Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e This material (Comp1_Unit9e) was developed.

Introduction to Healthcare and Public Health in the US

The Evolution and Reform of Healthcare in the US

Lecture eThis material (Comp1_Unit9e) was developed by Oregon Health & Science University, funded by the Department of Health and

Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

The Evolution and Reform of Healthcare in the USLearning Objectives

2

• Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c)

• Describe the patient-centered medical home model (Lecture d)

• Discuss the key issues driving healthcare reform in the US (Lecture e)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US

Lecture e

Healthcare Reform In The US

3Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture e

• Long history of healthcare reform in the US• The Social Security Amendments of 1965

– President Lyndon B Johnson signed the bill– 2 amendments to the Social Security Act of 1935

• Title XVIII – later known as Medicare– Part A: hospital insurance for elders– Part B: supplementary medical insurance

• Title XIX – later known as Medicaid– healthcare for economically disadvantaged individuals

The EMTALA Act

• The Emergency Medical Treatment and Active Labor Act (EMTALA)– Passed by Congress in 1986

• Part of the Consolidated Omnibus Budget Reconciliation Act (COBRA)

– EMTALA mandates hospitals and ambulance services to provide care to all, without discrimination

– Applies to hospitals that participate in Medicare program



Lecture e

The CHIP Program



Lecture e

• State Children's Health Insurance Program (SCHIP), also known as the Children's Health Insurance Program (CHIP)– Legislated in 1997 under title XXI of the Social

Security Act– Administered by the Department of Heath and Human

Services– Provides matching funds to states to insure children

The HIPAA Act



Lecture e

• Health Insurance Portability and Accountability Act (HIPAA) in 1996

• Workers could keep health insurance coverage with a change in their job status

• Mandated standards for protecting privacy and confidentiality of health information

Attempting Comprehensive Healthcare Reform



Lecture e

• Unsuccessful attempts:– 1933: President Franklin D Roosevelt

attempted to include public funding for healthcare programs in the Social Security Act

– 1949: President Harry Truman considered universal healthcare as part of the Fair Deal plan

– 1974: President Richard Nixon introduced the Comprehensive Health Insurance Act

Attempting Comprehensive Healthcare Reform

(continued)



Lecture e

• Unsuccessful attempts:

– 1993: Task Force on National healthcare Reform, headed by First Lady Hillary Rodham Clinton• Aim: to provide universal healthcare

– 2001: Patient Bill of Rights - allowed fundamental rights for patients as consumer

Two New Acts: New Healthcare Reform Measures



Lecture e

• Patient Protection and Affordable Care Act (PPACA)– Signed by President Barack Obama on

March 23, 2010

• Healthcare & Education Reconciliation Act– Signed on March 30, 2010

Insurance Reform



Lecture e

• Affordable Care Act, 2010– The Pre-Existing Condition Insurance Plan (PCIP)

• administered by states or the US Department of Health and Human Services

• Is a new health coverage option for patients who currently cannot get health insurance

• Plan functions until 2014 • In 2014: start of health insurance exchanges

– Competitive marketplace where individuals and small businesses can buy health benefit plans from a menu of choices

Insurance Reform (continued)



Lecture e

• Individual and group health plans cannot have lifetime dollar value limits

• Insurers cannot rescind coverage in most cases• No pre-existing condition exclusions for children• As of September 2010, young adults under age

26 can usually be insured under a parent’s insurance

• Improved insurance options for early retirees• Insurers must justify increases in health plan

premiums

Preventive Care Reform



Lecture e

• Health plans will be required to offer many preventive services without charging a co-payment or deductible

• Preventive services that are rated A or B by the US Preventive Services Task Force will be included in this reform

Preventive Care Reform (continued)



Lecture e

• Establish the National Prevention, Health Promotion and Public Health Council to develop a national strategy to improve the nation’s health

• Require chain restaurants and food sold from vending machines to disclose the nutritional content of each item

Medicare Reform



Lecture e

• The life of the Medicare Trust fund will be extended to at least 2029

• Commitment to reduce Medicare fraud by 50 percent by 2012

• In 2011 -- 50% discount on brand-name drugs when patients reached the Medicare Part D coverage gap (prescription ‘donut hole’ )

• Patients will pay less every subsequent year until 2020, when the Medicare Part D coverage gap will disappear

Medicare Reform (continued)



Lecture e

• Efforts to improve care coordination between clinicians to reduce unnecessary hospital re-admissions

• Hospitals will receive incentives to improve quality of care measures

• After 2014, the Affordable Care Act limits the amount that Medicare Advantage plans can spend on administrative costs and profits

Medicaid Reform



Lecture e

• Increase the Medicaid drug rebate percentage

• Establish the Community First Choice Option in Medicaid

• Create a new plan option to permit Medicaid enrollees to designate a provider as a health home

Quality Improvement



Lecture e

• Develop a national quality improvement strategy• Establish a non-profit Patient-Centered

Outcomes Research Institute to support comparative effectiveness research

• Improve coordination and integration of healthcare services for low-income, uninsured and underinsured populations by setting up a Community-based Collaborative Care Network Program

Workforce Reform



Lecture e

• Establish a Workforce Advisory Committee to develop a national workforce strategy

• Establish Teaching Health Centers to assist primary care residency programs

• Provide scholarships and loans for health professionals

Malpractice Reform



Lecture e

• Fear of medical liability leads physicians to practice “defensive medicine”

• 25 million dollars in grants to states to reduce medical malpractice law suits

(Massachusettes Medical Society, 2008)

Prescription Drug Reform



Lecture e

• Authorize the Food and Drug Administration (FDA) to approve generic versions of biologic drugs

• FDA can grant biologics manufacturers 12 years of exclusive use before generics can be developed

Other Changes In 2014



Lecture e

• By 2014:– US citizens and legal residents will be

required to have qualifying health coverage– Limits on deductibles for health plans in the

small group market– American Health Benefit Exchanges and

Small Business Health Options Program (SHOP) Exchanges will be created

Attempts to Repeal Healthcare Reform Law



Lecture e

• Legislative attempts– Members of 111th Congress introduced bills, but these

did not progress– 112th Congress voted in 2011 to repeal the Patient

Protection and Affordable Care Act and portions of the Healthcare and Education Reconciliation Act of 2010

– Unlikely to be approved by the Senate or President Obama

• Legal attempts– In 2011 a federal judge in Florida declared law

unconstitutional

What Is The Best Way To Reform US Healthcare?



Lecture e

• One opinion:• “To reform US healthcare, start with systematic reviews”

– Kay Dickersin, Director Center for Clinical Trials, Director US Cochrane Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

• The United States has lagged behind other countries in making a national commitment to creating and utilizing research on “what works”

• Evidence-based healthcare: “the integration of the best research evidence with clinical expertise and will incorporate patient values”


Summary – Lecture e

24

• Provided history of healthcare reform• Detailed most recent healthcare reform

legislation• Discussed impact of healthcare reform

legislation on the future

Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture e


Summary

• Described Evidence-Based Practice, clinical practice guidelines, and quality indicators in medicine

• Introduced the patient-centered medical home• Presented the key aspects of healthcare

reform in the US



Lecture e


References – Lecture e

References• Adamy, J. (2010, June 1). Grants Aim to Reduce Medical Malpractice Lawsuits. Retrieved December 6, 2011,

from The Wall Street Journal. Politics website: http://online.wsj.com/article/SB10001424052748704312104575299260780573220.html

• Bihari, M. (2010). Understanding the Medicare Part D Donut Hole Learn About the Medicare Part D Coverage Gap - Hitting the Donut Hole. Retrieved December 6, 2011, from About.com Health Insurance website: http://healthinsurance.about.com/od/medicare/a/understanding_part_d.htm

• Emergency Medical Treatment & Labor Act (EMTALA) - Overview. (2011). Retrieved December 6, 2011, from Centers for Medicare and Medicaid Services website: https://www.cms.gov/emtala/

• Good News for People with Medicare. (2010). Retrieved December 6, 2011, from HealthCare.gov. website: http://www.healthcare.gov/

• Investigation of Defensive Medicine in Massachusetts. Retrieved December 6, 2011, from Massachusetts Medical Society website: http://www.massmed.org/AM/Template.cfm?Section=Research_Reports_and_Studies2&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=27797

• Medicaid and CHIP Program Information. (n.d.). Retrieved December 6, 2011, from Medicaid.gov website: https://www.cms.gov/home/chip.asp

• Patient Protection and Affordable Care Act (PPACA). (2010). Retrieved December 6, 2011, from Marrs Maddocks + Associates Insurance Services, Inc. website: http://ppaca.com/index.php?page=hcr-timeline



Lecture e

Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture e This material (Comp1_Unit9e) was developed.

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