Health Policy Exam 1
Medicare Structure
Part A: covers hospitals and nursing home stays and hospice care. Part B: covers doctor services, outpatient hospital care, durable medical equipment, and other medical services Part C: covers all part A and B benefits, helps fill any gaps. Part D: Drugs
Is the only country in the western world without Universal health care
USA
step 4
a simple majority of both houses of congress vote a second time to pass the revised version of the bill on which they both agree
step 1 for a bill becoming a law
a simple majority- 218 of the 435 members of the house vote to pass their version of the bill
who is covered by medicare
age 65+ with 10 years of social security contributions social security disabled w/ 24 month waiting period end stage renal disease and ALS with no waiting period
The omnibus reconciliation act of 1981
allowed states to makes additonal payments to hospitals with disproprotionate share of medicaid and how low income patients know as DSH hospitals
Death of Ted Kennedy
august 25th 2009: Massachusetts senator Ted dies and puts the senate democrats 60- supermajority required to pass a piece of legislation at risk Sept 24th 2009: Pual Kirk is appointed interim senator to replace him which temporarily restores the democrats fillasbuster.
NURSING
before physicians there were hospitals Florence Nightingale- history of war, crimean war nurses used to be called nitingales nursing shortage-WWI medical assistants helped out Nursing shortage WWII licensed vocational nurse doctors treat diagnosis nurses treat the patient no hospital care without nurses
step 3
both houses of congress have a conference to create one revised version of the bill on which both houses agree.
Shortages lead to higher nurse patient ratios which led to
burnout job dissatisfaction higher mortality rates
who is covered by medicaid
children preg women elderly disabled parents with kids parents with kids who have no other way to pay
AMA (american medical association) and phRMA
code of ethics patent protections for drugs aggressive marketing high profit margins PhRMA- patent last 10 years a way to get back their research and development. Gov. allows so they will stay interested in making more drugs.
Medicare advantage purpose
cost reduction: cheaper for patients, medicare, taxpayers keep medicare sustainable
New Deal Health Plan
created by FDR. wanted universal coverage. dealt with infrastructure..making new jobs. 1945 WWII happened and plans did not go through.
Health Security Act a.k.a Hilary care
during bill clinton's first term task force headed by Hilary Clinton features: individual mandate-have to be insured expand employer sponsored health insurance to all employees.
EPSDT
early and periodic screening diagnosis and treatment.
federal medicaid guidelines
eligibility service benefits payment rates program admin
major ways americans can get health insurance
employers medicare and medicaid individual insurance
What is the problem with Uninsurance for individuals
income insecurity access to care lack of preventive meds medical care is expensive for everyone else: cost increase adverse selection wood work effects
Judicial Branch
interpt and evaluate laws court system supreme court life long position 8 justices usually 9
9/11 rescue worker Reggie Cervantes medicine in the us Cost 12o but in Cuba
it cost 3.20 pesos which is around 5 cents
History of Physicians
lack of consistency in training (informal apprenticeship) no licensure/certification (no assurance of quality-education) large number of doctors
1960s
medicare medicaid
statistics of medicare today
medicare covers around 55 million 505 billion in cost 14% of federal budget
democracy
not a true democracy people choose representatives. reps make decisions on their behalf of their constituents.
In a world health organization ranking of the worlds health system the US slipped to
number 37 just above solvina
part B and D of medicare is covered by
social security tax basically general revenue
Federation
soverign states that adhere to a single federal gov.
July 2009 ACA
speaker of the house nancy Pelosi and a group of democrats from the house reveal their plan for overhauling the health care system. HR 3962
Senator Obama's plan
-private and public group insurance with consumer protections and income-based subsides -similar to Massachusetts Romney care -expand medicaid and CHIP -employer mandates -national health insurance competition -offer citizens the federal employee health plan (public option) -tax credits -income based subsidies (national health insurance competition got dropped health insurers did not want because they would have to lower prices)
Senator John McCain's plan
-tax credits for individual market insurance -tax employer based health insurance premium contribution as income -national health insurance competition -federal assistance to states to cover vulnerable populations -was not well received - no more employer sponsored health insurance
Chronic Illness
1-24% 2-11% 3-7% 4-4% 5-3%
US health spending categorized
1.hospital/nursing homes 2. outpatient facilities 3. drugs 4. public health and admin
When Dr. Linda Peeno started a medical reviewer for Humana, she was told she must keep a
10% denial rate
RN positions unfilled
13%
percentage that doesn't have health insurance in 2009
16.7 or 50.7
Madelyn Durham
1922-2008 Obama's grandmother helped to raise him dies of cancer (no coverage) 3 days prior to his election.
Sen. Ted Kennedy
1932-2009 youngest brother of JFK held office from 1962-2009 called health care reform "the cause of my life" martyr for healthcare
social security amendment in
1967
history facts of medicaid
1982 Arizona was the last state to offer. offered in 56 states.
person to doctor ration
1:416 ratio does not account for specialty. There is not enough primary care doctors because of the huge market difference in payment.
filibuster
2/3 vote can end it (60)
step 2
2/3rds majority 60-100 senators vote to pass their version of the bill
high salaries
280 K- GP 450K- specialists 475K- surgical specilalists
numbers of people uninsured by 1980
30 million
percentage of enrolles in medicare on managed care plans
31%. 69%have not switched
Truman's national health plan
5 Point plan: construction of hospitals and related facilities expansion of public health, maternal, and child health medical education and research prepayment of medical care protection against loss of wages from sickness or disability.
percentage of employer sponsored health insurance
50%
percentage of american over the age of 65 and uncovered
56% reasons: retired forced into individual insurance market no income and very expensive
Every prescription in Great Britain is filled at a cost of
6.65 to the patient except for patients under 16 or over 60 which is free.
public opinion disagreed about how
65% of democrat favored providing health insurance to all uninsured. 42% of republicans favored providing health insurance to only some of the uninsured 27% said to keep things basically the same
how many doctors in the US
741,000
number of americans with some form of health insurance
83.3
percentage of nurses that account for hospital short staffed
84%
federal and state government contribute
9 percent of healthcare expenditures
Public Opinon 2008- Obamacare
90% of Americans felt U.S health care system should not be completely rebuilt or fundamentally changed.
ANA
American Nursing Association: Labor Union: professional credentialing and level pay different than the AMA- every level has a different union
MEDICARE PART C
Balance Budget Act of 1997: medicare choice now medicare advantage Managed Care Plans: HMO's, PPO's, etc. Available to all medicare enrollees except ESRD
Once Billy Tauzin for the drug companies' bill passed that would supposedly help senior citizens, he left congress to become
CEO of Pharma, the industry's drug lobby for a salary of 2 million dollars a year.
Senate Bill "America's Healthy Future Act"
Dec 24th 2009: Mark Baucus (D, Cali) proposed the senates version of the bill passes D-60 republicans against-39 abstinent: Jim Burning Jan 2010: Scott Brown a R,w ins the special election in Mass. to finish out the remaining term of Ted. Brown campaigned heavily against the health care law and won an upset victory in a state that consistently votes in favor of D party.
The US government is
Federalist republic democracy
First president of the American Medical Association
Flexner
tried to establish universal health care
JFK
on july 30th 1965 signed for medicare and medicaid and gave the first medicare card to President Truman
Lyndon B. Johnson
MEDICARE PART D
Prescription drug coverage medicare modernization act not administered through medicare but private companies patients can either enroll through medicare PDP's or apart of medicare advantage plan. a,b,d c with D c and D
Level of Care
Primary- care in office or clinic secondary- inpatient teritary- bigger cities, special care, academic medical centers. care at regional refferal center quaternary- care at national referral center
the only industrialized nation to have a market oriented health economy
The USA #1
The balance budget act of 1997
established the state children's health insurance program SCHIP. give states option to cover insured children with fam income at or below 20 percent
The Federal Government has
expressed Enumerated Powers. Outlined in constitution - in charge of taxes -declaration of war - interstate commerce (Currency) -Internattional commerce
republic
fed gov made up of rep from each state
what is medicaid
federal and state partnership (voluntary state participation) medical assistance program funded by the US federal and state government. designed to provide comprehensive and quality medical care for people who are unable to pay some or all of their own medical expenses.
ACA passing numbers
for democrats 219 R-1 against democrats 39 R-176 in the final bill there were no republican votes
Diversity issues in AMA
gender issues Less than 50 percent of physicians are AMA members it is still politically the voice of the medical profession. Half of all medical students are women
has universal healthcare
germany and UK
Physicians as independent entrepreneurs created fee-for service market
great contributor to cost Issue. Doctor's have an opinion on price and the incentive is to do more so they can get paid more.
old boys club
group controls sector (white and male). They still exclude.
proposed solution for over 65 uncovered
health insurance for all US citizens health service plan for the elderly health insurance for the elderly do nothing
which care providers are covered by medicare?
hospitals skilled nursing facilities physicians and clinics clinical lab tests drugs medical equipment hospice
has socialized medicine
one insurance provider that everyone pays into that is the government- Canada
early statistics of medicare
original budget-10 billion 19 million individuals enrolled in the first year
Flexner Report
part of universities 4 years of training including 2 years of science increased physician quality decreased physician numbers increased physician salaries was a good thing because created quality over quanity
OBAMACARE
patient protection and affordable care act signed into law on March 23rd, 2010
medicaid means tested porgram
payments are based on what you spent last year
part A of medicare is covered by
payroll taxes
TRUMAN CARE
popular with the public during the Great Depression. Wage freezes following WWII. Was opposed by chamber of commerce, american medical association who deemed it as socialism. Labor unions found it desirable (chose employer sponsored coverage due to its practicality) as coverage expanded, national insurance system lost political momentum and failed to pass.
Cost drivers of US health care
population is growing immigration baby boomers lifestyle chronic illness Medical Technology (competition is becoming an issue) Payment structures (fee for service) fraud, waste, and abuse litigation
1970s-1990s
rapid escalation of cost 1297 per capita (1970) to 2937 per capita (1993) reasons fee for service, drug cost, managed care plans.
the omnibus reconciliation act of 1986
requires states to provide medicaid coverage for treatment of emergency medical conditions for immigrants who would otherwise be eligible for medicaid. option of extending medical coverage to pregnant women and infants with family income at or below 100 percent. option to use medicaid funds to pay medicare premiums and cost sharing for qualified low income. medicare beneficiaries at or below 100p FPL.
State Government have
reserved powers -ratify amendments -manage public health and safety -trade and taxes within state
Nursing Shortage
shortage of 285K by 2020, 500K by 2025
Medicaid problem statements
the poor cannot afford medical care sick cannot medical care the children cannot afford medical care
step 5
the president signs the bill into law.
Budget Reconciliation
the senate used this process to get their version of the bill which was created by lawmakers as a way to bring down the deficit by easing the path of budget and tax deals (historically reserved for military) with Budget reconciliation -senate only needs 51 votes to pass legislation -debate on an issue in a bill is limited to 20 hours most importantly- no senate filibusters are allowed.
federal medical assistance
the specified percentage of state medicaid money the federal government pays.
the medicare modernization act of 2003
transfers drug coverage from medicaid to medicare for dual eligible beneficiaries
In france both full time and part time workers get
unlimited sick days a year
Executive branch
veto power can override a bill President (2,4 year terms) vice president- over sees senate departments
1940s
wage freeze employer sponsored insurance expansion
Legislative (Congress)
write laws, declare war house of rep (# based on population, 2 year terms) Senate (2 per state, 6 years terms)