Quiz 1_Review Sheet (1)

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The University of Oklahoma *

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Health Science

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Feb 20, 2024

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Quiz #1 Chapters 1-3 Review Questions 1. When thinking about our rights as Americans set forth in the Declaration of Independence, do any of them apply to health care? If so, which ones and how? - Life, liberty, and the Pursuit of Happiness o These principles can be interpreted to include access to health care as a means to protect and preserve life, ensure personal liberty (by not being burdened by overwhelming medical expenses), and enable the pursuit of happiness through good health - Equality and Consent of the Governed o This idea implies that all citizens should have equal access to essential services, which could include health care o Ensuring access to health care can be seen as a way to promote equality and uphold the consent of the governed - The right to alter or Abolish Government o Some argue that this principle can be invoked to advocate for changes in the health care system if it is perceived as failing to protect the right to life and health 2. Based on Chapter 1 in the text, which group of stakeholders should be at the center of the health system? - Patients or individuals receiving the health care services 3. The authors use the term “enterprise” rather than “system” when describing health care in the United States. Why is this distinction important? How would you explain this difference to a colleague? The use of the term "enterprise" instead of "system" when describing health care in the United States reflects a specific perspective on the nature and organization of healthcare delivery. This distinction can be important for several reasons, and here's how you might explain it to a colleague: 1. **Complexity and Fragmentation:** The term "enterprise" is often preferred because it highlights the complexity and fragmentation of the U.S. healthcare landscape. Unlike a neatly organized and integrated "system," healthcare in the U.S. involves a multitude of diverse entities, including hospitals, clinics, physicians' practices, insurance companies, pharmaceutical companies, and government agencies, among others. These entities often operate independently and are not always seamlessly coordinated. 2. **Market-Based Approach:** The use of "enterprise" underscores the market-based approach to healthcare in the U.S. The healthcare system in the U.S. is characterized by a significant degree of privatization and competition, with multiple stakeholders seeking to provide services, generate revenue, and achieve profitability. This contrasts with a "system" that might imply a more centralized or government-controlled approach. 3. **Patient as Consumer:** The term "enterprise" reflects the idea that patients are often viewed as consumers in the U.S. healthcare context. In a system, there might be a stronger emphasis on universal access and a sense of collective responsibility for healthcare. In contrast, an enterprise perspective

often places more decision-making power in the hands of individual patients who choose healthcare providers and insurance plans based on their preferences and needs. 4. **Policy Implications:** The choice of terminology can have implications for healthcare policy discussions. Advocates for healthcare reform may use the term "system" to emphasize the need for more centralized planning and regulation, while those who favor market-driven approaches may prefer the term "enterprise" to emphasize the role of competition and consumer choice. In summary, the distinction between "enterprise" and "system" in the context of U.S. healthcare highlights the unique characteristics of the American healthcare landscape, including its complexity, fragmentation, market orientation, and emphasis on individual choice. It underscores the diverse array of stakeholders involved and the challenges and opportunities associated with this approach to healthcare delivery and financing. 4. What is a fee for service system and how does it impact the healthcare provided in the system? A **fee-for-service (FFS) system** is a payment model in healthcare where healthcare providers, such as physicians and hospitals, are compensated based on the specific services or procedures they deliver to patients. In other words, healthcare providers receive a fee for each individual service, test, treatment, or procedure they perform. The amount of payment is typically determined by a fee schedule or a negotiated rate between providers and payers (such as insurance companies or government programs). Here's how a fee-for-service system impacts healthcare: 1. **Incentive for Volume:** One of the primary effects of a fee-for-service system is that it creates a financial incentive for healthcare providers to deliver more services, tests, and procedures. Providers are compensated based on the quantity of services they provide, which can lead to overutilization of healthcare resources. This may result in unnecessary tests, treatments, and procedures, driving up healthcare costs. 2. **Fragmented Care:** In a fee-for-service system, care may become fragmented as different providers focus on delivering specific services. Patients may see multiple specialists, undergo various tests, and receive separate bills for each service. Coordinating care and ensuring that all aspects of a patient's health are addressed can be challenging. 3. **Potential for Overtreatment:** The financial incentive to provide more services can lead to overtreatment, where patients receive unnecessary or excessive medical interventions. This not only drives up healthcare costs but can also expose patients to unnecessary risks and complications.

4. **Variability in Quality:** The FFS model may lead to variations in the quality of care because providers are not necessarily rewarded for delivering high-quality, efficient care. Some providers may prioritize quantity over quality, while others may strive for better outcomes. 5. **Patient Costs:** Patients in a fee-for-service system may face higher out-of-pocket costs, as they are often responsible for copayments, deductibles, and coinsurance for each service they receive. This can create financial barriers to accessing necessary care. 6. **Billing Complexity:** Billing and administrative processes in a fee-for-service system can be complex and time-consuming for both providers and payers. The system requires extensive documentation and coding to justify and receive payment for each service rendered. 7. **Shift Toward Value-Based Care:** In recent years, there has been a shift in healthcare policy and practice toward value-based care models. These models aim to incentivize providers to focus on quality, outcomes, and cost-effectiveness rather than simply increasing the volume of services. Value-based care models, such as accountable care organizations (ACOs) and bundled payments, are designed to align provider incentives with patient outcomes. In summary, a fee-for-service system compensates healthcare providers based on the quantity of services they deliver, which can incentivize overutilization, lead to fragmented care, and potentially result in higher costs and variability in quality. Efforts to transition to value-based care models seek to address some of these challenges by emphasizing quality and efficiency in healthcare delivery. 5. As part of federal health reform, President Obama introduced and was successful at having passed the Patient Protection and Affordable Care Act (ACA). President Trump has tried to repeal several of the provisions. How has ACA helped Americans and how would any repeal affect Americans? What are the two main parts of the Affordable Care Act? The **Patient Protection and Affordable Care Act (ACA)**, often referred to as "Obamacare," was a significant healthcare reform law signed into law by President Barack Obama in 2010. It aimed to address several issues within the U.S. healthcare system and has had both positive and controversial impacts on Americans. It's important to note that while there have been efforts to repeal or modify certain provisions of the ACA, the law remains in effect as of my last knowledge update in September 2021. **How ACA Helped Americans:** 1. **Expanded Access to Health Insurance:**

- The ACA expanded Medicaid eligibility in participating states, making more low-income individuals and families eligible for Medicaid coverage. - It created health insurance marketplaces where individuals and small businesses could purchase private insurance plans, often with subsidies to make coverage more affordable. 2. **Protection for Pre-existing Conditions:** - The ACA prohibited insurance companies from denying coverage or charging higher premiums based on pre-existing conditions. This provision ensured that individuals with chronic illnesses or previous health issues could access insurance. 3. **Coverage for Young Adults:** - The law allowed young adults to remain on their parents' health insurance plans until the age of 26, providing coverage to many who might have otherwise been uninsured. 4. **Essential Health Benefits:** - The ACA required insurance plans to cover a set of essential health benefits, including preventive care, prescription drugs, maternity care, and mental health services, among others. 5. **No Lifetime or Annual Limits:** - Insurance plans could no longer impose lifetime or annual limits on essential benefits, ensuring that individuals with serious health conditions could continue to receive necessary care. **How Repeal Would Affect Americans:** Efforts to repeal or significantly modify the ACA could have various impacts on Americans, including: 1. **Loss of Coverage:** A repeal could result in millions of Americans losing their health insurance coverage, particularly those who gained coverage through Medicaid expansion or the health insurance marketplaces.

2. **Pre-existing Conditions:** The protections for individuals with pre-existing conditions could be at risk, potentially allowing insurance companies to deny coverage or charge higher premiums based on health status. 3. **Young Adults:** Young adults under the age of 26 who are currently covered under their parents' plans might lose this option. 4. **Essential Benefits:** The requirement for insurance plans to cover essential health benefits could be weakened, potentially leading to less comprehensive coverage. 5. **Medicaid Expansion:** States that expanded Medicaid could face changes in funding and eligibility rules, impacting low-income individuals' access to healthcare. 6. **Marketplace Stability:** A repeal could disrupt the health insurance marketplaces, leading to uncertainty and potential premium increases for those buying coverage through these exchanges. **Two Main Parts of ACA:** 1. **Coverage Expansions:** This part of the ACA focused on expanding access to health insurance coverage. It included provisions for Medicaid expansion, the creation of health insurance marketplaces (also known as exchanges), subsidies to make insurance more affordable for low- and middle-income individuals, and the requirement for individuals to have health insurance (the individual mandate, which was later effectively eliminated). 2. **Insurance Reforms:** The ACA introduced a set of insurance market reforms aimed at improving the quality and affordability of insurance coverage. Key reforms included the prohibition of denying coverage or charging higher premiums based on pre-existing conditions, the extension of coverage for young adults on their parents' plans, and the requirement for insurance plans to cover essential health benefits. It's important to note that the ACA remains a subject of political debate, and the impact of any potential changes to the law can vary widely depending on the specific provisions being considered. As of my last knowledge update in September 2021, the ACA remains in place, and any significant changes would require legislative action.

6. What is population health? What is public health? Please provide an example public health service. How do these differ from healthcare? **Population Health** and **Public Health** are related concepts that focus on the health and well- being of communities and populations, rather than just individual health. While they share similarities, they have distinct emphases and objectives: 1. **Population Health:** - **Definition:** Population health is a broader concept that encompasses the overall health status and health outcomes of a defined group of individuals, such as a community, city, state, or nation. It considers various factors that influence health, including social determinants, lifestyle choices, genetics, and access to healthcare services. - **Focus:** Population health focuses on understanding and improving the health of entire populations by addressing the underlying determinants of health, promoting health equity, and preventing diseases and injuries. - **Example:** Population health initiatives may involve community-wide efforts to reduce smoking rates, improve nutrition, increase physical activity, and address social and economic factors that contribute to health disparities. These initiatives aim to improve the overall health of a population. 2. **Public Health:** - **Definition:** Public health is a field of study and practice that focuses on protecting and improving the health of communities and populations through organized efforts and informed choices of society, organizations, public and private communities, and individuals. - **Focus:** Public health professionals work to prevent and control diseases, promote healthy behaviors, prepare for public health emergencies, and address environmental and social determinants of health. They often engage in research, surveillance, education, policy development, and community interventions. - **Example Public Health Service:** Immunization programs are a common example of public health services. Public health agencies and organizations work to ensure that communities have access to vaccines and immunization clinics. This helps prevent the spread of vaccine-preventable diseases, protecting the health of the entire population. **Differences from Healthcare:** - **Healthcare:** Healthcare refers to the provision of medical services and treatment to individuals who are sick or seeking medical care. It is primarily focused on diagnosing and treating diseases and injuries in individual patients. Healthcare is delivered by healthcare providers, including doctors, nurses, and hospitals. - **Population Health:** Population health takes a broader view that includes both healthcare and non-healthcare factors influencing health. It aims to improve the health of entire populations by addressing the root causes of health disparities, promoting healthy behaviors, and preventing diseases. - **Public Health:** Public health is a field of study and practice that focuses on the health of communities and populations. While it includes healthcare services as one component, it also

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