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EXAM 1 704
| Question | Answer |
|---|---|
| Progressive Party Platform (1912) | TEDDY ROOSEVELT BULL MOOSE PARTY endorses social insurance with health coverage |
| *Baylor Hospital Plan (1929)* | BAYLOR HOSPITAL in Dallas creates hospital insurance for teachers (BLUE CROSS) |
| Social Security Act (1935) | establish MATERNAL AND CHILD HEALTH GRANTS, setting a precedent for federal health grants |
| Hill Burton Act (1946) | Funded hospital construction nationwide, but permitted RACIAL SEGREGATION |
| AMA Campaign (1949) | SOCIALIZED MEDICINE |
| Revenue Act (1954) | TAX-EXEMPT |
| *Landmark Legislation (1965)* | Johnson signs MEDICARE and MEDICAID into law (largest expansion of public health) |
| Medicaid Expansion (1967) | Coverage extends to more vulnerable groups (EPSDT, medicaid preventive care mandate for children) |
| Medicare | 65+ and certain disabled individuals |
| Medicaid | Low income individuals and families |
| EPSDT | Early and Periodic Screening, Diagnostic, and Treatment |
| Medicare Expansion (1972) | LONG TERM DISABILITIES and END-STAGE RENAL DISEASE (ESRD) |
| *HMO Act & Capitation (1973)* | HEALTH MAINTENANCE ORGANIZATION (HMO) federally encourages the growth of managed care. At its core: CAPITATION - provides a FIXED MONTHLY PAYMENT PER ENROLLED PATIENTS, regardless of how many services patients actually use. REDUCE UNNECESSARY UTITIZATION |
| *EMTALA & COBRA (1986)* | EMTALA requires emergency care regardless of ability to pay. COBRA lets workers keep employer coverage after job loss. |
| *HIPAA 1996* | HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT Three pillars: PORTABILITY , PRAACY RULES for personal health data, electronic security standards |
| *CHIP 1997* | STATE CHILDREN'S HEALTH INSURANCE PROGRAM fills a key gap- covering kids and families that earn too much for medicaid but too little to afford private insurance |
| *Medicare Part D 2003* | MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, and MODERNIZATION ACT (MMA) creates Medicare part D. Expanding pharmacist roles in MTM SERVICES and medication access |
| *Affordable Care Act (ACA) 2010* | Individual Mandate: required most Americans have insurance(Federal penalty was reduced to $0) Medicaid Expansion: 138% of the federal poverty level Insurance Market Reforms: Pre- existing condition exclusion Subsidized Marketplaces: premium tax cre |
| * Kennedy vs Braidwood Management Inc 2025* | Insures cover USPSTF A/B RATED PREVENTIVE SERVICES at no cost - protecting free preventive care for ten of millions. Ex: Pap smear, mammogram |
| Inflation Reduction Act 2022 | Medicare Drug Price Negotiation: 1st negotiated prices take effect in 2026 Inflation Rebates: drug makers owe medicare rebates when prices rise FASTER THAN INFLATION |
| *COVID 19 and Public Health Emergancy (PHE)* | - Expanded telehealth - Continuous medicaid enrollment - Suspension of many prior authorization - Rapid vaccine rollout |
| *HMO Act 1973* | 25+ workers must offer HMO OPTIONS alongside traditional insurance - PREPAID, MANAGED CARE |
| *ACA Repeal attempt & individual mandate zeroed out * | The TAX CUTS AND JOB ACT 2017 then eliminated the individual mandate penalty starting in 2019 , weakening the risk pool and fueling new legal challenges. |
| *COVID -19: CARE Act & operation Wrap Speed * | CARES Act (2020) funded Emergancy telehealth, providers relief, and testing. OPERATION WRAP SPEED delivered COVID-19 vaccines authorization in under a year. |
| *Pharmacist's Role on Public Health* | Pharmacist contribute through VACCINATION , covid/flu testing, ANTIMICROBIAL STEWARDSHIP |
| Persistant Tradeoffs | Access, cost, quality |
| Universal Coverage: Three core Dimensions | - Population coverage: everyone included - Service coverage: full range of ESSENTIAL HEALTH SERVICE - Financial Protection: cost must not push individuals or families into POVERTY OR CATASTROPHIC DEBT |
| * Beveridge Model* | Government FUNDS & DELIVERS Ex: UK, Spain, New Zealand |
| * Bismarck Model* | PAYROLL-FUNDED SICKNESS FUNDS covers workers, mostly private Ex: Germany, France, Belgium |
| * National Health Insurance (NHI)* | A SINGLE PUBLIC INSURER collects premiums and pays private provides Ex: Canada, Taiwan, South Korea |
| * Market/Private Dominant Model* | PRIVATE INSURANCE AND MARKET drives coverage with limited safety nets US mixes all four |
| United States Model: Mixed (Medicare, Medicaid, VA, CHIP) | Strength: MEDICAL INNOVATION Limitation: No universal coverage |
| US strength | - World leading biomedical innovation - Extensive provider choice - Rapid specialty access |
| US weakness | - Higher per capita spending - Million uninsured or underinsured - Extreme administrative complexity - Worse Outcomes on life expectancy |
| Canada Model: National Health Insurance (NHI) | Financing & delivery: FEE-FOR- SERVICE Strength: universal coverage for medically necessary care with LOW ADMINISTRATIVE OVERHEAD Limitation: LONG WAIT TIMES |
| *Japan* Model: Bismark style hybrid | Financing & delivery: PAYROLL CONTRIBUTION, GOVERNMENT SUBSIDIES, CO-PAYMENTS & TAXATION Strength: LOWER PER CAPITA COST Limitation: Rapidly AGING POPULATIONS |
| *Switzerland* Model: MANDATORY REGULATED PRIVATE INSURANCE buy from competing nonprofit insurers | Financing & delivery: COMMUNITY RATED PREMIUMS Strength : universal coverage with strong patient satisfaction Limitation: premiums are significant household burden |
| France Model : Bismarck / Statutory health insurance (SHI) | Financing & delivery: PAYROLL TAXES, INCOME TAXES & SOCIAL CONTRIBUTION Strength: universal access Limitation: Dual SHI + supplemental coverage added fiscal pressure |
| *Top performing systems* * Norway, Switzerland, Netherland, Taiwan, Japan & Singapore* | Strength - Universal primary care access - Centralized cost central - Social Determinants Investments - Balanced Public/ private mix |
Created by:
angelicap