Public Health Law Midterm Part 2

needs 1 to 3 as deficiency, or D-needs. Needs 4 and 5 are growth needs, also known as being, or B-needs.

1. The need for basic life—food and shelter 2. The need for a safe and secure environment 3. The need to belong and to be loved 4. The need for esteem, where status, responsibility, and recognition are important 5. The need for self-actualization, for personal growth and fulfillment

knowledge of law and ethics can also help you gain perspective in the following three areas:

1. The rights, responsibilities, and concerns of health care consumers. 2. The legal and ethical issues facing society, patients, and health care prac-titioners as the world changes. 3. The impact of rising costs on the laws and ethics of health care delivery.

professional corporation

A body formed and authorized by law to act as a single person.

American Medical Association Principles

A code of ethics for members of the American Medical Association, written in 1847.

protocol

A code prescribing correct behavior in a specific situation, such as a situation arising in a medical office

managed care organization (MCO)

A corporation that links health care financing, administration, and service delivery

registration

A credentialing procedure whereby one's name is listed on a register as hav-ing paid a fee and/or met certain criteria within a profession.

bioethics

A discipline dealing with the ethical implications of biological research methods and results, especially in medicine.

Patient Protection and Affordable Care Act (PPACA)

A federal law enacted in 2010 to ex-pand health insurance coverage and otherwise regulate the health insurance industry.

Health Insurance Portability and Accountability Act (HIPAA) of 1996

A federal statute that helps workers keep continuous health insurance coverage for themselves and their dependents when they change jobs, protects confi-dential medical information from unauthorized disclosure or use, and helps curb the rising cost of fraud and abuse

accountable care organization (ACO)

A health care payment and delivery model that rewards doctors and hospitals for controlling costs and improving outcomes by allowing them to keep a portion of the savings if standards of quality are met.

health maintenance organization (HMO)

A health plan that combines coverage of health care costs and delivery of health care for a specific payment. under HMO plans all health services are delivered and paid for through one organization. The two general types of HMOs are group model and staff model.

code of ethics

A list of principles intended to govern behavior—here, the behavior of those entrusted with providing care to the sick.

Exclusive provider organization (EPO):

A managed care plan that pays for health care services only within the plan's network of phy-sicians, specialists, and hospitals (except in emergencies).

licensure

A mandatory credentialing process established by law, usually at the state level, that grants the right to practice certain skills and endeavors.

preferred provider organization (PPO)

A network of independent physicians, hospitals, and other health care pro-viders who contract with an insurance carrier to provide medical care at a discount rate to patients who are part of the insurer's plan. Also called preferred provider association (PPA). Subscribers may choose their health provider from an approved list and must pay higher out-of-pocket costs for care pro-vided by health care practitioners outside the PPO group.

Hippocratic oath

A pledge for physicians, influenced by the practices of the Greek physician Hippocrates.

executive order

A rule or regulation issued by the President of the United States that becomes law without the prior approval of Congress. They are usually issued for one of three purposes: to create administrative agencies or change the practices of an existing agency, to enforce laws passed by Congress, or to make treaties with foreign powers.

categorical imperative

A rule that is considered universal law binding on everyone and requiring action.

managed care

A system in which financing, adminis-tration, and delivery of health care are combined to provide medical services to subscribers for a prepaid fee.

certification

A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate. national in scope and is most often sponsored by a nongovernmental, private-sector group.

beneficence

Acts performed by a health care practitioner to help people stay healthy or recover from illness acts of charity and mercy

Health Care Education and Reconciliation Act (HCERA)

Also enacted in 2010, a federal law that added to regulations imposed on the insurance industry by PPACA.

Independent practice association (IPA):

An IPA is organized and owned by a network of independent physician practices to contract with employers and/or managed care organizations such as PPOs or HMOs.

Acessory

An accessory is one who contributes to or aids in the commission of a crime—by a direct act, by an indirect act (such as encouragement), by watching and not giving aid, or by concealing the criminal's crime.

Invasion of privacy

An intrusion into a person's seclusion or private affairs, public disclosure of private facts about a person, false publicity about a person, or use of a person's name or likeness without permission. Improper use or breaching the confidentiality of medical records may be seen as invasion of privacy.

accreditation.

An official authorization or approval for conforming to a specified standard for health care education programs, health care facilities, and managed care facilities Accreditation is usually voluntary. It represents health care facilities, organizations, and educational programs as credible, reputable, and dedicated to ongoing and continuous compliance with the highest standards.

Examples of intentional torts

Assault, battery, defamation of character, false imprisonment, fraud, invasion of privacy

fidelity

Being faithful to the scope of practice for your profession.

medical boards

Bodies established by the authority of each state's medical practice acts for the purpose of protecting the health, safety, and welfare of health care consumers through proper licensing and regulation of physicians and other health care practitioners.

Health care equipment and product dealers and manufacturers can be held indirectly responsible for defective medical devices and prod-ucts through charges of the following types:

Breach of warranty Statements made by the manufacturer about the device or product that are found to be untrue Strict liability, for cases in which defective products threaten the personal safety of consumers Fraud or intentional deceit

ethics committee

Committee made up of individuals who are involved in a patient's care, including health care practitioners, family members, clergy, and others, with the purpose of reviewing ethical issues in difficult cases. may help with conflict resolution among parties involved in a case They do not, however, function as institutional review boards or morals police looking for health care workers who have committed unethical acts.

Autonomous decisions are characterized by:

Competency—a person must be competent to make his or her own decision The ability to act on the decision Respect for the autonomy of others.

Fraud

Deceitful practices in depriving or attempting to deprive another of his or her rights. Health care practitioners might be accused of fraud for promising patients "miracle cures" or for accepting fees from patients for using mystical or spiritual powers to heal.

deontological or duty-oriented theory

Decision-making theory that states that the rightness or wrongness of the act depends on its intrinsic nature and not the outcome of the act.

precedent

Decisions made by judges in the vari-ous courts that become rule of law and apply to future cases, even though they were not enacted by a legislature; also known as case law

legal precedents

Decisions made by judges in various courts that become rule of law and apply to future cases, even though they were not enacted by legislation.

administrative law

Enabling statutes enacted to define powers and procedures when an agency is created.

Acts generally clas-sified as fraud include:

Falsifying educational degrees, applications for licenses, licenses, or other credentials Billing a governmental agency for services not rendered Falsifying medical reports Falsely advertising or misrepresenting to a patient "secret cures" or special powers to cure an ailment

federal criminal offenses

Federal criminal offenses include matters affecting national security (treason); crimes involving the country's borders; and illegal activities that cross state lines, such as kidnapping or hijacking.

defamation of character

Involves damaging a person's reputation by making public statements that are both false and malicious. Defamation can take the form of libel or slander. Libel is expressing in published print, writing, pictures, or signed statements content that injures the reputation of another. Libel also includes reading statements aloud or broadcasting for the public to hear. Slander is speaking defamatory or damaging words intended to prejudice others against an individual in a manner that jeopardizes his or her reputation or means of livelihood.

criminal law

Law that involves crimes against the state.

Functions specific to the House of Representatives include the following.

Members of the House can Introduce legislation that compels people to pay taxes. Decide if a government official should be put on trial before the Senate if he or she commits a crime against the country. (Such a trial is called impeachment.)

Misdimeanor

Misdemeanors are less serious crimes than felonies. They are punish-able by fines or by imprisonment in a facility other than a prison for one year or less. Examples of misdemeanors include some traffic viola-tions, thefts under a certain dollar amount, attempted burglary, and dis-turbing the peace.

health savings account (HSA)

Offered to individuals covered by high-deductible health plans, these accounts let these individuals save money, tax free, to pay for medical expenses.

justice

Providing to an individual what is his or her due.

ethics guidelines

Publications that detail a wide variety of ethical situations that professionals (in this case, health care practitioners) might face in their work and offer principles for dealing with the situations in an ethical manner.

virtue ethics.

Refers to the theory that people who have moral virtues will make the right decisions

Functions specific to the Senate include the following.

Senators can: Approve and disapprove any treaties the president makes. Approve or disapprove any people the president recommends for jobs, such as cabinet officers, Supreme Court justices, and ambassadors. Hold an impeachment trial for a government official who commits a crime against the country.

reasons for losing a license

Sexual misconduct Substance abuse Professional discipline [for] criminal convictions or unprofessional conduct Fraud and misrepresentation Patient abuse Medication violations Unethical behavior Poor documentation or record keeping Unlicensed practice ("Forgetting" to renew a license is no defense.)

medical ethicist or bioethicist

Specialists who consult with physicians, researchers, and others to help them make difficult ethical decisions regarding patient care.

etiquette

Standards of behavior considered to be good manners among members of a profession as they function as individuals in society.

state criminal offenses

State criminal laws prohibit such crimes as murder, burglary, robbery, arson, rape, larceny, mayhem (needless or willful damage or violence), and practicing medicine without a license.

medical practice acts

State laws written for the express purpose of governing the practice of medicine.

autonomy

The capacity to be one's own person and make one's own decisions without being manipulated by external forces. (self-governce)

scope of practice

The determination of the duties/pro-cedures that a person may or may not perform under the auspices of a specific health care professional's license

False Imprisonment

The intentional, unlawful restraint or confinement of one person by another. The offense is treated as a crime in some states Refusing to dismiss a patient from a health care facility on his or her request or preventing an employee or patient from leaving the facility might be seen as false imprisonment.

judicial branch

The judicial branch interprets the law and oversees the enforcement of laws.

assault

The open threat of bodily harm to another or acting in such a way as to put another in the "reasonable apprehension of bodily harm."

tortfeasor

The person guilty of committing a tort.

primary care physician (PCP)

The physician responsible for directing all of a patient's medical care and deter-mining whether the patient should be referred for specialty care.

reciprocity

The process by which a professional license obtained in one state may be accepted as valid in other states by prior agreement without reexamination.

needs-based motivation

The theory that human behavior is based on specific human needs that must often be met in a specific order. Abraham Maslow is the best-known psychologist for this theory

legislative branch

The two houses of Congress—the Senate and the House of Representatives—make up the legislative branch. Each member of Congress is elected by the people of his or her state. The House of Representatives, with membership based on state populations, has 435 seats, while the Senate, with two members from each state, has 100 seats. Members of the House of Representatives are elected for two-year terms, and senators are elected for six-year terms. The primary duty of Congress is to write, debate, and pass bills, which are then passed on to the president for approval.

Health care ethicists agree that there are four ethical principles that are accepted as universal principles for all health care providers:

Those four are autonomy, beneficence, nonmaleficence, and justice. However, confidentiality, role fidelity, and veracity are also found in many codes of ethics.

principle of utility

Used in utilitarianism; requires that the rule used in making a decision must bring about positive results when gener-alized to a wide variety of situations.

intentional tort

When one person intention-ally harms another, the law allows the injured party to seek a remedy in a civil suit. The injured party can be financially compensated for any harm done by the tortfeasor Intentional torts may also be crimes. Therefore, some civil wrongs may also be prosecuted as criminal acts in separate court actions

Compensatory justice

a concept that applies to medical malpractice lawsuits, refers to an individual's right to seek monetary compensation in the form of damages for a wrong done.

Federal preemption

a doctrine that can bar injured consumers from suing in state court when the products that hurt them had met federal standards—has become an important concern in product liability law.

In rule-utilitarianism

a person makes value decisions based on a rule that if generally followed would produce the greatest balance of good over evil, everyone considered

act-utilitarianism

a person makes value decisions based on results that will produce the greatest balance of good over evil, everyone considered.

Plantiff

a person who brings a case against another in a court of law.

law

a rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority. Governments enact laws to keep society running smoothly and to control behavior that could threaten public safety. Laws are considered the minimum standard necessary to keep society functioning.

Defendant

an individual, company, or institution sued or accused in a court of law.

Formularies

are a plan's list of approved prescription medications for which it will reimburse subscribers.

Physician-hospital organizations (PHOs)

are another type of managed care plan. PHOs are organizations that include physicians, hospitals, surgery centers, nursing homes, laboratories, and other medical service providers that contract with one or more HMOs, insurance plans, or directly with employers to provide health care services.

Copayment fees

are flat fees that insurance plan subscribers pay for certain medical services. For example, a subscriber might be required to make a $20 copayment for each visit to a physician office.

Deductible amounts

are specified by the insurance plan for each sub-scriber. For instance, the deductible for a single subscriber might be $500 a calendar year. In other words, the plan does not begin to pay benefits until the $500 deductible has been satisfied.

Civil law

civil law does not involve crimes but instead involves wrongful acts against persons. Under civil law, a person can sue another person, a business, or the government. Civil disputes often arise over issues of contract violation, slander, libel, trespassing, product liability, or automobile accidents.

Group model HMOs

contract with independent groups of physicians to provide coordinated care for large numbers of HMO patients for a fixed, per-member fee. They often provide medical care for members of several HMOs.

Procedural law

defines the rules used to enforce substantive law. For example, laws that require law enforcement officers to read suspects their rights (the Miranda warning) and govern the arrest and trial pro-cess are procedural laws.

Nonmaleficence

duty to do no harm

Staff model HMOs

employ salaried physicians and other allied health professionals who provide care solely for members of one HMO.

Moral values

formed through the influence of the family, culture, and society—serve as the basis for ethical conduct.

Technical skills

include those abilities you have acquired in your course of study, including but not limited to the following: • Computer literacy • Proficiency in English, science, and mathematics. • A willingness to learn new skills and techniques. • An aptitude for working with the hands. • Ability to document well. • Ability to think critically.

Felony

is a crime punishable by death or by imprisonment in a state or federal prison for more than one year. Felonies include abuse (child abuse, elder abuse, or domestic violence), arson, burglary, conspiracy, embezzlement, fraud, illegal drug dealing, grand larceny, manslaughter, mayhem, murder or attempted murder, rape, robbery, tax evasion, and practicing medicine without a license.

Case law

is law set by legal precedent. Case law began with common law. In the early days in America, laws were derived from those originating in England, and they were often not written down. Matters of the law were decided based on the customs and traditions of the people. Judges shared their decisions with other judges, and these decisions became common law

Utilization review

is the method used by a health plan to measure the amount and appropriateness of health services used by its members.

Substantive law

is the statutory or written law that defines and regulates legal rights and obligations. It defines the legal relationships between people or between people and the state, and is further classified as criminal, civil, military, and international law. Examples of substantive laws include the criminal laws that define mur-der, arson, and armed robbery as crimes and the civil laws that allow individuals to sue persons or entities.

Confidentiality

keeping medical information strictly private

Constitutional

law is based on a formal document that defines broad governmental powers. Federal constitutional law is based on the U.S. Constitution. State constitutional law derives from each state's constitution.

medical services organization

may be formed with a physician group purchasing a hospital and then contracting with employers to provide full health care services.

teleological or consequence

oriented theoryDecision-making theory that judges the rightness or wrongness based on the outcomes or predicted outcomes.

litigous

prone to engage in lawsuits

Statutory law

refers to laws enacted by state or federal legislatures. Individual laws in this body of law are called statutes. Statutes begin as bills at the federal or state levels. The bills may become laws, or the president or governors may veto them. Once passed, the laws may be amended, repealed, revised, or superseded by legislatures. The courts can review statutes for constitutionality, application, interpretation, and other legal questions

Coinsurance

refers to the amount of money insurance plan members must pay out of pocket, after the insurance plan pays its share. For example, a plan may agree to pay 80 percent of the cost for a surgical procedure, and the subscriber must pay the remaining 20 percent.

Ethics

standards of behavior and the concept of right and wrong, over and above that which is legal in a given situation.

Summary judgment

the legal term for a decision made by a court in a lawsuit in response to a motion that pleads there is no basis for a trial because there is no genuine issue of material fact. In other words, a motion for summary judgment states that one party is entitled to win as a matter of law only in civil cases

Can Knowledge of a Crime Make You Guilty?

those individuals who have knowledge of a crime may, in certain circumstances, also be subject to prosecution.

Tort

tort is broadly defined as a civil wrong committed against a person or property, excluding breach of contract. The act, committed without just cause, may have caused physical injury, resulted in damage to someone's property, or deprived someone of his or her personal liberty and freedom. Torts may be intentional (willful) or unintentional (accidental).