Canvas Study Guide Students - Economic Influences
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California State University, Fresno *
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40
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Health Science
Date
May 8, 2024
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docx
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6
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Study Guide Economic Influences in Healthcare (see ATI book for now, PP, and textbook) Key Concepts
1. The Role of Public Health and Policy
Public health aims to provide top-quality healthcare while actively engaging with communities.
Public health policies are designed to influence and improve health outcomes.
As nurses, you are advocates for individuals, families, and communities, and understanding health policies is crucial to your role.
2. Health Policy and Economic Factors
Healthcare policy is influenced by economic factors and often involves political debates.
These policies affect various stakeholders, including patients, healthcare providers, and the healthcare industry as a whole.
3. Types of Health Policies
Health policies can be categorized as quality, access, or cost-related.
Another classification is between allocative policies (benefiting specific groups) and regulatory policies (influencing actions and behaviors).
Policies can also be substantive (leading to significant changes) or procedural (offering step-by-step guidance).
4. Healthcare Policy Context
Health policy is established at the federal, state, and local levels, with government involvement in providing services, setting regulations, and ensuring public safety.
Key government-funded health insurance programs include Medicare and Medicaid.
The private sector in healthcare must also adhere to public policies like HIPAA.
5. Nursing's Role in Policy
Nurses play a pivotal role in advocating for public health regulations and policies.
Your scope of practice is defined by legislation and regulatory boards.
Your expertise can influence policies in various healthcare settings.
6. Public vs. Private Sector
Public sector healthcare includes government-run programs like Medicaid, Medicare, and
more.
Private sector healthcare encompasses agencies, institutions, or companies owned by individuals or groups.
Each sector has strengths (innovation, private insurance) and weaknesses (limited funding, bureaucratic challenges).
7. Economic Influences
Economic factors significantly impact healthcare delivery and accessibility.
Microeconomic theory looks at individual preferences and finances in healthcare.
Macroeconomic theory focuses on overall economic behaviors, growth, and employment.
High healthcare costs can act as a barrier for many individuals seeking care.
Healthy People 2030 Goals
Attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death.
Eliminate health disparities.
Achieve health equity.
Attain health literacy to improve the health and well-being of all.
Third-Party Payers and Public-Private Partnerships
Third-party payers are private companies partnered with publicly funded programs.
Example: Medicare (part C) and Medicaid contract with private companies to manage care.
Purpose: Enhance healthcare services, cut costs, decrease utilization, and produce better client outcomes.
Healthcare Costs
Healthcare is expensive in the U.S., with rising costs in both public and private sectors.
Impact of Rising Costs:
o
Public Sector: Directly impacts profit and may limit innovation.
o
Private Sector: Consumer premiums often increase.
Factors Contributing to Rising Costs:
o
Public Sector: Regulation and legislation, lack of competition.
o
Private Sector: Hospital consolidation, health of the economy, price transparency.
Factors Contributing to Rising Costs
Other Factors: Medical provider shortages, rising cost of education in healthcare professions, consumers' inability to pay.
Impact of Provider Shortages on Chronic Diseases.
Impact of Education Costs on Aspiring Providers.
Access to Care and Funding Impact on Costs.
Healthcare Quality
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS): Measures healthcare quality.
Requirement for Institutions Receiving Federal Funding.
Based on Patient Experience.
Influence of Nurses on HCAHPS Results.
Use of HCAHPS in Private Sector and Impact on Profit.
Health Care Financing
Medicare: Insurance for those over 65 or with specific disabilities.
Federally Funded through Payroll Deductions.
Medicaid: Insurance for low-income individuals.
Funded by Federal and State Taxes.
Children's Health Insurance Program (CHIP): Insurance for low-income children not eligible for Medicaid.
Affordable Care Act (ACA): Aim to increase health insurance coverage.
o
Strengths: Taxpayer-funded subsidies, preventive care access, removal of pre-
existing conditions, dependent eligibility until age 26, removal of lifetime benefit limits.
Government Programs
Tricare: Insurance program for military and veterans.
Indian Health Service (IHS): Health program for Indigenous Peoples.
Federal Employee Health Benefits (FEHB) Program: Health coverage for federal employees.
Refugee Health Promotion Program (RHP): Provides healthcare for refugees and asylum seekers.
Payment and Resources
Payment Calculation: ICD, DRGs, out-of-pocket, HCAHPS, private insurance contracts.
International Classification of Diseases (ICD): Global classification system.
Out-of-Pocket: Personal expenses for healthcare.
Health Savings Accounts: Used to pay out-of-pocket expenses.
Impact of Budgets and Legal Parameters on Funding Allocation.
Role of Grants in Healthcare Research.
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