HSMP
Core functions of public health
1. Assessment 2. Policy development 3. Assurance
Federal grants
1. Categorial- main source of federal aid to state and local govt. Project basis (Head Start) and Formula basis (Ryan White) 2. Block- large amounts of funding awarded to state or local govt with only general provisions for the way the grant is to be spent. Temporary Assistance to Needy Families 3. Mandatory (earmark)- explicitly specified in appropriations by Congress
Health care delivery organization
1. Outpatient/ambulatory- care providers, physician practices, health centers, urgent care 2. Acute care/inpatient facilities- hospitals 3. Long term care-nursing homes, home health. expanding due people living longer 4. Hospice care
How does lack of health insurance affect access to health care?
1. People without insurance are less likely than those with insurance to have regular outpatient care, including preventative and primary care services. 2. People without health insurance are more likely than those with insurance to be hospitalized for avoidance health problems. 3. People without health insurance experience greater declines in their overall health than people with insurance.
Employer sponsored insurance trends
1. increase in premiums and increase in employee contribution towards the premium 2. increase in deductibles 3. increase in workplace wellness programs
Public health financing challenges
1. unstable funding sources 2. no system to evaluate how public health spending impacts health outcomes 3. decline in Medicaid revenues as states implement Medicaid managed care 4. decline in state revenues during the recession 5. limited workforce skills in financial mgmt
Key components of the Strategic Plan document include the strategic goals, objectives, and action steps. Which of the following is NOT true about the goals, objectives, and action steps. 1. "Goals" are broad statements of direction, whereas "objectives" are statements that relate to each goal. 2. "Goals" must be SMART (Specific, Measurable, Attainable, Rewarding, Timed) 3. "Action steps" are also known as "action plans" or tactics" 4. "Action steps" define the person/position in the organization who is responsible for achieving each task within a specified timeframe.
2. Goals must be SMART-objectives are SMART
decentralized/home rule (state/local)
2/3 of the states extend home rule authority to local governments. local governments can adopt their own local constitutions and exercise a board range of governmental powers reserved for states Home rule authority- state has extended the authority to locals to be in charge. unless state gives local authority, locals have no authority
Which of the following is true about state health agencies? 1. The majority of state health agencies are located within a super agency. 2. State health agencies have no power except that given to them by the local health departments. 3. More than half of states health agencies employ the free standing agency model where the agency is a cabinet level unit in the executive branch. 4. State health agencies function as the nation's largest consumer protection agency.
3. More than half of states health agencies employ the free standing model where the agency is a cabinet level unit in the executive branch.
In what ways does the ACA see to increase the quality of health care services that American services? 1. By paying providers (hospitals and physicians) based on the quality of care that they provide, not just based on the volume of services that they provide. This is known as pay for performance or value based purchasing. 2. By promoting meaningful use of electronic health records to enhance decision-making and population health management. 3. By making data about the quality of care at different provider facilities (hospitals and physicians) available to the public. 4. By incentivizing providers to adopt new models of care delivery, such as Accountable Care Organizations and Patient Centered Medical Homes, that emphasize care coordination.
All of these
In what way does the ACA seek to expand health insurance coverage in the US population: 1. By giving states the option to expand Medicaid coverage to all non-elderly adults with incomes up to 133% of the Federal Poverty Level. 2. By creating online health insurance exchanges/marketplaces, where individuals and small employers can shop for health insurance and receive premium/tax subsidies if they qualify. 3. By requiring employers with 50 or more employees to offer health insurance coverage to their employees or to pay a fine if they do not offer coverage. 4. By requiring all individuals (except those exempt) to have health insurance coverage, or to pay a fine. This is known as the individual mandate. 5. All the above.
All the above
10 essentail public health services
Assessment 1. monitor health 2. diagnose and investigate Policy Development 3. inform, educate, and empower 4. mobilize community partnerships 5. develop policies Assurance 6. enforce laws and regulations 7. link people to/provide care 8. assure competent workforce 9. evaluate 10. research
_____ strategies establish agreements that offer mutual benefits to constituents and their organizations.
Cooperative
One of the challenges facing the U.S. health care system is expanding access to care to people who lack health insurance coverage. Which of the following statements is TRUE about the uninsured population in the U.S.?
Country to common wisdom, most uninsured Americans are in working families.
Which of the following statements is TRUE about the performances of the U.S. health care system?
Disparities in health care access and health care outcomes among population groups remains a challenge that raises concerns about the equitable distribution of health care resources.
Medicaid enrollees who generate the largest proportion of program expenditures are
Elderly and Disabled
Which of the following health insurance mechanisms is not considered "public insurance?" 1. Medicaid 2. Medicare 3. Employer based 4. CHIP 5. VA
Employer based
Most Americans get their health insurance through which of the following mechanisms?
Employer sponsored insurance
Health insurance coverage US population
Employer- 50% Medicaid- 19% Medicare- 13% Uninsured- 10% Other public- 2% Private non-group- 6%
Policy development
Every public health agency should exercise its responsibility to serve the public interest by promoting the use of scientific knowledge in decision making about public health and by developing pubic health policy
Assessment
Every public health agency should regularly and systematically collect, analyze, and make information on the health needs of the community, including statistics on health status, community health needs, and epidemiological and other studies of health problems
In an effort to control health care costs, the ACA cuts benefits for people in the Medicare program. True or False
False
True or False. Shared leadership between public health organizations and the communities they serve is demonstrated by one-way, downward communication from the public health agencies to the community
False
True or False. Shared leadership between public health organizations and the communities they serve is demonstrated by one-way, downward communication from the public health agencies to the community.
False
True or False. Standardized degrees or professional credentials define all public health workers across the U.S.
False
True or False? The scope of public health services performed by local public health agencies has been standardized across regions and states
False
True or false. The CDC distributes 90% of its total funding in grants to states and territories, public, and private healthcare providers, and health professions training programs, totaling 7.5 billions
False
Ture or False. About 55% of companies offer health insurance coverage to their employees. Employers at those firms are increasingly contributing a larger share of the premium than their workers, making it increasingly affordable for workers to obtain coverage.
False
True or False. As the Community Engagement Continuum moves from outreach to shared leadership, the level of involvement of the community decreases.
False.
True or False. Mandatory or entitlement programs, such as Medicare, Medicaid, and Social Security, make up a relatively small portion of the federal budget. This means that most federal funds are left to support "discretionary" programs, such as public health, transportation, and education
False.
Which of the following represents the largest source of funding for states health departments?
Federal funds
States revenue source
Federal funds (53%) State/territory funds (24%) Fees and fines (4%) state/territory other funds (10%) other (9%)
State health agency models
Free standing (55% of states) organizational unit with larger superagency (different agencies are grouped together like dept of health and senior services) (45% of states)
Taxation may be use to
Generate revenue to fund federal public health programs Discourage unhealthy activities by raising the "price" of the unhealthy activity/product
Health Maintenance Organization (HMO)
In the HMO, patients have a PCP (Primary Care Provider) who serves as the gatekeeper. Specialty care is only covered with referral from the gatekeeper. Physicians are employed by insurance. Physician gets pre-determined amount of money for service
Preferred Provider Organization (PPO)
In the PPO (most common), there are incentives for patients to receive care from a network of contracted providers who have agreed to receive discounted fee for services from the insurer. Network includes primary and specialty care. Patients can self-refer to specialists within the network.
The Medicaid program plays a central role in our health care system. Which of the following statements is True about the Medicaid program? 1. The ACA limited Medicaid eligibility and services. 2. Medicaid covers hospital and physician services but does not cover long term (during home) care services. 3. The Medicaid program was recently established and as such, has no track record in expanding access to care to low income individuals and families. 4. Medicaid covers nearly 70 million Americans who do not have access to employment based insurance
Medicaid covers nearly 70 million Americans who do not have access to employment based insurance
Which of the following statements is NOT true about the Medicare program? 1. Medicare is a public health insurance program that provides coverage for people 65 and older and for younger individuals with disabilities. 2. Medicare was enacted in 1965 and celebrates its 50th birthday in 2015 3. Medicare includes 4 parts: A,B,C, and D with each part covering different services and having different requirements 4. About 1/3 (30%) of Medicare beneficiaries are enrolled in a private Medicare Advantage plan, such as HMO or PPO, rather than traditional Medicare program
Medicare covers long term care services and supports, including extended nursing home stays
HHS budget
Medicare- 53% Medicaid-32% Discretionary programs (public health)- 8% Children entitlement programs (children health insurance)- 3% TANF- 2% Other mandatory programs- 2.2%
Public Health Service (PHS) Agencies
NIH FDA CDC ATSDR- agency for toxic substances and disease registry IHS- indian health services HRSA- health resources and services admin SAMHSA- substance abuse and mental health services admin AHRQ- agency for healthcare research and quality
What percent of the population needs population based services, primary care services, secondary care services, tertiary care services?
Population- 100% Primary- 70% Secondary- 30-40% Tertiary- less than 30%
Assurance
Public health agencies are to assure their constituents that needed services are provided either by: 1. encouraging other entities (private or public sector) to deliver such services 2. requiring such action through regulation 3. providing services directly
Local health departments (LHDs)
Retain the most direct and immediate responsibility for performing public health activities at the community level mostly at county level
The Strategic Planning process involves a series of sequential steps that proceed in the following order
Situational analysis, strategy development, action planning, progress reporting
What is the primary role and responsibility of the Agency of Healthcare Research and Quality (AHRQ)?
Sponsoring research on the organization, delivery, and financing of health services
Health services pyramid
Tertiary medical care (top)- most of the budget, only for select people. open heart surgery, kidney transplant Secondary medical care (second to top tier)-speciality care and treatment, chronic problems. outpatient surgeries Primary medical care (second to bottom)- clinical preventive services, treatment for common conditions like a cold Population based services (bottom)- preventive and health promotion- safe food, homes, roads, vaccination programs. spend the least on this
The constituency engagement framework begins with:
The understanding that people need a reason to invest their energy in processes that address community health
Which of the following statements is NOT true about Strategic Planning? 1. SP is critical for the survival of all types of organizations, including health care delivery organizations and public health agencies. 2. SP focuses on finding the best future for the organization and determining how the organization will evolve to realize that future. 3. SP is grounding in the mission and vision of the organization and informed by assessments of the internal and external environments of the organization. 4. There is currently no link between SP and accreditation of public health organizations
There is currently no link between SP and public health organizations.
Health care spending
Top 5% account for half of health care spending Bottom 50% account for 3% of health care spending
HHS Goals
Transform healthcare, advance scientific knowledge, advance health and safety for people
True and False. Cross-country comparisons of health care costs show that the U.S. spends a disproportionate amount of health care relative to its wealth. On average, other wealthy countries spend about half as much per person on health care than the U.S. spends.
True
True or False. One of the key provisions of the ACA is the Individual Mandate, whereby all individuals (with some exemptions) are required to either have health insurance coverage or to pay a fine. The Individual Mandate was designed to limit "Adverse Selection" by younger and healthier consumers.
True
True or False. Public health leaders must facilitate the development of mission and vision statements for the organization. Whereas the "mission" statement highlights the current purpose for the organization's existence, the "vision" is futuristic, energetic, and describes the organization's long-term direction
True
True or False. The ACA was enacted in 2010 and involves major changes to the US health care system. Key goals of the ACA are to increase access to the US population to health insurance coverage, and to increase the quality of health care services.
True
True or False. The Situational Assessment/analysis is key phase in the strategic planning process. During the Situational Assessment/analysis, the organization evaluates its external and internal environments in order to identify, among other things, its strengths, weakness, opportunities, and threats
True
Ture or False. The ACA gives state the options of expanding their Medicaid program to cover more low income uninsured adults
True
True or False. Public health administrators learn from and adopt practices from different sectors including industrial administration, business management, information technology, and public administration.
True.
True or False. The Women, Infant, and Children (WIC) program is an example of a federal pass-through grant.
True.
Which of the following is a key strategy to enhance the current public health workforce capacity?
Worksite-based training programs for practicing public health workers
3/4 LHD operate with local board of health. board functions
advise LHD on policy, programs, budget set policies, goals of LHD adopt public health regulations approve LHD budget hire and fire LHD
Conventional insurance
almost extinct. traditional/indemnity insurance, where insurer pays for services provided in any setting. Financing and delivery of health care are separate. No incentives to control costs. Indemnity plans are almost extinct today.
Deductible
amount of money that the policy holder must pay out of pocket for covered services before their policy kicks in
Fiscal federalism
assigns responsibility for specific functions to national, state, and local levels and puts financing in place to fulfill those functions
HHS organization
conducted by the Office of the Secretary (executive branch) and 11 agencies that administer public health and human services programs
CDC role
conducts health surveillance and disease control
Managed care
dominant model. models that integrate the financing and delivery of care. Level of integration varies by type of plan. PPO, HMO, POS
FDA role
ensures food safety and regulates medicines and medical devices
Environmental protection agency (EPA) role
environmental safety
centralized (state/local)
establish rules for local agencies make key decision regarding agency staffing, financing, organization staffing and finance at state level centralized have state employees, no county workers
Co-payment
fixed amount of money that the policy holder must pay each visit
USDA role-
food safety, nutritional support
State health agencies (SHA)
full or shared responsibility of federal initiatives address CDCs winnable battles direct clinical services laws and regulations tobacco control
AHRQ role
funds research on the medical care system
Department of education role
health education and services to students
plans with lower premiums have
higher deductibles and vice versa
High deductible health plans/savings
instead of buying a plan, put pre-tax money in a saving account to use for health services
Department of Health and Human Services (HHS) role-
lead health agency at national level. focal point of health concerns at federal level. Includes Medicare/Medicaid, admin for children and families (ACF) and admin of aging (AoA). Medicare/Medicaid get most of budget
Shared (state/local)
local health agencies are subject to the shared authority of both the state agency and the local government local health units led by employees of the state or of local government (who they are led by makes decisions)
Local health department revenue
local- 29% state direct- 23% federal pass-through- 13% federal direct- 7% Medicaid- 9% Medicare- 2% Fees- 6% Other- 12%
IHS role
manages health care for indian tribes
Adverse selection
many younger and healthier people are not interested in health insurance and may decline insurance or delay it until they need it. this works against risk spreading. ACA works to limit both adverse selection and risk selection
Health care services refer to
medical services received by individuals (doctors)
Point of service plan (POS)
mix of PPO and HMO plans
Workforce preparation
multidisciplinary workforce formal training is NOT common continuing education in Public Health is just beginning
Federal budgets
only Congress can raise revenue, borrow funds, and provide funding to Federal agencies Congress decides: what each agency gets to do the purpose of funds amount of funds amount of time the funds are available
Co-insurance
percentage of the health care bill that the policy holder must pay out of pocket
Risk pooling
pool many people together to spread or share cost of the few sick people
Public health services relate to
population services carried by federal, state, and local governments
ATSDR role
prevents exposure to hazards from waste sites
Premium
price of the health insurance policy. the amount of money that the policy holder must pay every month for the policy to remain active
Public health mission
promote health to society.
HRSA role
provides resources for underserved populations
Department of housing role
public housing and homeless shelters
determinants of health
social (poverty, education, culture) and economic environment physical environment (urban design, clean water and air, toxins, food-borne) biologic factors personal behavior/lifestyle access and use of health services
Mixed (state/local)
state health agencies maintain decentralized relationships with local health agencies in some jurisdictions within the state while exercising centralized administrative control over agencies in other jurisdictions mixed authority model predominates among states that extend home rule authority to some local governments but not others
NIH role
supports biomedial research
The constituency engagement framework begins with
the understanding that people need a reason to invest their energy in processes that address community health
True or False. People are motivated to work for change when the conditions surrounding an issue are no longer acceptable to them.
true.
Department of labor role
workplace safety and health
SAMHSA role
works to reduce substance abuse
