Chapter 2: Benchmark Developments In The U.s. Health Care

Front 1

Baylor University Hospital Plan

Back 1

One of the first, most influential insurance experience that arose during the time of the depression.
-Enrolled 1,250 public school teachers @ 50 cents a month for a guaranteed 21 days of hospital care.
- Credited with the birth of Blue Cross Hospital Insurance,

Front 2

The word Inimical means

Back 2

- Likely to cause damage or bad effect
- Not friendly

Front 3

What did the government do after WWII to help stimulate the health care market?

Back 3

The government gave a huge boost to the private health insurance industry by excluding health insurance benefits from wage and price controls and by excluding workers' contributions to health insurance from taxable income.
- The effect was to encourage employees to take wage increases in the form of health insurance fringe benefits rather than cash.
- Insurance companies responded by raising their insurance premiums rates rather than exerting pressure on physicians and hospitals to contain costs.
-Post-WWII health insurance system pumped an ever increasing proportion of national income into health care.

Front 4

What percentage of federally sponsored programs account for this country's personal health expenditures?

Back 4

Roughly 40%

Front 5

what percentage of health care expenditure is dedicated to research?

Back 5

Roughly 6%.

Front 6

Social Security Act of 1935

Back 6

Established Federal aid to the states for:
- public health and welfare assistance
- Maternal and child health
- Children w/ disabilities

Front 7

The National Institute of Health

Back 7

- Created in 1930
Addresses concerns related to:
-Cancer
-Heart disease
-Stroke
-Mental Illness

Front 8

The government is a major player and payer in the field of health care

Back 8

True.
Creative Federalism (Kennedy - Johnson presidential policy) created:
- FDA

Front 9

What is New Federalism?

Back 9

This was Nixon's intent to undo the categorical programs and shift revenues to the state and local governments.

Front 10

What does the word underwriting mean

Back 10

To give money to support, and to give money if any losses occur, i.e. insurance policy

Front 11

Medicare reimbursement rates set the standards for most insurance companies

Back 11

True

Front 12

Comparing cost of health care when Medicaid started to now

Back 12

In 1965, cost of health care for U.S. was $42 billion.
Today, it now exceeds $2 Trillion and consumes about 17% of the GNP.

Front 13

Hill-Burton Act of 1946

Back 13

Was a response to a critical shortage of medical facilities during WWII, made sure facilities:
- Were not discriminatory
-Provide a reasonable volume of free care each year

The act gave federal funds that demonstrated a need to build up capital.
**This act "over-built" the system and Medicaid / Medicare of 65 helped put older people into that system.

Front 14

Public Health Service Act & Comprehensive Health Planning Act

Back 14

In 1965, this act was amended to address quality issues in hospitals. It established a nationwide network of regional medical programs to address the leading causes of death: Heart disease, cancer, stroke.

*The Comprehensive Health Planning Act*
Another quality initiative program enacted by the government.

Because both of these programs addressed similar areas, but disagreed about how problem should be taken care of, they come formed one program known as the National Health Planning and Resources Development Act of 1974.

Front 15

Health Systems Agency (HSA) [Johnson Era Programs]

Back 15

Was a response to the National Health Planning and Resources Development Act of 1974.

This organization had broad representation of health care providers and consumers on governing boards.

The HSA eventually fell apart because it was not representing what it was intended to represent.

Front 16

The Health Professions Educational Assistance Act of 1963 [Johnson Era]

Back 16

Provided direct federal aid to medical, dental, nursing, pharmacy, and other professional schools as well as their students.

Front 17

The Nurse Training Act [Johnson Era]

Back 17

1

Front 18

The Health Maintenance Organization Act of 1973

Back 18

Development of HMOs:
- An organization responsible for financing and delivery of comprehensive health services to an enrolled population for a prepaid, fixed fees.
-They were expected to hold down costs by changing the profit incentive from fee for service to promoting health and wellness.

Front 19

PPOs

Back 19

A derivative of managed care organization (2001)
-Organized by hospitals and physicians to meet the needs of the private, third party, and self-insured firms.

Front 20

Concerns about HMOs

Back 20

-HMO controls on costs are compromising the quality of care
-HMOs restrict choice of providers
-Manage care backlash
- limits care

Front 21

New Federalism Policy

Back 21

Although Nixon and Ford failed to implement New Federalism, Regan was able to do it.
New Federalism decentralizes program responsibility to the states.

Front 22

Diagnosis Related Groups (DRGs)

Back 22

Implemented by Regan
-Changed payment to prospective rather than retrospective.
-Provides hospitals w/ set dollar amount based on pt dx at admission

Front 23

How did congress control costs during Regan era?

Back 23

1.) Conversion of categorical and disease-specific programs to block grants
2.) Withdrawal of federal support for professional education
3.) Creation of Medicare resource-based relative value scale to contain physician's fees.

Front 24

What does the word putative mean

Back 24

Commonly accepted or believed to be true.

Front 25

Cost Sharing

Back 25

Refers to the amount insured individuals must pay for medical services in ADDITION to their annual insurance premiums.
-Copays
-Deductibles
-Coinsurance.

Insurances that cover ALL costs are known as "first-dollar insurance".

Front 26

Co-insurance

Back 26

When the insurer has to pay a % of the bill. Different from co-pay.