SmolhaAshlyeeQuestionsWeek11
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University of South Alabama *
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PSC 585
Subject
Medicine
Date
Jan 9, 2024
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docx
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10
Uploaded by Ashlyee91
Health of the Elderly: Policy Issues and Challenges
1.
How and why have demographics changed? Who is utilizing hospitals and physicians the most? Are there any subgroups who are especially needy or utilize these services more?
a.
The population of adults 65 and older has increased significantly. With this population living longer it has caused an increase in demand for health services.
b.
Men tend to have worse medical conditions and utilize the hospital more.
c.
Elderly and disabled.
2.
Review exhibit 4. What are the major conclusions of this table? Do you think anything has changed or would be different if the table were updated for the 2000’s?
3.
Discuss the two future projection theories discussed in “Future Implications of Changing Morbidity…” Do you believe either of these are accurate characteristics of the implications since the 1980s? What influence do/should these outcomes have on public policy?
a.
What other projections did you find interesting or impactful on policy-- why?
4.
What are the structural and policy recommendations of the authors in the conclusion of this piece? Do you agree with them? Would you add any personally now?
Theories of Disability in Health Practice and Research
5.
Terms and major concepts: a.
What is the social model of disability?
Radically different view.
Based on positivist theories
What is the difference between an impairment and a disability?
Impairment is the functional limitation within the individual caused by physical, mental, or sensory impairment.
Disability is the loss or limitation of opportunities to take part in the normal life of the community on an equal level with others because of physical and social barriers. b.
What is the positivist theory?
Remain the dominant influence on healthcare given disabled people. c.
What is the stance of functionalists?
Medicine’s role to cure and to main the “normal” functioning of people and society.
What is the impact of treating disables individuals in the "sick role"?
By failing to identify that disabled individuals do not necessarily have “something wrong with them,” it simply reproduces biased norms and standards, instead of addressing the ethnic and financial
forces that precipitate them. d.
What is the
stance of social construction?
The experience and subjectivity as central to the research process, and critical theory sees disabling barriers as a key research issue. e.
How does critical theory see the world of health care and disability?
Sees disabling barriers as a key research issue.
Covers similar ground to the other theories, but it sees disabled individual’s problems explicitly as the product of an unequal society.
What has been this theory's impact on health care and policy?
It tends to be indirect and has raised political awareness. Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status
6.
Connections across lectures: a.
The study finds that children of Latino descent are less likely to be treated for mental health when in need. Using lessons learned from previous readings, discuss at least two distinct reasons why this might be.
The first is many children of Latino descent come from families that live in rural communities, and do not have the adequate care they need.
They may also have issues with not having health insurance, and it leads to them not having care they need.
b.
The study finds that children that are uninsured, as opposed to publicly insured, are less likely to be treated for mental health when in need. Using lessons learned from your insurance reading, discuss why this is the case. Be sure to use the appropriate terms and concepts learned.
According to the text from Jones and Bartlett individuals who are uninsured have limited options for medical care and have three options on how to receive it.
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1.
The patient can pay physicians out of pocket at rates that are typically more expensive than those under insurance plans. 2.
Seek care from a safety net provider. 3.
Obtain treatment for acute illnesses at a hospital emergency room.
a.
The hospital does not receive direct payment unless patients can afford them. 4.
We also have to look at Mediating Factors which is associated with
healthcare services such as health insurance, access to healthcare, quality of healthcare.
7.
The study reviews literature that found that when studying insured children, there were lower rates of use for African American children when compared to Caucasian children. Hypothesize why this might be, based upon what you have learned in this course.
Many African American children come from low-income families many are often a single parent home, with that being said if African American children come from a single parent home this puts them at risk for not utilizing the healthcare services as needed. The reason for this is because
if the child has a parent working more than one job then it is almost impossible for them to take the child to the doctors. b.
Further, another study found that there was no disparity between rates of use
across race in the Great Smoky Mountains. Why might this be?
There was not enough information to determine why there was no disparity, also insurance status affects the use of child mental health services is also unclear. 8.
Discuss the results. Using Tables 1, 2, and 3, describe the major conclusions of the study in your own words.
Implementing Community-Based Systems of Services for Children and Youths with Special
Health Care Needs: How well are we doing?
9.
Policy need not come directly from Congress. Discuss the role of the Department of Health and Human Services' role in policy creation and implementation. What about the Surgeon General himself?
Convened a Workshop on Children with Handicaps and Their Families.
o
The workshop developed a number of major recommendations for action, which policy makers at the federal and state levels, families, service providers, and professional organizations began to address during the next several years.
The Surgeon General spoke of “our continuing interest in assisting the family as the prime source of nurture, support, protection, and guidance to the growing child. a.
What are the core outcomes put forth by the Maternal and Child Health Bureau for children with special health care needs?
1. Families of CSHCN will partner in decision making and will be satisfied with the services that they receive.
2. CSHCN will receive coordinated, ongoing, comprehensive care within a medical home.
3. Families of CSHCN will have adequate private and/or public insurance to pay for the services that they need.
4. Children will be screened early and continuously for special health care needs.
5. Community-based service systems will be organized so that families can use them easily.
6. Youths with special health care needs will receive the services necessary to make transitions to adult life, including adult health care, work, and independence.
10. The article describes the transition towards policy for children with special health care needs from state policies for "crippled children". What were some of the problems under the older systems?
The older system served mainly children with orthopedic impairments and broadened their focus to include children with other physical disabilities, sensory impairment, developmental disabilities, and chronic physical illnesses. The focus of care also shifted, from care for the defect to caring for the child and, finally, to care for the family.
a.
What would the functionalist perspective (covered in Theories of Disability in
Health Practice and Research) say about "crippled children" programs. In other words-- what does this have to do with the "sick role"?
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Emphasize medicine’s role to cure and to maintain the “normal” functioning of individuals and of society. In this model, the “sick role” involves being compliant and wanting to get well.
This can make people with incurable conditions, including disabled people who are classified as sick, seem to be deviant.
The link between disability and social deviance that functionalists make influences health care and research and supports the continued dominance of professionally controlled health and welfare services for disabled people.
11. What did this article ultimately find regarding the progress towards the core outcomes broadly? Pick three of the outcomes to discuss in detail.
a.
Children with special health care needs will receive coordinated ongoing comprehensive care within a medical home.
Disaggregated into 5 essential elements or underlying concepts: 1.
1) having a usual source of care
2.
2) having a personal doctor or nurse (ie, a health professional who knows well the child and his or her health history)
3.
3) receiving all needed referrals for specialty care
4.
4) receiving help as needed in coordinating care within the health care system and outside the health care system (eg, in special education)
5.
5) receiving family-centered care.
b.
The concept of family-centered care described previously was measured using 5 questionnaire items from the National Survey of CSHCN:
1) the family reports that the child’s doctors spend enough time with the child
2) the doctors listen carefully to family concerns
3) the child’s doctors are sensitive to family values and customs
4) the child’s doctors provide needed information
5) the child’s doctors make the family feel like a partner in the child’s care.
c.
Core outcome 3: families of CSHCN will have adequate public and/or private insurance to pay for the services that they need.
Child had public or private insurance at time of interview.
Child had no gaps in coverage during year before the interview.
Insurance usually or always met a child’s needs.
Costs not covered by insurance were usually or always reasonable.
Insurance usually or always permitted the child to see needed providers.
The Medical Home
12. In terms of the policy process, what is the American Academy of Pediatrics and what role do they play in the development or implementation of policy?
The American Academy of Pediatrics proposed a definition of the medical home in a 1992 policy statement. o
Efforts to establish medical homes for all children have encountered many challenges, including the existence of multiple interpretations of the
“medical home” concept and the lack of adequate reimbursement for services provided by physicians caring for children in a medical home.
a.
Do they participate in indirect or direct democracy? Is there anything else you learned in class that may apply? b.
Overall, what was the point of this "Policy Statement"?
The organizational principles guide and define the healthcare system for children and to improve the health of all children.
The new policy statement has expanded and has a more comprehensive interpretation of the concept and an operational definition of the medical
home.
13. What is a "Medical Home"? What are the components?
The medical care of infants, children, and adolescents preferably should be available, constant, all-inclusive, family centered, coordinated, compassionate, and culturally effective.
It should be provided or oversaw by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.
The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them.
These characteristics define the “medical home.”
a.
What, if anything, does this have to do with the Quality, Access, Cost triad?
The cost to manage the different needs of different age groups for children, and potentially any kind of specialist needed for them can be costly. Especially, if they are uninsured.
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Many of these children come from poorer environments, and potentially suffer from not having access to proper care.