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Allied Health Exam 2

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
Late 1800's to the Early 1900's set the stage for health insurance due to the   show
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show a form of disability coverage that provided income during temporary disability due to bodily injury or illness  
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show national health care plan.  
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During the great depression social service took   show
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show any plans to protect Physician wages  
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AMA & AHA 1948   show
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show first broad-coverage health insurance in the U.S., originally designed to make cash payments to workers for wages lost because of job-related injuries and disease  
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show a national health care program  
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show Justin Kimball began a hospital insurance plan for teachers at Baylor University Hospital in Dallas, Texas, capitated fee structure , became the model for Blue Cross plans around the country  
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show coordinated them into a Blue Cross network  
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Blue Cross Network transformed insurance from a mechanism to reimburse for lost wages to one that   show
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show shareholders.  
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Control of Blue Cross plans was transferred to an independent body forming   show
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show 43 states and serving 20 million people.  
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show commercial insurance.  
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show Blue Cross structure.  
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Private Insurance industry included   show
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show 9% to 57%  
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show Blue Shield plan  
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show physician fees.  
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Blue Shield plans were aimed at protecting the   show
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Blue Shield was AMA   show
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show merged, today they are a joint corporation, and are in almost every state.  
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During World War II, employees accepted employer-paid health insurance to   show
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show nontaxable, was equivalent to getting more salary without having to pay taxes  
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show union-management negotiations  
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By mid-1950’s commercial insurance companies offered   show
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show provide coverage.  
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show primary source of payment of healthcare services in the U.S.  
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show Collection of premiums assumption of risk, responsibility for delivery of services, making of payments to providers  
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show money that is spent in the process of doing business  
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Health Care Expenditures include the   show
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Goal is to keep health care expenditures   show
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Cost is related to the charge to the patients and insurance companies   show
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show Financing,Technology and supplies,Facilities,Personnel  
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show source of money used to run a business  
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Increased health care spending can be caused by   show
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show hospital care, physician and clinical care, prescription drugs, nursing and home healthcare. Other sources include specialty services, com minty/school spending, medical equipment.  
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show Demand is determined by the process of goods and services on the one hand and people's ability to pay on the other  
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Heath Insurance desensitized both consumers and providers to the   show
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show demand for services, covered services expand rapidly, growth of medical technology.  
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Negative effects of financing and insurance include   show
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Moral Hazard + provider-induced demand =   show
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show restricting the availability of expensive medical technology and care (i.e. insurance will only pay for some procedures)  
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Demand-side rationing   show
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show many payers, many forms of payment, many programs and many reimbursement options.  
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show patients (directly pay portion of the total cost of services) and the employers and government which are the primary financiers of health care.  
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Patients finance their   show
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show wages, medicare tax is also deducted from pay as a prepayment for when 65.  
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General taxes subsidize health care for   show
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Cost-shifting and tax subsidies   show
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show private insurance programs, public insurance programs, uncompensated or charity care.  
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Types of insurance include   show
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Private health insurance includes   show
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Public health insurance includes   show
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show any mechanism that gives people the ability to pay for health care services  
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In most cases, financing is necessary to   show
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Insurance   show
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Insured   show
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Insurer (3rd party payer)   show
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show individuals providing care or services  
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show plan that employee chooses; contains the conditions and services under which payment is made  
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show cost (usually by monthly fee) that is paid by the insured for coverage  
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Policy   show
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show time period when employees can take advantage of benefits  
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show out of pocket expenses; dollar amount of services that must be paid by the patient or person responsible for the bill before the insurance will pay  
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Copay   show
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Coordination of benefits   show
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show patient pays provider directly from own savings – no insurance involved  
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Fee for service   show
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Pre-payment   show
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show system of identification of diagnoses, procedures and services that were provided to the patient; describes the services  
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Billing   show
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show form sent to insurance company explaining charges incurred by the patient  
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show a statement sent to the patient that explains which claims were paid and at what level  
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show the possibility of substantial financial loss from some event, where probability of occurrence is small  
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show protects against risk  
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show an individual protected by insurance  
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Insurer   show
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show evaluates, selects/rejects, classifies, and rates risk  
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A insurance policy premium is based on   show
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Four principles of insurance risk include   show
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Restriction of usage   show
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Limitation of access   show
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Major concern of risk management is how to effectively control rising   show
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Part of risk management is to reduce the number of people who require expensive car this is done through   show
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Due to risk management many people who are most in need of health insurance   show
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Cost Sharing   show
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show cost sharing.  
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show risk.  
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Cost sharing reduces the misuse of   show
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show cost share lowers utilization without lowering quality  
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show premium cost sharing, deductibles, and copayments.  
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Premium cost sharing   show
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show payment before insurance pays  
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show out of pocket expenses patient contributes to care.  
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Coinsurance   show
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show Limits total out-of-pocket costs to a certain amount in a given year, once reached insurance pays 100%, protects against catastrophic illness or injury  
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Lifetime cap may be part of insurance   show
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show insurance companies, managed care organizations, BlueCross BlueShield, government  
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show payment made by third-party payers to the providers of services  
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Types of reimbursements include   show
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show Charges set by providers, each service is billed separately, UCR became common, usual customary and reasonable, main drawback is providers induce demand, payment to provider from insurance or out of pocket.  
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show number of related services in one price, reduce provider induced demand because fees are inclusive of all bundle services.  
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show Under the omnibus budget reconciliation act of 1989, medicare developed the program to reimburse physicians according to "relative value" assigned to each service, based on time skill, intensity to provide service.  
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Discounted fees   show
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show Used by HMO's, per member per month fee to cover all needed services, prudent delivery of services, minimize provider-induced demand.  
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Retrospective reimbursement   show
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show uses pre-established criteria to determine in advance the amount of reimbursement.  
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show Diagnosis related groups (DRG), ambulatory payment classifications (APC), resources utilization groups (RUG), home heath resources group (HHRG)  
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Diagnosis Related Groups (DRGs)   show
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show Implemented August 2000, medicare's outpatient prospective payment system (OPPS) for services provided by hospital outpatient departments. Bundled rate, reimbursement rates are associated with each APC group.  
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show Medicare payments reimburse skilled nursing facilities, case mix, overall acuity level in a facility, evaluate patient's medical and nursing care needs, case mix determines a fixed per-diem amount, higher the case mix score, higher the reimbursement.  
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Home Health resource Groups (HHRG)   show
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Patient Protection and Affordable Care Act (ACA) 2010   show
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Two functions of financing are   show
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show private insurance programs, public insurance programs, and uncompensated or charity care.  
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show taxpayers.  
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Most popular form of financing health care is through   show
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Private or voluntary/personal insurance types include   show
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High deductible health plans can also be group or   show
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Managed Care organization can also be individual as well as   show
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Public or government insurance types include   show
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Private insurance is voluntary insurance meaning that it is not   show
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show family plans.  
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Most private insurance is   show
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show Commercial, blue cross blue shield, managed care organizations, HDHP.  
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show the insurance company.  
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Those covered by individual private health insurance can pick options of coverage based on   show
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show early retirees, and self-employed individuals.  
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In individual private health insurance risk is   show
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show coverage picked.  
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Within individual private health insurance high risk people are often unable to receive   show
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show employer, union, or professional organization.  
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Group insurance anticipates large numbers of   show
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Within group insurance cost and risk are distributed   show
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Group insurance typically includes major medical and   show
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show covers itself.  
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Self-insurance occurs when large employer's work forces are   show
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Those with self-insurance can predict their own   show
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Those with self-insurance can assume risk and   show
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Within self-insurance high losses are covered through reinsurance which is   show
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Consumer Driven Health Plans (CDHP) feature high   show
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Consumer Driven Health Plans gives consumers greater control and responsibility   show
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show Pay less for health care but still covered for catastrophic illness.  
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show premiums but higher deductibles, as well as no copays for MDs.  
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show covered.  
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show out of pocket expenses.  
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The two main types of high deductible health plans or HDHPs are   show
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show health savings account, mainly the employee contributes to saving account on a tax-deductible bases, money in account is used to pay for health services until the high deductible is reached.  
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show expenses and employers may contribute, the funds belong to holder of account and accumulate without limit, unused money roll into the next year.  
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show tax exempt.  
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show exempt payments made for qualified medical expenses.  
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Within a HDHP/HRA employees pay medical expenses, premiums, and LTC insurance and then the employee is   show
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A HDHP/FSA is a flexible spending account it is similar to an HSA but   show
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Managed Care Organization is a type of   show
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The three critical factors in differentiating between the types of MCOs are   show
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show choice of providers.  
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show health maintenance organization HMO, preferred provider organization PPO, exclusive provider organization EPO, and point of service organization POS.  
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show low premiums but less options, are copay driven rather than deductible, part of your premium goes to medical group whether you use or not, capitation is the primary method of reimbursement, increase in fee for service.  
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show in network providers and services are covered only.  
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show coordinated by an HMO provider or gatekeeper, who make all the decisions.  
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HMO's focus on wellness care feature   show
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show staff model, group model, network model and independent practice association or IPA model.  
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HMO staff model features fixed salaried MD on staff in a   show
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show sometimes hospitals, that service only those enrolled in HMO.  
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show deliver care.  
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HMO staff model features more control over practice and   show
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show utilization.  
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show cover costs.  
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Enrollees in an HMO staff model are limited on the MDs   show
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show group practice.  
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In a HMO group model MDs are not employed by the HMO but by a   show
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show one or more hospitals for specialty services.  
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show control over utilization.  
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In an HMO group model the HMO pays group practice to   show
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show non-HMO patients  
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show one that is administratively tied to the HMO-service exclusive to HMO members.  
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show more than one medical group.  
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show group practices are located.  
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show which provider.  
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In an HMO network model the group practice is paid by   show
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In an HMO network model the group practice is responsible for providing   show
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show responsible for reimbursing them for the referrals not the HMO.  
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In an HMO network model there is low utilization control since   show
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show HMO and providers.  
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show bearing entity.  
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show HMO.  
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In an IPA the HMO contracts to the IPA instead of   show
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An IPA establishes contracts with both independent solo pracitioners and   show
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IPAs are independently established by   show
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show MDs to participate  
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An IPA is hospital based and structured so that only certain   show
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IPA assumes the responsibility for   show
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show IPA.  
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Preferred Provider Organization or PPO is the   show
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show lower deductibles and co pays if in network, typically higher copay for out of network.  
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A PPO is not   show
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show higher to pay for this option.  
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show discounted fees.  
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show plan that is paid annually.  
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In a PPO patients can use out of   show
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In a PPO there is no gatekeeping within the   show
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A PPO guarantees volume of business to hospitals and MDs who in return accept   show
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show service at an agreed upon reduced rate.  
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In a PPO a hospital is insured a   show
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show HMO and PPO.  
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A POS is more flexible with in and out   show
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In a POS providers paid by   show
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In a POS gatekeepers may be used to   show
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show out of network providers.  
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show driven model.  
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show Consolidated Omnibus Budget Reconciliation Act of 1985  
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show coverage for individuals between jobs and their family.  
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Due to COBRA employer must extend benefits to former employees for   show
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COBRA may be extended to spouse or dependent up to   show
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show cheaper than purchasing on own.  
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show any form of insurance NOT subsidized by the government, includes individual and employer-based.  
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show employer driven.  
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show vary.  
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Public insurance is government   show
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show public health insurance  
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Piecemeal was the addition of new programs and   show
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show public insurance.  
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show it can be used for uninsured or all people.  
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show certain category of people who meet the eligibility criteria to become beneficiaries.  
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show social security amendments of 1965.  
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show widely available source of payment for health care.  
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Before 1965 private health insurance was available primarily to   show
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show government overseeing health care.  
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show health status was typically worse, and could not afford increasing health care costs also medical needs were usually more critical.  
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In 1957 a health care bill was introduced in Congress early debates on to include hospital and nursing home care for elderly however AMA   show
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show President Kennedy revived the effort to enact hospital insurance for the aged, congress responded with the Kerr-Mills Act. Act involved federal grants given to states so they could extend health services under welfare.  
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The Kerr-Mills Act was a failure to   show
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show top priority.  
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AMA urged congress to expand   show
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show Medicare Part A which included hospital and nursing home, medicare part B MD premium based and medicaid which made poor eligible.  
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Medicare is   show
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show title 19 of the social seurity act.  
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Medicare and Medicaid were instrumental in covering   show
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Medicare and medicaid are financed by the government but delivered by   show
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show gross domestic product.  
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Medicare is title 18 of the social security amendment of 1965 it finances medical care for 3 categories of people,   show
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show Agency under the US department of health and human services that administers the program. Enrollees expected to grow.  
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show everything.  
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show medicare deductibles and co-payments, may pay for services not covered by medicare.  
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show Hospital insurance HI  
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show Physician insurance/ Supplementary insurance SI  
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Medicare Part C   show
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Medicare Part D   show
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show social security tax and covers inpatient services, short term convalescence and rehab in a skilled nursing facility, home health, hospice, managed care, and administrative costs.  
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show primary care MD  
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show doctor, hospital, other providers and facilities but must be medicare approved.  
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show medications.  
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show employer, union, etc.  
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show deductible, and coinsurance, out of pocket.  
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show benefit period.  
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show hospitalized.  
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Benefit period ends when the beneficiary   show
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A beneficiary can have unlimited   show
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show all expenses paid for the 1st 60 days after deductible met, deductible applies for each benefit period, copayment required from 61-90 days, max benefit period is 90 days, higher copay applies after 90 days. After 90 days lifetime reserve of 60 days.  
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Medicare acute hospital benefits include all expenses paid for first 60 days after   show
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Medicare acute hospital care requires a copayment from   show
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show 90 days.  
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Acute care hopsital benefits includes a higher copay after   show
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Acute care hospital benefits include a lifetime reserve of 60 days after   show
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show 190 days lifetime.  
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show medicare is exceeded.  
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Medicare certified SNF benefits eligibility begins after   show
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show maximum.  
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Medicare admission to SNF must be within 30 days of discharge from   show
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show 20 days, then a copay from days 21-100.  
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Medicare home health benefits require the patient to be homebound and   show
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show 100 home visits after hospitalization.  
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Medicare home health benefits cover durable medical equipment at   show
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In order for those under medicare to receive the hospice benefit the patient must be   show
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Medicare hospice only need a token copayment required   show
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show physician insurance/supplementary medical insurance SMI  
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show general taxes and premium contributions.  
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show medicare but you can opt out.  
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Medicare is voluntary enrollees pay monthly   show
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show physician services hospital outpatient services (surgery) diagnostic tests radiology emergency department rehab ambulance dialysis radiation medical equipment and supplies Some preventive services  
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show Medicare Advantage which was formerly the medicare + choice 1998.  
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show Balanced Budget Act of 1997.  
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show medical benefits, additional benefits may be offered by the private plans.  
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show Part A, B, and D  
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show medigap insurance.  
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In order to enroll in Medicare part C you must be   show
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Medicare contracts with   show
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show captivated fee structure from Medicare, premiums that are set by MCO, may have copays deductibles and a gatekeeper depending on the plan, HMO, PPO, fee for service, etc.  
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show accept the plan coverage and fee terms.  
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show prescription coverage.  
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Medicare Part D   show
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Medicare Part D was created under the   show
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Medicare Part D is available to enrollees in   show
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show Stand alone prescription drug plans (PDPs) – for those in Part A & B and Medicare Advantage Prescription drug plans (MA-PD) – part C beneficiaries  
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Medicare Part D is   show
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show comprehensive coverage, no vision, eyeglasses, dental, hearing aids, or routine exams.  
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show pap smears, glaucoma screenings, cholesterol and prostate screenings, and pneumonia vaccines.  
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Medicaid is title 19 of the   show
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show indigent, low income elderly, children under 21 in low income families, adults with dependent children from low income homes, the disabled and the blind.  
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show state and federal govt.  
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When financing medicaid the government matches   show
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Means Tested Program for Medicaid   show
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Medicaid Disabilities everyone is   show
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Enrollees are also able to buy in to Medicaid disabilities if you are   show
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ACA 2014 will cover people under 65 including disabilities through medicaid if income   show
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Medicaid covers   show
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Accountable Care Organization   show
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show Authorized the Centers for Medicare and Medicaid Services to provide integrated delivery system for medicare patients, develop reimbursement methods, and offered incentives to reduce costs and improve quality, still in developmental phase.  
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show Created in 1997 under title 21 of the social security act to reduce the number of uninsured children in low income families.  
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CHIP was reauthorized through March 2009, in February 2009, the children's health insurance program reauthorization act of 2009 was   show
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CHIP in most states is available to families with income up to 200 percent of the poverty level 45,000 and if   show
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CHIP is a low cost insurance for children in families who earn too much to qualify for   show
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Federal Government matches state funds if they expand medicaid eligibility to enroll children under 19 years of age who do not qualify for   show
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States can use existing Medicaid, create a separate CHIP program, or use a   show
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show routine checkups, immunizations, dental and vision care, inpatient and outpatient services, laboratory and xray services.  
🗑
COBRA is the   show
🗑
show individuals between jobs.  
🗑
In COBRA employer must extend benefits to   show
🗑
show spouse or dependent up to 36 months.  
🗑
show cheaper than purchasing own insurance.  
🗑
show meet eligibility criteria to become beneficiries.  
🗑
Public insurance includes   show
🗑
show consists of cost, quality and access, an interactive relationship exists between the cost of health care, the quality of service delivered and people's ability to get health care when needed.  
🗑
Past attempts at universal health care access have failed because increasing access means more   show
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Macro perspective is   show
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show compares medical inflation to general inflation, measured by annual changes in the consumer price index, also compares changes in the national health spending to changes in the gross domestic product.  
🗑
Micro perspective consists of   show
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Micro perspective involves   show
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show the ACA.  
🗑
show gross domestic product.  
🗑
show private insurance.  
🗑
Rising health care expenditures have been attributed to   show
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Third party payment leads to   show
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show demand.  
🗑
In an imperfect market quantity of health care produced and delivered is usually higher than in   show
🗑
In an imperfect market prices are permanently higher than the   show
🗑
Growth and intensive use of technology have a direct impact on   show
🗑
show expensive to develop, once developed creates new demand for use, technology also raise the expectations of consumers about what medical science can do to diagnose, treat disease and prolong life.  
🗑
Increase in elderly population leads to higher health care costs because the elderly consume more health care at   show
🗑
show increases in elderly population which drives up cost.  
🗑
Elderly drive up health care costs because chronic conditions   show
🗑
show medical intervention while, de emphasizing medical prevention.  
🗑
show have not accorded their place in the US health care delivery system.  
🗑
show the management of the financing, insurance, delivery and payment functions and can include managing enrollment, monitoring utilization, claims processing, denials and appeals, and marketing and promotion.  
🗑
Administrative costs can amount to about   show
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Defensive medicine which drives up health care cost results because   show
🗑
show health care costs.  
🗑
show fraud.  
🗑
show billing claims or cost reports are intentionally falsified.  
🗑
show medicare and medicaid.  
🗑
Practice variations are referred to as   show
🗑
show differences in practice patterns and have been associated with geographic areas of the country.  
🗑
Practice variations signal gross inefficiencies in the   show
🗑
show outcomes.  
🗑
Cost control efforts in the US have   show
🗑
Implementing a system wide cost control initiative has   show
🗑
Cost control efforts in the US have also been unsuccessful due to cost shifting   show
🗑
show its weaknesses.  
🗑
show the most expensive means of providing health care in the world.  
🗑
show hospitals with PPS and physicians services with resource based relative value scales.  
🗑
show health planning, price controls, peer review, and competitive approaches.  
🗑
Health planning was an undertaking by the government to   show
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Health planning does not fit well in the US due to   show
🗑
show price for inpatient hospital care.  
🗑
show prospective system which was based on diagnosis related groups as authorized under the social security amendments of 1983, caused costs to shift from inpatient to outpatient.  
🗑
Peer review is the process of medical review of   show
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PRO was a new system of peer review organizations established in 1984 to determine whether care was   show
🗑
show quality improvement organizations.  
🗑
Competition is   show
🗑
show providers of health care services try to attract patients who have the ability to choose from several different providers.  
🗑
Demand side incentives are   show
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show antitrust laws in the United States, which prohibit business practices that stifle competition among providers such as price fixing, price discrimination and mergers.  
🗑
show cost efficient.  
🗑
show The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge  
🗑
show cost and access  
🗑
show quality occurs on a continuum, unacceptable to excellent, that the focus is on services provided by the system not the individual behaviors, that quality may be evaluated from the individual or populations perspective, emphasis on desired health outcomes  
🗑
According to the institute of medicines implication of quality professional consensus is used to develop   show
🗑
show micro perspectives, and macro perspectives.  
🗑
Micro perspectives of quality focus on   show
🗑
Macro perspectives of quality look at   show
🗑
show health care.  
🗑
US has tremendous advances in   show
🗑
US trails far behind in   show
🗑
Donabedian in 1980 proposed three domains in which health care quality should be examined which are   show
🗑
show facilities, resources, and staffing.  
🗑
show The relatively stable characteristics of the providers of care, of the tools and resources they have at their disposal, and of the physical and organizational setting in which they work  
🗑
show poor quality, inability to provide good processes of care.  
🗑
show delivery of health care, the specific way in which care is provided.  
🗑
show correct diagnostic test, correct prescriptions, accurate drug administration, communication, and compassion.  
🗑
show Clinical practice guidelines.  
🗑
show medical practice guidelines.  
🗑
CPGS constitute a plan for managing a   show
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CPGS intentions are to   show
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Cost efficiency is referred to as   show
🗑
show greater than the cost incurred.  
🗑
Optimal quality is when the   show
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Critical pathways are   show
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Critical pathways provide a timeline that identifies planned medical interventions along with   show
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Critical pathways improve quality by   show
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show prevent adverse events related to clinical care and facilities operations, focusing on avoiding medical malpractice.  
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Outcomes are   show
🗑
show effectiveness of the health care delivery system.  
🗑
show improvement in health stats.  
🗑
Measures of outcomes include   show
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Along with access and cost the third main concern of health care policy is   show
🗑
The Health care Quality act of 1986   show
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show documentation, analysis, and prescription.  
🗑
documentation includes   show
🗑
show program evaluations and outcomes research, look for what does and does not work  
🗑
show course of action that has a desirable consequence.  
🗑
show ability to obtain needed, affordable, convenient, acceptable, and effective personal health services in a timely manner.  
🗑
Access is a determinant of   show
🗑
show monitor access trends.  
🗑
show surveys that have data on health care use and expenditures.  
🗑
show data  
🗑
Both low socioeconomic status and minority group members are associated with   show
🗑
show ongoing care.  
🗑
Hispanics are less likely to have a   show
🗑
show cancer screenings, flu shots, and ambulatory visits.  
🗑
Access to care also relies on having available   show
🗑
show providers and that their geographic distribution is desirable.  
🗑
show rural health clinics to expand access.  
🗑
The National Health Service corp has student assistance programs to   show
🗑
show inner cities and rural towns.  
🗑
Two main concerns about the medicare policy are   show
🗑
Minorities are more likely than whites to   show
🗑
show access problems.  
🗑
Access policies should encourage   show
🗑
show most health care organizations are established in more urban areas .  
🗑
show a limited time.  
🗑
show create incentives for permanent practices in rural areas  
🗑
Low income mothers and their children have problems accessing the health care system because   show
🗑
SCHIP   show
🗑
People with AIDS and those with HIV have problems   show
🗑
AIDS patients have difficulty getting insurance because   show
🗑
show universal access.  
🗑
show increasing costs, lack of access, and concerns about quality.  
🗑
show highest in the world.  
🗑
show health status, demographics and ability to pay.  
🗑
Quality is assessed through   show
🗑
show optimize quality and minimize expenditures.  
🗑
show it does have a history of federal, state and local govt. involvement in health care and health policy.  
🗑
show payer of health care, provider of health care, and a regulator of the health care system.  
🗑
show medicare, medicaid, CHIP, and TRICARE  
🗑
The role of the govt. as a provider of health care includes   show
🗑
show involvement in the political process to make laws, as well as controlling licensure.  
🗑
Public policies are   show
🗑
show make laws.  
🗑
The executive branch is known as the presidential branch and they   show
🗑
The judicial branch of government is known as the supreme court and they   show
🗑
Public policies are intended to direct or influence the   show
🗑
show public policies that pertain to or influence the pursuit of health.  
🗑
show distribute resources, services, and political influences that impact the health of the population.  
🗑
show public social policies enacted by the government.  
🗑
show health care at all levels including policies affecting the production, provision, and financing of health care services.  
🗑
show groups or classes of individuals as well as types of organizations.  
🗑
show regulate health care and allocate resources for health care.  
🗑
Regulative health policies ensure   show
🗑
show paying for health care, funding initiatives, and financing research.  
🗑
show behavior of particular groups.  
🗑
States supervise the nation's system of   show
🗑
show quality of care by health care providers.  
🗑
States control the administer workers   show
🗑
show protection efforts.  
🗑
Some states regulate control over   show
🗑
Allocation involves the direct provision of   show
🗑
show distributive and redistributive.  
🗑
Distributive allocation policies   show
🗑
show take money or power from one group and gives it to another such as in medicare or medicaid.  
🗑
In the US the government is seen as a   show
🗑
The US health care policy features a decentralized role for the   show
🗑
The US health policy is   show
🗑
show presidential leadership.  
🗑
show development and evolution of health policy.  
🗑
show primary responsibility of government, because the private sector has a dominant role.  
🗑
show government intervention.  
🗑
show informed decisions.  
🗑
Health coverage is seen as a   show
🗑
show perceived problems and negative consequences such as escalating cost, excessive regulation, fraud and abuse and conflicting or non funded public directives.  
🗑
Government is left to fill the gap for the   show
🗑
show its role in health costs, and its health benefits to people.  
🗑
There is a constant struggle between the development of technology and the   show
🗑
show cost efficient and accessible.  
🗑
The government regulates drugs and   show
🗑
show uniform, smooth running system.  
🗑
The mix of government and private insurance within the US health care system results in a   show
🗑
The employed are insured by voluntary insurance through   show
🗑
show tax revenues such as medicare part a and b, and medigaps.  
🗑
The poor are covered through medicaid via   show
🗑
Special populations such as veterans, native americans, and the armed forces have coverage provided directly by the   show
🗑
Process of legislation regarding policy development and enactment is   show
🗑
There are 31 congressional committees and   show
🗑
show pass through both to be a law.  
🗑
Medicare and medicaid revisions are not   show
🗑
States are left to interpret and enact medicare and medicaid revisions   show
🗑
show should and should not be included in reform.  
🗑
show health care policy  
🗑
show such as in medicaid and SCHIP.  
🗑
States develop and implement health care policies involving Quality assurance, practitioner and facility oversight   show
🗑
States develop and implement health care policies involving regulation of health care   show
🗑
show government health services.  
🗑
show regulate the health care system.  
🗑
The state can license and regulate health care   show
🗑
show health insurance.  
🗑
show quality standards.  
🗑
The state can enact controls on health care   show
🗑
show services.  
🗑
show health policy decisions.  
🗑
show enact policy at the federal level .  
🗑
The fact that states vary in implementation of service leads to inadequacies in   show
🗑
show original policy.  
🗑
Different ethnic, religious, and political groups view health care and policy   show
🗑
show groups needs.  
🗑
Groups involved in health care policies include   show
🗑
Interest groups are the   show
🗑
Interest groups are adamant about   show
🗑
Interest groups combine and concentrate the resources of their members to   show
🗑
show american medical association AMA, the american association of retired persons AARP, and the american hospital association.  
🗑
show benefits for their employees, dependents, and retirees.  
🗑
show the cost.  
🗑
show business and industry operate.  
🗑
show uniform.  
🗑
show organize and advocate for their own best interests.  
🗑
show consumers of health care.  
🗑
show alliances among themselves and with members of the legislative body to protect and enhance the interests of those receiving benefits from government programs.  
🗑
Each member of the alliance receives   show
🗑
show identification of a problem where markets fail, or do not function well.  
🗑
Government regulates and allocates resources of health care through   show
🗑
show legislative branch of the US govt.  
🗑
show idea becomes a law, and how the law is implemented.  
🗑
The legislative process of health care law making is known as the   show
🗑
Policy cycle   show
🗑
The five components fo the health policy cycle are   show
🗑
The components of the policy cycle are shared by the   show
🗑
show propose or sponsor a new law.  
🗑
An idea is drafted as a bill, the legislators may ask other legislators to become   show
🗑
Co sponsors are assigned a   show
🗑
show committee by the authorizing body.  
🗑
When a bill is introduced into the senate or house of representatives it is reassigned to a subcommittee who reviews it and may   show
🗑
show full committee.  
🗑
show conduct further review, hold more public hearings, or simply vote on the report from the subcommittee.  
🗑
show die in the committee, which many do.  
🗑
The legislative process is repeated until the   show
🗑
show prepares and votes on its final recommendations to the House or Senate.  
🗑
show report about the bill is written and published, includes purpose of the bill and its impact on existing laws, budgetary considerations, and any new tax increases required by the bill.  
🗑
Committee report typically contains transcripts from   show
🗑
Full house or senate review involves the bill being added to the   show
🗑
Once the bill is approved by the full house or senate by majority vote it is sent to   show
🗑
The legislative chambers may forward the bill to a   show
🗑
show members of similar committees in both house and senate, and are charged to reconcile differences between the senate and house versions of the bill. If no agreement the bill dies, if a agreement on a compromised version they prepare a report detailing.  
🗑
show the bill will be sent back to them for further work.  
🗑
After the bill has passed in both House and Senate in identical form it is   show
🗑
Presidents role in the legislative process includes   show
🗑
show overrule by 2/3 vote, otherwise the bill is dead.  
🗑
show appropriate agency for implementation.  
🗑
New regulation is posted in the federal register and hearings are held to see how the law will be   show
🗑
show rewrites regulations.  
🗑
show enabling legislation.  
🗑
show shape the final outcome.  
🗑
Health policies are developed to   show
🗑
National health care is supported, but the idea of federal government running the system is   show
🗑
show the market to improve coverage and affordability.  
🗑


   

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