Week 4 Chapter 6 and 7
Healthcare rights under Affordable Care Act
- Access health insurance - Equitable treatment by their insurers - Exclusion and discrimination based on health status of pre-existing health conditions is banned. - Access to necessary care without regard to artificial annual or lifetime expenditure caps. - Once in place, insurance coverage can not be rescinded, except in the case of applicant fraud. - Expansion of Medicaid eligibility.
Rights to be free from wrongful discrimination
- Hill Burton Act funded new post-WW2 hospitals and expansion of existing hospitals. - Allowed racial segregation where separate hospital facilities were provided until declared illegal. - Title VI of the Civil Rights Act
Rights to personal privacy
- Informational Privacy: limiting other's access to and use of an individuals private information. - Individual autonomy and freedom from government interference in making basic personal decisions. - Cases hold that Bill of Rights creates "penumbras" or zones of guaranteed privacy.
Areas involving discrimination in healthcare:
- Physical and Mental disability - Socioeconomic status - Gender - Age
Rights related to freedom of choice and freedom of government interference.
- Right to make informed decisions about the scope and course of their own care. - Right to refuse treatment, regardless of the treatment's nature of urgency. - Modern notions of informed consent have roots to the Nuremberg Code.
Constitutional limits on police powers
- public health necessity - police powers must be reasonable - must be proportionate - Should not pose a health risk to individuals subject to it.
What laws narrow the scope of the no-duty to treat principle?
1) Federal Examination and Treatment for Emergency Medical Conditions and Women in Labor Act (EMTALA) 2) Medicaid 3) State and Federal prohibitions against certain forms of discrimination.
Healthcare rights under EMTALA
1) Stabilize the emergency medical condition /or 2) Transfer the patient if the hospital is incapable of treating the condition.
welfare rights
1) US Supreme Court has rejected the notion of a constitutional right to welfare. 2) Education is not a fundamental right. 3) Healthcare is treated as a COMMODITY subject to private market forces in the US.
What are the 5 ways laws can be social determinants of health?
1) can be used to design and perpetuate social conditions that can have terrible physical, mental, and emotional effects. 2) used as a mechanism through which behaviors and prejudices are transformed into distributions of well-being. 3) Under-enforcement 4) Interpretation of law 5) used to structure direct responses to health-harming social needs that result from factors like impoverishment, illness, market failure, and individual behavior that harms others.
When was EMTALA enacted?
1986 to prevent patient dumping
Health Equity
A situation in which everyone has the opportunity to attain his or her full health potential.
What do other high-income nations with social democracies treat the provision of healthcare as?
A social good.
Hospitals participating in Medicare have a duty under EMTALA to provide?
An appropriate screening examination to all individuals who present at a hospital's emergency department seeking care for an emergency medical condition.
Foreign universal healthcare rights stem from?
Commitment to human rights principles generally or the particular country's own constitution.
How are community-based resources social determinants of health?
Connects residents to local healthcare providers and can provide access to recreational/physical activities.
Law does what 3 things for individual rights in the context of health care and public health?
Creates, protects, and restricts
Entitlement as a legal concept?
Denotes a legal claim to something. Seen in some public health insurance programs - like Medicaid -
Biologic factors, psychosocial factors, behavioral factors, and social factors are all ____
Determinants of health categories.
Racial and ethnic health disparities
Differences in healthcare access, treatment and outcomes between populations of color and Caucasians
Types of SDH
Education, medical, social media/technology, community-based resources, resources meet daily needs, culture, language/Literacy, public safety, residential segregation, social norms and attitudes, socioeconomic conditions, transportation.
Medicaid
Eligibles are entitled to and can enforce program obligations.
EMTALA (Emergency Medical Treatment and Active Labor Act)
Enables all individuals to access some hospital care in medical emergencies.
Hospital's do not have to adhere to established emergency care guidelines. T/F
F: Hospital's MUST adhere to established emergency care guidelines established under EMTALA.
According to the federal CDC, what are determinants of health?
Factors that contribute to a person's current state of health.
Rights related to receiving services explicitly provided under healthcare, health financing or health insurance laws:
Freedom of Choice. Freedom of Gov interference when making health care decisions. Free from unlawful discrimination when accessing or receiving healthcare.
How has Social Media and Technology become Social Determinants of health?
Has created greater ease in online appointments, appointment reminders, even allowing you access to the internet to search your symptoms.
Individuals have no legal right to _______
Healthcare services, or to public health insurance.
Individual rights in the US healthcare system
In a 1952 presidential commission it was said that "access to the means for attaining a preservation of health is a basic human right" this eventually led to the development of Medicaid and Medicare.
When was the first formal Medical-Legal Partnership made?
In the early 1990s.
Some determining factors for health and healthcare disparities:
Individual Behaviors, Healthcare provider bias, cultural expectations/differences, the location/funding of healthcare systems, social factors, and many others.
Police powers may not extend past:
Individual conformance with established standards of conduct.
How is having access to high quality education a social determinant of health?
Individuals with access to consistent high-quality education opportunities are more likely to obtain higher-income jobs.
The concept of discrimination I see Title VI applies to both _____ acts and to actions and policies that unintentionally have the effect of discrimination against racial and ethnic minorities.
Intentional
Title VI of the Civil Rights Act of 1964
Makes it illegal for programs and activities that receive federal funds to discriminate on the basis of race, color, or national origin.
What is I-HELP?
Medical-Legal Partnership framework. Stands for: Income, Housing, Education, Legal Status, and Personal / Family stability.
How is access to medical care services a social determinant of health?
People who do not live close to medical care providers, or cannot afford them, are less likely to see a physician regularly and will often seek care only in emergencies.
Providers have no general legal duty to what?
Provide care
Under the MLP model ——-
Public interest lawyers work with healthcare workers to screen for health-related legal problems.
Police power my not be used to:
Punish, cannot be arbitrary or capricious, and cannot be used for purposes unrelated to public welfare.
What is SDH?
Social Determinants of Health
Define Social Determinants of Health (SDH)
Social conditions into which people are born and that affect their daily lives and overall well-being.
Nuremberg Code (1947)
Ten guidelines for the ethical treatment of human subjects in research
Who is the only developed nation that has not implemented a system for ensuring at least all but the wealthiest segment of its population against healthcare costs?
The US
What happened in 2006 that resulted in the MLP framework to expand dramatically?
The creation of the National Center for Medical-Legal Partnership (NCMLP). MLP is now practiced in 46 states by more than 300 hospitals and health centers.
Daily need resources are important social determinants of health because:
They determine the lifestyle of eating for the individual. The further someone lives from a store selling health food the more likely they are to eat unhealthy food or fast food.
EMTALA is nondiscriminatory T/F
True
The US is one of the only High-Income nations that does not guarantee health care as a fundamental right. T/F
True
patient dumping
Turning away poor of uninsured people in need of hospital care.
What is Health Disparity?
When one population group experiences a higher burden of disability or illness relative to another group.
Can laws be social determinants of health?
Yes
No duty to treat principle
individuals have no legal right to health care services or to public health insurance and, correspondingly, there exists on the part of health care providers no general legal duty to provide care
The Americans with Disability Act
is a federal law that prohibits discrimination based on an individual's disability if the disabled person is able to perform the essential functions of the job.
