pubh 6127 final exam essay and short answer questions.

How does a health management organization (HMO) type of insurance lower healthcare costs? You have to see a provider within the HMO's network. The network is made up of providers that have agreed to lower their rates for plan members and also meet quality standards. If you opt to see a doctor outside of HMO, you will have to pay the entire cost of medical services. You may need a primary care physician (PCP) referral to be covered when seeing a specialist What did the Affordable Care Act mandate? (Obamacare), requires most Americans to have a basic level of health insurance coverage. This requirement is commonly referred to as the law's "individual mandate." What is medical malpractice? This occurs when a hospital, doctor, or health care professional, through a negligent act or omission, causes injury to a patient. The negligence might be the result of errors in diagnosis treatment, aftercare, or health management What are the top 10 health issues in the US? 1. Alcohol-related harms 2. Food safety 3. Health-care associated infections 4. Heart diseases and stroke 5. HIV 6. Motor Vehicle Injury 7. Nutrition, physical activity, and obesity 8. Prescription drug abuse 9. Teen pregnancy 10. Tobacco use What is the social determinants of health? Describe the types of SDH? Definition: Determinants of health are factors that contribute to a person’s current state of health. These could be biological factors, psychological factors, behavioral factors, and social factors. Social determinants of health are social conditions into which people are born and that affect their daily lives and overall well being as they move through the various stages of life. Social determinants include factors that may have led to an individual’s disadvantaged state to begin with- institutional racism, exposure to crime and violence, a lack of available community-based resources, and many other factors that can all be healthharming. Types: - Access to high-quality educational opportunities Individuals with access to consistent, high-quality educational opportunities are more likely to obtain higher-income jobs. With low-quality education, low paying options will be availed which might not offer health insurance as a jib benefit making it difficult for individuals to access routine and specialty physician services. Educational attainment and corresponding income levels tend to be strong predictors of individual and population health. - Access to medical care services Individuals who do not live close to medical care providers are less likely to see a physician regularly and will often seek care only in emergencies,eschewing to preventing care ultimately leading toa decreases quality of life. - Access to social media and other technologies The internet and cell phones are becoming increasingly useful in individual and population health, from reminders of appointments to learning about symptoms of diseases and to buying of insurance through state exchanges under ACA. - Availability of community-based resources and opportunities for recreational activities Community-based resources can connect residents to local health providers and recreational/ physical activities increasing the likelihood of people leading healthier lives overall - Availability of resources tp meet daily needs Individuals living in food deserts are more likely to consume fast foods or other relatively unhealthier options contributing to a poor diet and high levels of obesity and other dietrelated diseases like diabetes and heart disease - culture While traditions can have important positive effects in treating illness, cultural norms can also impact health in unseen ways. - language/ literacy If adequate translation and interpretation services are not in place in health care facilities, foreign-language speaking patients may be discouraged from seeking care. - Public safety Individuals who live in dangerous neighborhoods tend to remain indoors, which closes off opportunities for exercise and social interaction. People who have less access to public transportation will miss doctors’ appointments. Also, alcohol, drugs, violence, and adverse health outcomes are more relevant in unsafe neighborhoods. - Residential segregation Physicians may prefer to set up their practice in locations dominated by certain demographics. As a result, low income and minorities suffer from a lack of healthcare facilities. - Social norms and attitudes Discriminatory attitudes remain a cause of health disparities. Bias in physicians and other healthcare professionals plays a significant role in how patients of certain races, gender, ethnicities, social status, age, and education levels are treated. Patient attitudes about medical professions can also affect health. - Socioeconomic conditions Concentrated poverty and the stressful conditions that accompany it can have a jeopardizing effect on health. Greater wealth correlates with lower rates of morbidity and longer life spans. - Transportation options Many individuals miss medical appointments because they cannot afford private transportation and live long distances from reliable public transportation. How to SDH affect health outcomes Relationship between SDH and health outcomes Links can be drawn between social determinants and both physical and mental health. Half of the deaths in the united states involve behavioral causes. Health-related behaviors are strongly shaped by three important social factors: employment, education level, and income. Lower socioeconomic status is associated with increased prevalence of disease, morbidity, and mortality. Access to safe, quality, affordable housing represents one of the most influential SDH. Regardless of income or housing cost, living in a predominantly minority neighborhood increases the likelihood of having poor access to healthy food choices. SDH play a significant role in mental health outcomes as well Emotional stressors such as neighborhood violence, poverty, or familial abuse can lead to severe consequences in life. How is law a SDH ? - Law can be used to design and perpetuate social conditions that can have terrible physical, mental and emotional effects on individuals and populations. - Law can be used as a mechanism through which behaviors and prejudices are transformed into distributions of well being among populations. - Law can be determinative of health through their under enforcement - Law can be determinative of health through their interpretation - Law can be used to structure direct responses to health-harming social needs that result from factors like impoverishment, illness, market failures, and individual behavior that harms others. MLP ( Medical-legal partnership) Combats health-harming social conditions MLP functions as a patient care team that includes both medical and legal professionals ( a legal attorney is literally embedded in a medical setting). The goal of MLP movement is to help create an interconnected care system that focusses on the whole patient including the ways in which myriad social conditions factor into individual and population health. MLP has its roots in the late 1960s when the nation’s first community health centers were funded by the federal government with aims to provide health and social services to medically underserved populations. Under the MLP model, public interest lawyers work with health care workers to screen for health-related legal problems often encompassing family matters, housing problems, special education advocacy, food security concerns, ad additional problems that can lead to stress. Typical practice of a comprehensive MLP can be understood by the mnemonic I-HELP Income, Housing, Education, Legal status, and Personal and family stability. MLP approach is built on the understanding not only that many SDH require legal interventions but that moving upstream to assist vulnerable populations with legal needs is preferable to wait until a legal crisis erupts. It is similar to preventive health care It is often the most cost-effective Beneficial to the patient both physically and emotionally Benefits: - Impact on patient health and well being - The financial impact on partners and patients - Impact on knowledge and training of health providers Reasons behind not being able to achieve health reform in US Factors predominantly acting as difficulties in achieving the health reform in US are: - Country’s culture - Nature of US political institutions - Power of interest groups - Path dependency - Culture The twin concepts of entrepreneurialism and individualism have had a real impact on health policy decisions. Americans generally oppose government solutions to social welfare. Americans have a complicated partisan view of the proper role of the federal government in the healthcare arena. The country’s culture and lack of consensus about health reform have impeded attempts to create universal coverage health plans. US political system. - US political system tHe country’s system of government also has made it difficult to achieve universal coverage. Although states are generally home to social welfare changes, it is difficult to provide universal healthcare on a state by state basis. The federal government is often politically divided with different parties holding power in legislative and executive branches. This often results in partisanship and policy inaction due to different policy priorities and views. Legislators in Congress may have confidence in focussing on their districts or states needs before those of entire nation. In the senate, a 60% vote is required to support inaction or incremental reform over changes Also, because both the house and senate have to pass bills containing the same policies and language to have any chance at becoming a law, a large political majority in one chamber or the other does not guarantee the ability to enact a policy. - Interest groups Interest groups often influence the decisions of politicians. The interest groups represent their members’ interests in policy decisions. In terms of health reform, interest groups representing various providers, businesses, employer groups, insurance companies, and managed care organizations often have opposed to comprehensive health reform. - Path dependency The concept of path dependency has been a hindrance to major health reform. The notion of path dependency emphasizes the power of inertia within political institutions meaning that once a certain way of doing things becomes the norm, it is hard to change the course. It was assumed that comprehensive health reform would likely change the condition of the insured population to some degree by changing their source of coverage, benefits included in coverage, and cost of coverage which could crowd out the political capacity to insure the remaining. How ACA became law Commitment and leadership Lessons from failed health reform efforts Political pragmatism