INSURANCE 101
HEALTH CARE MODELS
BIG GOVERNMENT
DEFINITIONS
ACRONYMS
100
What characteristics does someone who is uninsured typically have?
*low income;
*part-time worker;
*lack primary care provider;
*utilize services at public hospitals
(Review "access to health care" topics; Kovner p. 37, 158)(Part-time workers, self employed, small business employees, (nearly 80% are employed) - taken from week 2 poweropint)
100
What is a single payer health care system?
Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands.
Double points: True or False: this is the type of health care the U.S. has?
100
What services does private insurance cover?
"Private health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover. Ambulance cover may be available separately, combined with other policies, or in some cases is covered by your state government."
https://www.privatehealth.gov.au/healthinsurance/whatiscovered/privatehealth.htm
100
What is "risk pooling"?
"Health insurance risk pools are special programs created by state legislatures to provide a safety net for the "medically uninsurable" population. ... The board contracts with an established insurance company to collect premiums and pay claims and administer the program on a day-to-day basis."
100
What is CHIP?
(double points for explaning what it is/does)
Children's Health Insurance Program: States use CHIPD funds concurrently with Medicaid and/or state programs to provide childre with health care.
(see Kovner, p. 39)
200
List some barriers to health care that patients may have
*cultural
*language
*distrust of Western medicine
*differing views on illness and treatment
*access to health care
*health care literacy
*education level
(review "economic" versus "noneconomic" factors- see Kovner p. 19)
200
What is Systems Theory?
The view of organizations as social systems, focused on the needs and desires of people working within the organization. The belief is that organizations have social components that interact and these components are affected by factors from the outside environment. Social components (people, relationships, & roles) interact with the environment, technology, & organizational structure to create a unified, dynamic system.
(Giddes, p. 514; also in powerpoint from week 1)
200
What levels of government participate in health policy?
State
Local
Federal
(week 5 powerpoint)
200
What is Bureaucracy?
Is a machinelike collection of components to be coordinated.
Developed by Max Weber in the early 20th century
Principles were for efficiency in work design and were thought to be the most effective way to organize work
Hierarchical in leadership
Common to organizations that developed during the Industrial Revolution
Coordinated precision in production-materials in, widgets out
Focuses on authority and control
Strong focus on management to attain maximal productivity from workers through planning and control.
Doesn’t take into account the social system of an organization and outside influences.
Doesn’t allow for worker input, decision making, etc
(taken from week 1 powerpoint)200
What is OECD & what do they do?
"Organization for Economic Cooperation and Development"- compares countries health care systems. Compares dollars spent on health care per person vs. outcomes
(from week 2 powerpoint)300
What are co-payments?
"A specified amount that an insured individual must pay for a specified service or procedure (i.e., $8 for an office visit)."
(Kovner p. 19, 39, 140, 233, 243, 263, 366)300
What is the Beveridge Model?
It operates on the basis of a set of one or more common characteristics:
Health care is a human right, not a privilege
Government ownership and operation of health care
National government responsibility for delivery of equitable and efficient health care
Full access to all regardless of ability to pay
Primary care physician as gatekeeper to the rest of the system
(http://healthmatters4.blogspot.com/2010/12/beveridge-model.html)
Taxes are collected for health insurance-government run, single payer (from week 2 powerpoint)
300
What does inaction mean?
A proposed health program is not adopted by a state agency due to resource constraints.
(week 5 powerpoint)
300
What defines Medicare versus Medicaid?
MEDICARE: provides health insurance to citizens not generally covered by mainstream employer-sponsored health insurance systems
MEDICAID: "not a single national program but a collection of 50 state-administered programs, each providing health insurance to low-income residents but with different eligibility rules, benefits, & payment schedules"
(See Kovner, p. 33-37)
300
What is SNAP?
Supplemental Nutrition Assistance Program- SNAP offers nutrition assistance to millions of eligible, low-income individuals and families and provides economic benefits to communities.
(https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program-snap); (Kovner p. 157-158, 162)
400
Who are stakeholders in health care?
Persons with an interest in the performance of an organization. i.e., physicians, nurses, payers, managers, patients/consumers, insurance companies, government.
(Giddens definition p. 377; also p. 9, 340-341, 297, 10)
400
What is the shared governance model?
"A set of guidelines about the various roles and authority of the board, staff, and administration in such things as professional decisions, budget decisions, selection of the president, and other operational decisions. Effective shared governance takes the form of a systems approach, one in which staff, board members, and administrators actively engage to share responsibility for identifying and pursuing an aligned set of mission-driven sustainable outcomes and priorities."
https://www.agb.org/blog/2015/12/22/what-is-shared-governance
400
What does "grass roots advocacy" mean?
"Grassroots advocacy differs from traditional lobbying, which brings arguments for or against a specific measure directly to legislators and government officials. The goal of grassroots advocacy is usually to reach the general public and ask them to contact their legislators and government officials."
(https://www.aaos.org/AAOSNow/2014/Oct/advocacy/advocacy1/?ssopc=1)
400
What is health policy and who makes the decisions regarding health policy?
Goal-directed decision made about health that is the result of an authorized, public decision-making process.
Those actions, nonactions, directions, and/or guidance related to health that are decided by governments or other authorized entities.
Giddens page 517
400
What is GDP?
"Gross Domestic Product"- "GDP is the total value of everything produced by all the people and companies in the country"
(Kovner p. 16, 58, 66-67, 233, 254, 256, 257, 275, 318)(https://www.thebalance.com/what-is-gdp-definition-of-gross-domestic-product-3306038)
500
What is the difference between each of these types of health care organizations:
for-profit
not-for-profit
government-owned (public)
investor-owned (private, for-profit)
For-profit vs. not-for-profit: Profits are distributed to shareholders vs. put back into the organization. Many educational institutions are similar, eg. Marian is not for profit, Globe University is for profit. These classifications also change their tax status. Not for profit organizations can apply to be tax exempt, others cannot (taken from week 1 powerpoint)
500
What is Anderson's framework of policy process?
500
What are the differences between the roles of legislatures, courts & judiciaries, executive branch, & regulatory agencies?
Legislatures- establish laws to serve a policy goal; determine funding & provide oversight for policies that are administered by government agencies.
Courts & judiciaries- the staging ground for determining rights in health policy disputes through judicial review.
Executive branch- executes laws passed by legislatures.
Regulatory agencies- can be part of the executive branch or may be independent. Established by legislatures to implement & enforce laws through a rule-making process.
(Giddens p. 526)
500
What is political activism? Give an example.
"Activism is action that goes beyond conventional politics, typically being more energetic, passionate, innovative, and committed. In systems of representative government, conventional politics includes election campaigning, voting, passing laws, and lobbying politicians."
500
What is EMTALA?
Emergency Treatment and Labor Act: Enacted in 1986 in response to “patient dumping” ER patients who cannot pay
Emergency Medical Conditions must be treated and includes women in labor
(week 5 powerpoint)