Policy Making and Community Health Advocacy Exam 2

Policy Making and Community Health Advocacy Exam 2 Scenario: NP is assessing john and noticed he is obese. So then the np talks to john about his habits and assesses that if things continue as they are that weight will be a problem as he continues to get older. So she talks to mom about things she can do. (physical activity and more healthy food choices) -How did the current system of healthcare work well here? - Correct Answer Worked well - this family did have access to a healthcare provider (does everyone have this access?); the provider recognized the potential health problem and addressed it with Mom giving recommendations and suggestions. Scenario: NP is assessing john and noticed he is obese. So then the np talks to john about his habits and assesses that if things continue as they are that weight will be a problem as he continues to get older. So she talks to mom about things she can do. (physical activity and more healthy food choices) -What are some additional concerns/questions/aspects for this scenario? - Correct Answer Some additional concerns/questions/aspects: -*healthier food choices*: we should look to see if this family has access, where do they live, their economic status, culture, marketing being driven-fast food/cereal, etc, agriculture policies, grown locally, policies about food safety, additives labeling, does mom know how to read labels? -*physical activity*: where does person live? Is it safe to play in community? Are there recreations near by? School or community activities? Does mom have time to watch john outside? Parks? In the US we take healthcare seriously. What GDP do we spend on healthcare? (also what is GDP?) - Correct Answer -In the U.S. we take healthcare seriously - spending *17.5 of the gross domestic product on healthcare* - double that of other comparable countries [*spend double on healthcare* compared to other countries] [GDP: the total value of goods produced and services provided in a country during one year.] Since the US takes healthcare seriously (spend double that of other comparable countries in GDP), how do we stand up to other countries? - Correct Answer the *US does not stand up to other comparable countries as far as* life expectancy, mortality rates for chronic illnesses, mortality rates for communicable disease, infant mortality The Institute of Medicines (IOM) 2013 report found what *positive* feedback in reference to the US healthcare system? - Correct Answer provided positive feedback for our comparisons towards *cancer and stroke mortality, control of BP and cholesterol, suicide, elderly survival and self-rate health* The Institute of Medicines (IOM) 2013 report found what *negative* feedback in reference to the US healthcare system? - Correct Answer -however *we rate poorly when compared in* infant mortality and low birth weight, injuries and homicide, adolescent pregnancy and STI, HIV / AIDs, obesity and diabetes, drug-related deaths, cardiovascular disease, chronic lung disease, and disability. What did the IOM 2013 report that the US was doing wrong in reference to healthcare? - Correct Answer The IOM reports a *lack of attention to the social determinants of health* - aka the *challenge with access to healthcare and the nonclinical causes of poor health* The IOM reported a lack of attention to the social determinants of health - aka the challenge with access to healthcare and the nonclinical causes of poor health as reasons for issues with the US healthcare system. What are nonclinical causes of poor health? - Correct Answer nonclinical causes of poor health: -our private pay system/private insurance and the lack of national health care system for all ages-this exacerbates poor outcomes and nonclinical causes of poor health Explain the US 20th Century Thinking of healthcare: -Focus on __________ treatment -Fee-for-service financing -_______________-based insurance -Significant investment in medical technology & pharmaceuticals -_____________ financial support for prevention and public health. - Correct Answer US 20th Century Thinking of healthcare: -Focus on *medical treatment* -Fee-for-service financing -*Employment*-based insurance -Significant investment in medical technology & pharmaceuticals -*Limited* financial support for prevention and public health. Why has the 20th century way of thinking for healthcare led to a present day crisis? - Correct Answer Since people living longer and baby boomers are getting older and have increased chronic illness=our system is not working now because can't support all Below is 20th Century Thinking: -Focus on medical treatment -Fee-for-service financing -Employment-based insurance -Significant investment in medical technology & pharmaceuticals -Limited financial support for prevention and public health Health Care Analysis: -While there are many opinions about the ACA (affordable care act) the truth is it is an attempt to fix the issues that are causing the US to fall behind in health care excellent. -True, it is far from perfect or even the best option - but it has set into motion a way to change healthcare as we know it. - Correct Answer Health Care Analysis: -While there are many opinions about the ACA (affordable care act) the truth is it is an attempt to fix the issues that are causing the US to fall behind in health care excellent. -True, it is far from perfect or even the best option - but it has set into motion a way to change healthcare as we know it. What are the 4 Major Types of Healthcare Policies? - Correct Answer Type of Healthcare Policies: -Substantive -Procedural -Distributive -Regulatory What is important to note when considering healthcare policy/payment? - Correct Answer HEALTH POLICY/PAYMENT *IS POLITICALLY BASED* Which Type of Healthcare Policy is this: -policy that involves action or activity (ex: funding for health program) (Example: federal funding for the Indian Health Service & its activities) A: Distributive B: Procedural C: Regulatory D: Substantive - Correct Answer Types of Healthcare Policy: *Substantive: policy that involves action or activity* (ex: funding for health program) -Example: federal funding for the Indian Health Service & its activities [D] Which Type of Healthcare Policy is this: -involve how something is done, procedure by which an outcome is sought. (Example: voting rights polices for voting eligibility) A: Distributive B: Procedural C: Regulatory D: Substantive - Correct Answer Types of Healthcare Policy: -*Procedural*: involve how something is done, procedure by which an outcome is sought. (Example: voting rights polices for voting eligibility) [B] Which Type of Healthcare Policy is this: -polices that allocate services or benefits to specific groups of people. (Example: Medicare to people who meet age / physical condition criteria) A: Distributive B: Procedural C: Regulatory D: Substantive - Correct Answer Types of Healthcare Policy: -*Distributive*: polices that allocate services or benefits to specific groups of people. (Example: Medicare to people who meet age / physical condition criteria) [A] Which Type of Healthcare Policy is this: -place limitations on activities or behaviors of certain groups / individuals. (Example: age limits to purchase alcohol or health licensure regulations) A: Distributive B: Procedural C: Regulatory D: Substantive - Correct Answer Types of Healthcare Policy: -*Regulatory*: place limitations on activities or behaviors of certain groups / individuals. (Example: age limits to purchase alcohol or health licensure regulations) [C] How are different policies important when trying to help a community? - Correct Answer With different kinds of policies *we need to understand each one when considering how the policy connects with the community* What's the term? -the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health services - Correct Answer *Public health nursing* is the practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health services The PHN must address policy implications and look at creating policies to promote and maintain health for communities and populations - Correct Answer The PHN must address policy implications and look at creating policies to promote and maintain health for communities and populations The APHA (American Public Health Association): -What resource has it devevloped to help public health nurses? - Correct Answer The APHA (American Public Health Association): -has developed a resource called *"Health in all Polices"* to help *guide the policy and development of health care to improve population health* What 3 things are described to help a public health nurse be competent in policy? - Correct Answer Be competent in policy: -*Assess the impact* in your domain -*Understand policy* to be able to exert influence -*Exert influence* Must be policy competent (same thing but more words): -Assess the impact of public policies on one's domain of interest / responsibility -Understand policy and the policy process sufficiently to be able to exert influence on the process and impact policy -Exert influence on the policy-making process - Correct Answer Must be policy competent (same thing but more words): -Assess the impact of public policies on one's domain of interest / responsibility -Understand policy and the policy process sufficiently to be able to exert influence on the process and impact policy -Exert influence on the policy-making process Policy & The Public Health Nurse: -I understand that we may not all be this bold. However - this isn't as difficult as it seems. -If you want to stand for something what do you do? You research it, find reputable resources, and study. You come out of the gate ready to stand for what you believe in armed with knowledge for the debate. -If you are defeated you go back and do more research to be able to answer any question thrown at you and to better wage a war for your beliefs and values. -If you want to promote change you must first know what you need to accomplish and know what may potentially stand in your way so that you many learn how to overcome! [This is how PHN work in the development of policies to promote positive change for population health! (note: you can educate others, write to legislators, vote, etc)] - Correct Answer Policy & The Public Health Nurse: -I understand that we may not all be this bold. However - this isn't as difficult as it seems. -If you want to stand for something what do you do? You research it, find reputable resources, and study. You come out of the gate ready to stand for what you believe in armed with knowledge for the debate. -If you are defeated you go back and do more research to be able to answer any question thrown at you and to better wage a war for your beliefs and values. -If you want to promote change you must first know what you need to accomplish and know what may potentially stand in your way so that you many learn how to overcome! [This is how PHN work in the development of policies to promote positive change for population health! (note: you can educate others, write to legislators, vote, etc)] What's the difference between policy and public policy? - Correct Answer -Policy = laws, regulations, and administrative rulings -Public Policy = issued by national, state, or local governments *She did not cover in lecture* Public Health Policies can be distributive or redistributive: -Distributive Health Policy: What is it? Example? -Redistributive Health Policy: What is it? Example? - Correct Answer Public Health Policies can be distributive or redistributive: -*Distributive Health Policy*: promotes nongovernmental activities that benefit society as a whole [Example: Nursing training act and Public Health Service Act] -*Redistributive Health Policy*: changes allocation of services from one group to another - usually to a broader or different group [Example: Medicare - now broader benefits and coverage (older than 65 or disabled)] Policy Across All Levels: -Everyone's hand is in the pot and as you probably know - *the new policy or policy change that entered is very seldom that one that leaves. Compromises, changes* and proof a policy is born and it is hopefully at least half of what you wanted it to be (note: that is why you need to continue to follow its progress) -Did you know that only 5% or less of bills introduced in congress actually become laws? Between *only 2-3% of bills became laws.* - Correct Answer Policy Across All Levels: -Everyone's hand is in the pot and as you probably know - *the new policy or policy change that entered is very seldom that one that leaves. Compromises, changes* and proof a policy is born and it is hopefully at least half of what you wanted it to be (note: that is why you need to continue to follow its progress) -Did you know that only 5% or less of bills introduced in congress actually become laws? Between *only 2-3% of bills became laws.* What is the first step in analyzing policy? *Know* - Correct Answer The first step in analyzing policy is *knowing where it originates from. Is it a local, state, or national policy?* This will tell you the policy makers responsible are. Local Policy: -What are 5 examples of local policy? - Correct Answer Local Policy: -Tobacco use in public places -Exercise facilities -Farmers market venues -Gun ownership (within government guidelines) -Speed limits on public roads Local Policy: -While these are mostly handled on a local level - the *US government may having influencing power* - it is important for the PHN to know if this is or is not the case -For the most part the *PHN is able to discuss these policies openly with local policy makers.* - Correct Answer Local Policy: -While these are mostly handled on a local level - the *US government may having influencing power* - it is important for the PHN to know if this is or is not the case -For the most part the *PHN is able to discuss these policies openly with local policy makers.* State Policy: -What are 5 examples of State policy? - Correct Answer State Policy: -Public health guardians -Health care service providers -Public health laboratory services -Medicaid eligibility and services -Health professional license regulation and scope of practice (Must be licensed as an RN in the state you wish to practice) State Policy random: -With the ACA - marketplace participation and available plans were made by state legislatures [Though ACA is national policy] - Correct Answer State Policy random: -With the ACA - marketplace participation and available plans were made by state legislatures [Though ACA is national policy] National Policy: -What are 4 examples of National policy? - Correct Answer National Policy: -Funding for Medicare -ACA -Parts of Medicaid -Health care research Is the following an example of Local, State, or National policy: -District of Columbia requires public schools teach sex ed -Mayor of Chicago increased age to purchase tobacco from 18 to 21 -Due to "climate change" the EPA is now monitoring greenhouse gas emissions and developing regulatory polices - Correct Answer -District of Columbia requires public schools teach sex ed [*State policy*] -Mayor of Chicago increased age to purchase tobacco from 18 to 21 [*Local policy*] -Due to "climate change" the EPA is now monitoring greenhouse gas emissions and developing regulatory polices [*National policy*] National Policy: -Challenges of national policy include? (2) -PHN must be aware of the impact of national policy and be sure they are within compliance. - Correct Answer National Policy: -Challenges include *a large number of stakeholders as well as the burden of implementation and evaluation* -PHN must be aware of the impact of national policy and be sure they are within compliance. Policy Across All Levels: -Remember Pseudoephedrine? Well its use as an ingredient in Meth has gained National policy to keep it behind the counter with verification of license needed for its purchase. As well the purchasers name is logged in a book. However, states took a tighter hold with some not requiring an rx (medical prescription) for its purchase. - Correct Answer Policy Across All Levels: -Remember Pseudoephedrine? Well its use as an ingredient in Meth has gained National policy to keep it behind the counter with verification of license needed for its purchase. As well the purchasers name is logged in a book. However, states took a tighter hold with some not requiring an rx (medical prescription) for its purchase. Why must the PHN have a finger on the pulse congress? - Correct Answer They need to know what bills are being proposed/voted on since *Policy sets Practice.* -Ex: Changes in Medicare funding may impact the PHN client base and affect who can be included in heath promotion / disease prevention programs -The PHN understanding this impact can be a vital force to explaining to agency administrators all the way up to the state legislatures what impact this would have on public health. [*Overview*: Need to keep up with congress so that if a bill is being proposed that might affect the PHN's clients then they can reach out to the congressmen and tell them how the bill would impact the pts/public health. Name the 2 Policy Frameworks for Public Health and Policy Making - Correct Answer 2 Policy Frameworks for Public Health: -Rational Framework -John Kingdon's Framework Explain the Rational Framework for Public Health Policy - Correct Answer Rational Framework: -Straightforward way to comprehend the intent and effect of a particular policy [Similar to nursing process] -1st: *define the policy problem to be addressed* [the problem instigating why this policy needs to be] -2nd: *understand possible solutions to the problem and compare / contrast them to determine which is most politically feasible, easily implemented, and will reach the desired outcome* -3rd: *select an alternative to implement and evaluate for its effectiveness* Rational Framework: Mario Dumbed Down Version: 1st: define the policy problem to be addressed 2nd: understand possible solutions to the problem and compare/contrast the easiest political/implementable option that can solve the problem 3rd: select an alternative to implement and evaluate for its effectiveness - Correct Answer Rational Framework: Mario Dumbed Down Version: 1st: define the policy problem to be addressed 2nd: understand possible solutions to the problem and compare/contrast the easiest political/implementable option that can solve the problem 3rd: select an alternative to implement and evaluate for its effectiveness What's the drawback to the Rational Framework for Public Health Policy? - Correct Answer Rational Framework Drawback: -•Drawbacks to this framework is that *it examines policy as structured and linear which it often is not.* Explain the John Kingdon Framework for Public Health Policy - Correct Answer John Kingdon Framework for Public Health Policy: -Basis was to address the question of why some issues came to the forefront in policy development and others did not -He *believed policy was enacted when "window of opportunity" was open* -His *framework is constructed by looking at problems, indicators, and is defined by focusing events* Name the 5 Stages of PHN Activism (steps to being active in policy development) - Correct Answer 5 Stages of PHN Activism: -1st: Select policy issue to address -2nd: Conduct analysis -3rd: Define the jurisdiction -4th: Is goal well defined? -5th: Determine level of involvement necessary 5 stages to being active in policy development (PHN Activism): 1st: Select the policy issue to address: -What do you do during this stage? - Correct Answer 1st: Select the policy issue to address: -What health concerns are in your community? -What impact does current public health policy or lack thereof have on your community? -Next *ask if it involves public policy such as laws and regulations that are related to funding, services, or rights / behaviors* (NOTE: so then you know what to focus on) -Example: Recent increase in VPD 5 stages to being active in policy development (PHN Activism): 2nd: Conduct a brief policy analysis -What can you use to help with the analysis? -What do you need to do here? - Correct Answer 2nd: Conduct a brief policy analysis *using a framework such as Kingdon*: -What is the problem, are there solutions that are adequate and appropriate, what are the politics - who are the stakeholders? -This allows the PHN to see if this is already an issue being addressed or if it is a new issue 5 stages to being active in policy development (PHN Activism): 3rd: Does it fall under local, state, or nationally jurisdiction? -Why does this matter? - Correct Answer 3rd: Does it fall under local, state, or nationally jurisdiction? -*because that/they are who you are going to contact and focus on* 5 stages to being active in policy development (PHN Activism): 4th: Is the goal well defined? -What do you need to think of/consider here? - Correct Answer 4th: Is the goal well defined? -Do you need more data? Is there already a policy in place that simply needs adjustment? 5 stages to being active in policy development (PHN Activism): 5th: Determine level of involvement necessary and move forward -Why is this important? - Correct Answer 5th: Determine level of involvement necessary and move forward -Ex: If its through your job and they're trying to have a level of stance that's your involvement. If its individual there is all kinds of levels of involvement you can do. JUST FOCUS ON WHATS IMPORTANT AND DECIDE WHAT LEVEL OF INVOLVEMENT YOU ARE GOING TO TAKE What nurse was a frontrunner for the social health campaign by preserving health and prevention measures - Correct Answer *Lillian Wald* is a frontrunner for the social health campaign by preserving health and prevention measures What 3 things did Lillian Wald & Mary Brewster do to help with Social Justice? - Correct Answer Lillian Wald & Mary Brewster: -Established the *Visiting Nurses Association* -Formed *Henry Street Settlement House* [for poor immigrants and others regardless of ethnicity or religion] -*US Children's Bureau* [oversaw fair child labor laws] Lillian Wald and Mary Brewster established the visiting nurses association and later formed the Henry Street Settlement House: -These were for poor immigrants and others regardless of ethnicity or religion. They made sure that all had access to health care and adequate housing. -Wald presented at the Department of Nursing and Health at Columbia University's Teachers College beginning in 1920 -*Wald* was also pivotal in creating the US children's bureau in 1913 which oversaw fair child labor laws -What is so cool about these ladies is that they accomplished all this in a time where females were to be submissive and were supposed to be seen and not heard. At this time women did not even have the right to vote! You go girls! - Correct Answer Lillian Wald and Mary Brewster established the visiting nurses association and later formed the Henry Street Settlement House: -These were for poor immigrants and others regardless of ethnicity or religion. They made sure that all had access to health care and adequate housing. -Wald presented at the Department of Nursing and Health at Columbia University's Teachers College beginning in 1920 -*Wald* was also pivotal in creating the US children's bureau in 1913 which oversaw fair child labor laws -What is so cool about these ladies is that they accomplished all this in a time where females were to be submissive and were supposed to be seen and not heard. At this time women did not even have the right to vote! You go girls! At the root of it all, what is the reason for public health and public health nursing? - Correct Answer At the root of it all *social injustice* IS the reason for public health and public health nursing. (NOTE: public heath nurses are doing this because of the injustice) Social Justice: -The ANA's public health nursing: Scope and Standards of Practice highlight the basic value of social Justice in community nursing - Correct Answer Social Justice: -The ANA's public health nursing: Scope and Standards of Practice highlight the basic value of social Justice in community nursing -The definition of social injustice varies based on the discipline involved. Overall it is the fair allocation of both costs and rewards of being a member of a group - focusing on the processes, perceptions and roles [I think this would be social *justice*] -While we want fairness - what does that mean? How can you alleviate suffering in your community when you cannot reach your community? - Correct Answer -The definition of social injustice varies based on the discipline involved. Overall it is the fair allocation of both costs and rewards of being a member of a group - focusing on the processes, perceptions and roles [I think this would be social *justice*] -While we want fairness - what does that mean? How can you alleviate suffering in your community when you cannot reach your community? Everyday we are advocates for our patients, but what is advocacy defined as? - Correct Answer Advocacy: pleading the case of another or championing a cause Advocacy: -*Everyday we are advocates* - advocates for proper treatment, for proper medications, for treatment changes, and for fairness for the patients we are caring for -*By doing this we are trying to influence outcomes that affect our patients.* -*We need to do the same in society - be an advocate for our patients once they leave our care*. We can do this by building support or taking action! Maybe it is simply *empowering those less able to present their views or needs and giving them a voice *(something we do when we include the patient in their plan of care) - Correct Answer Advocacy: -*Everyday we are advocates* - advocates for proper treatment, for proper medications, for treatment changes, and for fairness for the patients we are caring for -*By doing this we are trying to influence outcomes that affect our patients.* -*We need to do the same in society - be an advocate for our patients once they leave our care*. We can do this by building support or taking action! Maybe it is simply *empowering those less able to present their views or needs and giving them a voice *(something we do when we include the patient in their plan of care) The Story of Health Insurance: -Before WWI? - Correct Answer The Story of Health Insurance: *Before WWI*: -Before WWI most people used folk medicines and relied on family friends/churches The insurance topic was birthed from WWI. Why was this the case? - Correct Answer The Story of Health Insurance: WWI: -For *WWI Draft Eligible men had health conditions that prevented them from serving* -Then they *initiated the first proposal for a national health insurance or some sort of coverage for health services* (because they figured they could have drafted more men if they had already taken care of these health conditions) -While they were not successful in their argument, the topic spun around for over a century How did the Roosevelt administration contribute to the Story of Health Insurance? How about during WWII? - Correct Answer The Roosevelt administration was *when national health insurance was originally included in legislation but later bargained away* in order to pass other seemingly more important legislation. -WWII *gave another chance but was dropped due to wartime sacrifices* What happened post WWII that contributed to the story of health insurance? - Correct Answer Post WWII *war industries trying to be competitive included paying for health care insurance*: -This allowed many companies to attract the best workers -This raised the question - what to do when they retire? What about those that can't find work? Enactment of Medicare in 1965: -What caused this to occur? - Correct Answer Enactment of Medicare in 1965: -Post WWII companies included HC insurance, but there were no options after retirement and for those who couldn't find work Enactment of Medicare in 1965: -Who did this give healthcare insurance to? - Correct Answer Enactment of Medicare in 1965: -provided health insurance coverage for the *elderly and Medicaid for the poor and unemployed* Enactment of Medicare in 1965: -What 2 issues came from this? - Correct Answer Enactment of Medicare in 1965: -As medical treatments expanded and the *technologies grew* with *new pharmaceuticals* and medical interventions, *so rose the cost.* -*Raising costs began to raise the questions of what should and should not be covered by CMS* (center for Medicare/Medicaid services)? More issues for CMS (Centers for Medicare/Medicaid Services): -Do we provide coverage to those with the greatest need or those with the most potential for recovery? -IE: Do we cover renal dialysis upon its invention? -*In the end they decided to cover all renal dialysis costs which found that a large number of people now survived ESRD - however this GREATLY increased costs to CMS.* -Every time a new procedure came out, a potentially life-changing one it *thus increased the cost and the costs were expected to rise exponentially* - Correct Answer More issues for CMS (Centers for Medicare/Medicaid Services): -Do we provide coverage to those with the greatest need or those with the most potential for recovery? -IE: Do we cover renal dialysis upon its invention? -*In the end they decided to cover all renal dialysis costs which found that a large number of people now survived ESRD - however this GREATLY increased costs to CMS.* -Every time a new procedure came out, a potentially life-changing one it *thus increased the cost and the costs were expected to rise exponentially* More issues for CMS (Centers for Medicare/Medicaid Services): -Now the *population is living longer with chronic diseases*! People are surviving from previously fatal illnesses, infants born earlier now survive! (note: so then the CMS and private insurance plan is *no longer sustainable in providing equity in healthcare for people*) -This *spurred the discussion* - these patients are living longer - *we need to provide all Americans with the same access.* - Correct Answer More issues for CMS (Centers for Medicare/Medicaid Services): -Now the *population is living longer with chronic diseases*! People are surviving from previously fatal illnesses, infants born earlier now survive! (note: so then the CMS and private insurance plan is *no longer sustainable in providing equity in healthcare for people*) -This *spurred the discussion* - these patients are living longer - *we need to provide all Americans with the same access.* While National health insurance was discussed after the Enactment of Medicare in 1965, it was opposed by a wide variety of groups. What are 3 reasons this occurred? - Correct Answer Reasons National Health Insurance is opposed: -fear of socialism -fear of rationing of healthcare -wanting the state to have a say ACA: -The war raged on until the eventual birth of the ACA. -Now *is the ACA a cure all? Not exactly.* -The current fee-for-service care has not led to positive health outcomes for the population as a whole and *while the ACA has largely changed this thought process we have a long way to go!* - Correct Answer ACA: -The war raged on until the eventual birth of the ACA. -Now *is the ACA a cure all? Not exactly.* -The current fee-for-service care has not led to positive health outcomes for the population as a whole and *while the ACA has largely changed this thought process we have a long way to go!* *The Affordable Care Act:* -The publics view is that the ACA was to mandate health insurance coverage for all US citizens by mandating a minimal health care requirement and requiring employers provide health insurance or make a contribution for individuals so they can buy their own. (note: resulting in more social justice and healthcare equity) (note: did away with penalizing pre existing conditions and then focused more on broader payment/reimbursement for preventative services<trying to change the culture to focus on preventative measures) - Correct Answer *The Affordable Care Act:* -The publics view is that the ACA was to mandate health insurance coverage for all US citizens by mandating a minimal health care requirement and requiring employers provide health insurance or make a contribution for individuals so they can buy their own. (note: resulting in more social justice and healthcare equity) (note: did away with penalizing pre existing conditions and then focused more on broader payment/reimbursement for preventative services<trying to change the culture to focus on preventative measures) The Affordable Care Act Negatives: -And you are right - the word affordable - well that's a stretch as many pay upwards of $700 a month with a $15,000 deductible for terrible insurance! - Correct Answer The Affordable Care Act Negatives: -And you are right - the word affordable - well that's a stretch as many pay upwards of $700 a month with a $15,000 deductible for terrible insurance! The Affordable Care Act Positives: -With the ACA newly insured citizens has risen to 16.9 million - and while it has many wrinkles the fact is that is has *a lot of favorable assets* -Health insurance agencies can *no longer penalize for preexisting conditions* and are *required to provide a broader array of preventative services.* - Correct Answer The Affordable Care Act Positives: -With the ACA newly insured citizens has risen to 16.9 million - and while it has many wrinkles the fact is that is has *a lot of favorable assets* -Health insurance agencies can *no longer penalize for preexisting conditions* and are *required to provide a broader array of preventative services.* How is the ACA trying to change the culture of healthcare? - Correct Answer -The ACA is truly trying to change the culture to *focus to preventative medicine with primary prevention (disease prevention)* Name the ACA's 7 strategic priorities to eliminate health disparities and inequities *KNOW* - Correct Answer ACA 7 strategic priorities: -Tobacco-free living -Preventing drug abuse and excessive alcohol use -Healthy eating -Active living -Mental and emotional well-being -Reproductive & sexual health -Injury and violence-free living ACA: -The National Prevention Council and the Federal Advisory Group are appointed to guide these efforts (ACA 7 strategic priorities) - Correct Answer ACA: -The National Prevention Council and the Federal Advisory Group are appointed to guide these efforts (ACA 7 strategic priorities) Two additional changes that are hopefully a component of ACA are *value-based purchasing and accountable care organizations (ACOs):* -What do these require nonprofit hospitals to do? -To be nonprofit these hospitals are supported by? -Why has the government really charged these hospitals to be the frontrunners in community health. This is a great advancement and opportunity for PHNs! - Correct Answer Two additional changes that are hopefully a component of ACA are *value-based purchasing and accountable care organizations (ACOs):* -These *require nonprofit hospitals to* conduct community health needs assessments and develop plans for improvement of community health. -*To be nonprofit these hospitals are supported by* tax exemptions and increased reimbursement from CMS -With the addition of so many newly insured, charity care is dwindling and therefore the *government has really charged these hospitals to be the frontrunners in community health*. This is a great advancement and opportunity for PHNs! What is Value-Based Purchasing (VBP)? (notes version) - Correct Answer Value-Based Purchasing: -Moving away from fee-for-service which has increased health care costs, VBP arose which reimburses a specific amount based on achieving the likely outcome for clients with in specific diagnostic categories. So instead of insurance paying for office visits, lab fees, prescriptions - they now have bundled care or bundled management. These bundles agree based on the clients demographics and diagnosis. It *essentially is paying healthcare for achieving the best outcomes for the patient*. This *includes primary or preventative health, managing normal laboratory value and keeping patients out of the hospital*. What is value based purchasing? (Quizlet version) - Correct Answer payment method that rewards quality of care through payment incentives and transparency. What are Accountable Care Organizations (ACO's)? What do they emphasize? (Notes Version) - Correct Answer Accountable Care Organizations: -These, like VBP are *emphasizes quality over quantity*. This is where *each patient has a care team that work together towards positive outcomes for each patient*. By a multidisciplinary team (endocrinologist, PCP, cardiologist) working together they can better streamline the patients care. This *reduces duplicated test and procedures.* -ACOs not only *reimburse based on quality outcomes but also penalize for negative outcomes making the risk fall into the laps of the providers rather than the government*. For example if a patient was hospitalized then released only to find themselves readmitted within 30 days the hospital may find themselves penalized by non-payment for the readmission. This is why many facilities, CC for sure, have moved away from the word discharge towards "transitioning of care" by following up with the patient, promoting home visits and ensuring they understand their d/c instructions and that no one falls through the healthcare cracks. (note: ex: preventing falls and pressure ulcers<amped up care due to this) What are Accountable Care Organizations? (Quizlet Version) - Correct Answer groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients ACA/VBP/ACO's: -ALL OF THESE THINGS ARE GOOD IN THEORY, BUT THE BATTLE CONTINUES WITH HOW TO DO THIS IN OUR POLITICAL/PUBLIC SYSTEM NOT WANTING THE FEDERAL GOVERNMENT TO MANDATE THINGS<<so us as nurses need to keep up with what's happening because it affects our careers! - Correct Answer ACA/VBP/ACO's: -ALL OF THESE THINGS ARE GOOD IN THEORY, BUT THE BATTLE CONTINUES WITH HOW TO DO THIS IN OUR POLITICAL/PUBLIC SYSTEM NOT WANTING THE FEDERAL GOVERNMENT TO MANDATE THINGS<<so us as nurses need to keep up with what's happening because it affects our careers! For PHN's to influence policies they must make sure that they are heard. But how can you be heard while being firm and assertive, but while also not alienating those you wish to influence? - Correct Answer *Use the ten commandments of lobbying (or advocating).* List the ten commandments of lobbying/advocating - Correct Answer Ten commandments of lobbying/advocating: -*Honesty* is the best policy -*Start early* -*Know what you want* -*KISS* -*No permanent enemies, no permanent friends* -*Know your opponents* -*Compromise* (have to compromise) -There is *strength in numbers* -*Work at the local level* -*Thank you* Remember the Global Community Health lecture and the discussion of difference Health Systems? The question being asked is why is the U.S. the ONLY rich/developed nation without Universal Health Care? Is it working...can it continue to work (now think back to Adults and the discussion of a growing older adult population and extended life expectancy straining our current health system. Have you heard any stories of people going into bankruptcy because of a major health crisis? However you feel, understand what Universal Healthcare as a framework means [*No 2 single-payer healthcare systems are alike.*] - Correct Answer Remember the Global Community Health lecture and the discussion of difference Health Systems? The question being asked is why is the U.S. the ONLY rich/developed nation without Universal Health Care? Is it working...can it continue to work (now think back to Adults and the discussion of a growing older adult population and extended life expectancy straining our current health system. Have you heard any stories of people going into bankruptcy because of a major health crisis? However you feel, understand what Universal Healthcare as a framework means [*No 2 single-payer healthcare systems are alike.*] What's the definition? -a health care system that provides health care and financial protection to all residents of a particular country or region - Correct Answer *Universal healthcare* (AKA: universal health coverage, universal coverage, or universal care) Universal healthcare: -Also known as (3)? - Correct Answer Universal healthcare AKA: -universal health coverage -universal coverage -universal care Universal healthcare: It is organized around providing a specified package of benefits to all members of a society with the end goal of? (3) - Correct Answer Universal healthcare: It is organized around providing a specified package of benefits to all members of a society with the end goal of *providing financial risk protection* (so you can't go bankrupt just cuz you're sick), *improved access to health services*, and *improved health outcomes* T/F: Universal healthcare offers coverage for all people for everything - Correct Answer Universal healthcare *does not imply* coverage for all people for everything, *only that* all people have access to healthcare What are two ways Universal Healthcare systems are funded? - Correct Answer Some universal healthcare systems are *government funded*, while *others are based on a requirement that all citizens purchase private health insurance* (note: that the private insurance is affordable). [*Overview*: Either government funded or everyone is required to purchase private health insurance] Universal healthcare can be determined by what three critical dimensions? - Correct Answer Universal healthcare can be determined by three critical dimensions: 1: who is covered 2: what services are covered, and 3: how much of the cost is covered. What does the WHO think about Universal Health Coverage? - Correct Answer It is described by the World Health Organization as a situation where citizens can access health services without incurring financial hardship. The Director General of WHO *describes universal health coverage as the "single most powerful concept that public health has to offer"* since it unifies "services and delivers them in a comprehensive and integrated way". One of the goals with universal healthcare is to *create a system of protection which provides equality of opportunity for people to enjoy the highest possible level of health*. What do the Sustainable Development Goals say about health coverage? - Correct Answer As part of Sustainable Development Goals, United Nations member states have *agreed to work toward worldwide universal health coverage by 2030*. [So there is a GLOBAL push that healthcare should be universal] NOTE: SHE SAYS KNOW HOW IT WILL IMPACT OVERALL HEALTH IN HOSPITALS AND COMMUNITY, HOW IT IMPACTS HEALTHCARE AS A WHOLE, AND HOW IT IMPACTS YOU AS A NURSE [I think this relates to Universal Healthcare] - Correct Answer NOTE: SHE SAYS KNOW HOW IT WILL IMPACT OVERALL HEALTH IN HOSPITALS AND COMMUNITY, HOW IT IMPACTS HEALTHCARE AS A WHOLE, AND HOW IT IMPACTS YOU AS A NURSE [I think this relates to Universal Healthcare]