers request healthcare rather than relying on MD advice Terrorist attacks are becoming more commonplace in the 90's starting with 1993 - first WTC bombing and culminating with 2001 - Terrorist attack tat twin towers. WTC/Pentagon/Shanksville 2001 - War on Terrorism begins as response to 9/11 2001 - anthrax mail attacks

2000s legislation

2003 - Medicare Modernization Act (MMA) - Prescription drug coverage for seniors. 2007 - Reauthorized CHIP for 2 years without expanding any portion 2009 - CHIP reauthorized and expanded through 2013 2009 - American Recovery and Reinvestment Act - awarded physicians and hospitals for meaningful use of electronic records, funding for state Medicaid and subsidies to help with COBRA

2010s legislation

2010 - Patient Protection and Affordable Care Act (PPACA). Constitutionality of law questioned and Supreme Court ruled PPACA was simply a punitive tax. 2012 - Accountable Care Organizations (ACOs) and electronic records move forward 2013 - Exchanges open for enrollment with significant glitches with enrollment Outcome - employers shifting employees to part-time status to avoid benefits. "Obamacare encourages more people to buy insurance on their own, in part by incentivizing employers to drop health coverage."Also, greater demand with fewer providers. May start to see rationing with poorer reimbursement having longer waits. 2014 - Reduction in Medicare payment rates for physician services by almost 25%

Important Political and social events in the 2000's?

9/11/2001: World trade center attacks 2001: US military action in Afghanistan 2003: IRAQ war Great Recession 2007

Describe the rational model model of policy analysis

Analysis of the operational goals, alternative policies, and the values and resources available. After this comparison is made, a decision is made.

1960's themes

AHA recommends statements of human rights in hospitals and healthcare organizations). Conservative 1950s turned into young and revolutionary ways of thinking. Healthcare issues included rising costs (faster than inflation), shortage of nurses (Nurse Training Act), and access to care for elderly and poor. Use of a formulary system incorporating generic drugs, one Blue Cross established, AHA meetings about LTC for elderly though opposed to expanding Social Security. Hill Burton expanded to fund out-modeled hospitals in urban areas. Army PTs have practiced under direct access after Vietnam due to physician shortage

Events of he 1950s

AMA strongly opposed changes in response to Truman's health care bill, "Fair Deal" since this would decrease reimbursement and large media campaign was launched to tell patients their choices would be limited and this was a "Socialist agenda". Commercial insurance aggressively entered. Individual rates based on health risks. This left Blue Cross with the sickest and highest risks. Middle class could no longer afford health insurance. PT moved beyond hospital-based practice, including outpatient clinics, public schools, SNFs, and rehab facilities. The Medical Facilities Survey and Construction Act amended Hill Burton to include rehab centers, nursing homes, and outpatient facilities to be constructed. 1950 - 1953Korean War. Eisenhower elected in 1952.

Describe the policy implementation stage of the longest model

Activities guided by rulemaking that guide the implementation of policies and the operationalization of those policies. Rulemaking Establishment of formal rules or regulations, development of the detailed specifications of the legislation. Operation Involves the actual running of the programs or processes embedded in the legislation.

Describe the policy modification stage of the longest model

Allows for all prior decisions made within the process to be revisited and possible changed. Feedback loop that can influence all phases of policy formulation (agenda setting and legislation development) or implementation (rulemaking and operations). Feedback provided by individuals, organizations, interest groups. Policies can be modified through amendments in the creation of legislation, or through judicial decisions relating to the legality and enforcement of the legislation.

Health policy: Important event in 1899

American Hospital Association (AHA) was created

Health policy: Important event in 1846

American Medical Association (AMA) was established. Became strong lobbyists by stopping proposals for universal health insurance during the Progressive Era and the New Deal

Describe the Elite model of policy analysis

An elite few decide the policy for the masses

What is the main reasoning of Egosit ethics?

Argue that what is right is that which maximizes a person's self- interests. Rational Egoist This version of egoism still places primary focus on what is best for the individual to determine the course of action

Discuss assent in medical care of minors

Assent differs from consent in that while the willingness of a minor to accept treatment is an important consideration, it is just a consideration . Parental permission may trump assent

Define Autonomy and potential downside?

Autonomy and self-determination indicate the ability of a person to make a free and informed decision without pressure or coercion Only the individual can delegate his or her own autonomy. Includes confidentiality Potential downside? Not being involved enough in client's decision making

What is negligence and what are the different levels of negligence?

Commission or omission of an act that a reasonably prudent person would or would not do Malpractice - professional negligence (related to standards of practice) Criminal negligence - reckless disregard for safety of another

Define Beneficence and potential downside?

Beneficence is the principle of working in someone's best interest. Clinicians strive to promote a patient's welfare and balance the benefits and the burdens of clinical decisions. Potential downside? Paternalism Paternalism is limiting the freedom of another person (usually against their will) with the justification that such interference prevents harm. Paternalism carries with it the danger of intrusive beneficence, ie, my values are better than yours, although paternalisms may be weak or strong and are often valued differently depending on the culture

Describe the institutional model of policy analysis

Branches of government Executive Legislative Judicial

Define burden of proof and list the different levels?

Burden of proof refers most generally to the obligation of a party to prove its allegations at trial reasonable suspicion probable cause some credible evidence Substantial evidence Preponderance of the evidence Clear and convincing evidence

1950's themes

Capitalism vs. Communism Cold War starts Space Race starts Second Red Scare

What is Clear and convincing evidence?

Clear and convincing evidence is a higher level of burden of persuasion than a "Preponderance of the Evidence. This standard is used in many types of equity cases, including paternity, PINS, juvenile delinquency, child custody, the probate of both wills and living wills, petitions to remove a

Policies & developments in healthcare during the 1970s

Communicable disease center is renamed the Center for Disease control (CDC) 1972: Canterbury vs Spence: Doctor must disclose all health risks to a patient before procedures 1973: Roe vs Wade: The US Supreme Court, in a 7-2 decision, affirms the legality of a woman's right to have an abortion under the Fourteenth amendment to the Constitution 1979: HHS is created 1979: Carter proposes another national health plan which is defeated

What are the different types of damages awarded in a legal case?

Comparative - both partially responsible (damages can be split ie 80/20) Contributory - if one contributed to the problem cannot get damages from the other

What are allocative health policies?

Distributive: provide net benefits to some distinctive group or organization at the expense of others to meet public objectives. Allocative policies are intended to help individuals gain access to needed services.

Define fidelity?

Do as you say you will do and respect confidentiality. Keep commitments to your patients

What do you need to prove negligence?

Duty to care Breach of duty Causation Injury actually occurred

E.U. & US total population to undocumented immigrant population

EU: 500 million to 2 million : 2007 US: 300 million to 12 million: 2007

Policies & developments in healthcare during the 2000s

Early in 2000s, congressional interest turned to terrorism and away from health concerns. 2003: Medicare Modernization Act: Provides drug coverage under medicare 2003: Sequencing of human genome completed 2003: SARS (Severe Acute respiratory syndrome) epidemic 2004: Flu vaccine shortage 2004: Project Bioshield Act: Provides funding for vaccines and medicine to guard against sudden biological attacks 2005 Deficit ReductionAct: Makes significant changes to Medicaid in order to control costs. 2006: Medicare prescription drug planPart D goes into effect 2006: Increased concern is US about raising levels of obesity 2006: Vaccine for the Human papilloma virus created. 2009: Childrens Health Insurance Reauthorization Act: Extends CHIP for 4.5 more years. 2009: Health spending to GDP rate at 19% 2009: H1N1 Flu epidemic 2010: The Affordable Care Act: Comprehensive health reform including an individual mandate, medicaid expansion, and creation of state health "exchanges".

Important Political and social events in the 1960's?

Economic Downturn

What is the main reasoning of Authority based?

Essentially, authority- based theories determine the right thing to do based on what some authority has said. Can be religious or ideological.

Health policy: highlights of 1887 - 1923 Progressive Era Politics

European countries forming government healthcare systems (Germany being the first) Compulsory health insurance was attempted in US by American Association Labor Legislation Bill in 1915 but failed, partly due to AMA lobbying power and Unions didn't like the bill since it was concerned government would overtake the union's role in providing social benefits. As a result, third party health insurance companies gained strength in US Physicians were gaining more power and authority which gave them better pay and increased health care costs. WWI (1914-1918) - Anti-German fever denounced German socialist insurance (a communist idea). Also the first school of PT was at Walter Reed and recruited women to rehabilitate injured soldiers. Also during WWI, new programs for veterans started, such as disability compensation, insurance, and vocational rehab.

What is the executive branch's job in regards to health policy?

Executive branch implements policy Implements laws Vetoes Appoints judges Proposes legislation Approves or vetoes legislation Disseminates rules or regulations

What is reasonable suspicion?

Reasonable suspicion is a low standard of proof in the U.S. to determine whether a brief investigative stop or search by a police officer or any government agent is warranted

Important Political and social events in the 1990's?

Gulf War 1990 - 1991 NAFTA Whitewater Investigation Oklahoma City Bombing

Describe the major aspects of the Health security Act of 1996

Had an employer mandate and an individual mandate. Died in congress with huge opposition.

Health policy: Important events in 1920's

Hospital expenses were becoming more burdensome for families. APTA started. PT profession grew as treatment for polio became more popular

Important Legislature of 1900s

Hurley vs Eddingfield 1901: Physicians are under no duty to treat Jacobson vs Massachusetts 1905: State statute requiring compulsory vaccination against smallpox

Describe the game theory model of policy analysis

Independent decision making by 2 or more players. Give and take. If you do X, I'll do Y.

Important Political and social events in the 1860's?

Industrial revolution ended in 1860 US Civil War 1861 - 1865

What are regulatory health policies?

Influence the decisions of others by directive. There are 5 main categories of regulatory policies_ social regulations, Market controls on the provision of health services, Market-entry decisions, Rate or price setting controls on health service providers and Market- preserving controls.

What is the judicial branch's job in regards to health policy?

Judicial branch interprets policy Interprets constitution and statutory laws Develops a body of case law Preserves rights Resolves disputes

Important Political and social events in the 1950's?

Korean War: 1950 - 1953 McCarthyism. Early 1950's

What is the legislative branch's job in regards to health policy?

Legislative branch formulates policy Enacts laws Veto override president Appropriations Senate confirms judges Congress creates lower courts and may impeach judges Although, only one Supreme Court justice ever impeached in 1805 Creates and funds health programs Balances health policy with other policy domains

What are the different types of negligence?

Malfeasance - bad act Misfeasance - wrong act/ acting improperly Nonfeasance - failure to act

What are the methods interest groups can use to influence health policy?

Methods Lobbying: communication methods to persuade policymakers to support choices that are in their best interest Electioneering: using resources to help policymakers obtain or keep political office, so they will vote in the groups interests. Litigation: challenge existing policies or alter policy implementation through litigation in state or federal courts. Influencing public opinion: media and public campaign to convince public opinion to support or challenge a policy.

How is insurance set up in most countries worldwide wide for undocumented migrants

Most countries provide for emergency care only Smaller numbers of countries provide more services or allow undocumented migrants who meet certain requirements access to the same range of services as nationals. 1) focusing on segments of the population, like children or pregnant women; 2) focusing on types of services, like preventive services or treatment of infectious diseases; or 3) using specific funding policies, like allowing undocumented migrants to purchase insurance.

Define Nonmaleficence and potential downside?

Nonmaleficence applies to the principle of doing no harm. Malfeasance deals with negligence or failing to act. There may be direct negligence by healthcare workers or indirect harms caused by fear of retaliation or failing to report an incident. . Potential downside? Non-action for fear of doing harm

Describe the incrimental model of policy analysis

Over time, policy changes incrementally by adding to and modifying existing policy

Who are the 9 traditional stakeholders?

Parent Physician Government Child Society School Pharmecuetical companies Scientists/researchers Insurance

Describe the implementation phase of policy making?

Policies, once enacted as laws, are implemented through rules and regulations that guide implementation. Establishing these rules is the purview of departments and agencies in executive branches, such as those in the US Department of Health and Human Services or in state health departments.

Describe the formulation phase of policy making?

Policy formulation incorporates activities associated with setting the policy agenda and, subsequently, with the development of legislation driven by that agenda. It is largely the purview of legislative bodies . Congress and state legislatures formulate policy in the form of laws. The formulation however is influenced or affected by many factors.

Who are the different players on a bill according to the Brookings institute?

Political parties president State and local governments Judiciary Media and press Special interest lobbyists Legislature

Describe the possible inputs of the longest model

Preferences of individuals, organizations, and special interest groups Biological, cultural demographic, ecological, economic, ethical, legal, psychological, social, and technological inputs.

What is Preponderance of the evidence?

Preponderance of the evidence, also known as balance of probabilities is the standard required in most civil cases

What is probable cause?

Probable cause is a relatively low standard of evidence, which is used in the United States to determine whether a search, or an arrest, is warranted

Describe the steps of the Dye analysis model.

Problem identification Agenda setting Policy Formulation Policy Legitimization Policy Implementation Policy Evaluation

Important Political and social events in the 1980's?

Regan: New Federalism 1989: Berlin Wall Fell

What is Substantial evidence?

Substantial evidence is "more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion

1950's healthcare breakthroughs

THR, pacemaker, polio vaccine mainstreamed, organ transplant successful, and JCAHO created

What is the main reasoning of consequentialism?

Teleological theories consider the ethics of a decision to be dependent on the consequences of the action.

1910's themes

WW1

Important Political and social events in the 1910's?

WW1: 1914 - 1919

1940's themes

WW2

Important Political and social events in the 1940's?

WW2: 1939 - 1945

What is the main reasoning of Utilitarianism?

The correct decision is always the one that maximizes happiness and minimizes pain for the greatest number of people.

What is the main reasoning of natural law ethics?

The key idea behind natural law is that nature has order both rationally and providentially.

What is the main reasoning of Virtue ethics?

The key idea behind virtue ethics is to find the proper end for humans and then to seek that end.

Describe the modification phase of policy making?

The policy modification phase allows for all prior decisions made within policymaking to be revisited and perhaps changed. This phase exists because policies are established and operate in a dynamic world.

What is the main reasoning of Deontological ethics?

The term deon is from the Greek and means " duty." Thus, deontology could be called the science of determining our duties. Most authors place Kant in extreme opposition to consequentialism, because he argued that the consequences themselves are not relevant in determining what is right.

Economics in the 1990s

There was a recession in the early 1990s from 1990 - 1991. Continued high unemployment until 1993 Coorelation vbetween unemployment rate and rate of non-elderly individuals without insurance During the recession, most employer chose to shift healthcare costs for premiums to their employees rather than from healthcare coverage totally. Economic boom at end of 1990s led by private sector. Luckily, this was not eaten up by the government until the 2000s. Clintons second term also saw sweeping welfare reform with many policies aimed at moving individuals off of the welfare system.

Define Veracity and potential downside?

Truth telling. True and honest disclosure. Potential downside? Negative effects on patients and/or family by "assaulting" them with the truth

Define Justice and potential downside?

Upholding what is right, with a fair distribution of benefits Non discriminatory practice Procedural Justice Distributive justice Potential downside? Going out of business due to distributing services equally to those who can not pay