community

Economics of Health Care.  

Politics and The Law.

Environmental Health.

Read chapter 8, 9 and 13 of the class textbook and review the attached Power Point presentations.  Once done answer the following questions;

1. Do you feel it is better to allow individuals the freedom to choose any type of  (or no) health insurance coverage available to them or to increase government involvement in a person’s/family’s healthcare via mandates, such as the ACA and/or the government as a single insurer for all residents.  Why?

             2.  Discuss the mission of the Patient-Centered Outcomes Research Institute (PCORI) and the Center for Medicare &                                 Medicaid Innovation (CMMI).

              3.  If you could reform the malpractice or tort laws, what types of changes would you make? When do you feel it is                                      appropriate for someone to claim damages from medical procedures or treatment? Do you feel there should be a cap on                        the payments, and if so, how would you decide what that cap would be? What are all the different costs involved in                                medical malpractice suites? Is it easier to talk about tort reform than to actually try to define it?

               4.  Based in your windshield survey and/or community assessment, did you find any environmental hazards while doing the  assessment.   If yes, What was the origin of the hazards? How could they be addressed? Is/was the community doing                                 anything to deal with the problems?

Present you assignment in an APA format word document, 12 Arial font attach to the forum in the discussion tab of the blackboard title
“week 3 discussion questions”.  Your assignment must contained at least 2 evidence based references (excluding the class textbook).  A minimum of 2 replies to any of your peers sustain with references are required.  Assignment must contained at least 500 words (excluding the first and reference page).  

Chapter 13
Environmental Health

Trends in Exposure and Disease
World view
Health risks from environmental toxicants
Rapid increase in the world’s population
Changes in urbanization and agricultural production
Recent ecological changes
Population movement
Deforestation
Irrigation
Expanding urbanization
Change in agricultural practices

Environmental Health
Definition: freedom from illness or injury related to toxic agents and other environmental conditions
Applications range from hospital rooms to international and global perspectives on health of the planet

Environmental Health Policy: Historical Perspectives
Early environmental health focused on sanitation, water quality, and housing
Mortality rates decreased
Influential publication:
Carson, R. (1962). Silent spring. Boston: Houghton Mifflin
Legislation and commissions
Clean air and water acts
Occupational health
Safety acts
Pollution Prevention Act of 1990
Toxic Substances Control Act
Environmental Protection Agency
Occupational Safety and Health Administration Nuclear Regulation Commission

Recent Health Issues & Trends
Issues
Damage to the environment
Population growth
Urban spread
Advanced technology
Industrialization
Modern agricultural methods
Trends
Focus on the built environment
Children’s environmental health
Chemicals, pesticides, mercury, smoke
Environmental justice movement

Historical Perspectives on Environment and Health
Epidemiology
Time
Person
Place
Chronic disease epidemiology
Asbestos and mesothelioma
Prenatal exposure to diethylstilbestrol (DES)
Occupational exposure

Origins of Environmental Health Policy
Industrial Revolution—1800s
Focus on modernization and rapid production of goods and services
Growing concern for working conditions and safety of workers
1900s
Environmental health and safety
Passages of laws to protect the public
Pure Food and Drug Law
Food and Drug Administration
1960s–1970s
Post-war industrial rebuilding
Consumer-driven environmental movement

Environmental Policy: Governmental Roles
Protect and safeguard
Pass laws and enact rules and regulations
Identify and monitor risks and hazards
Healthy People 2020
Monitor compliance with rules
Gather data to inform policymakers

Nursing and the Environment
Nightingale
Pure, fresh air
Pure water
Efficient drainage
Cleanliness
Light
Emerging Role
Intervene directly in environmental factors

Role of the Community Health Nurse
Identify risks
Assess exposures
Communicate risks
Assess and refer clients
“Upstream Thinking”
Ethical Principles
Social justice
Environmental justice

Chapter 9
Politics and the Law

Government Authority
Protection of the public’s health
U.S. Constitution
Bill of Rights
State power

Power, Authority, and the
Health of the Public
Concepts of power
Coercive
Reward
Expert
Legitimate
Referent
Information
Connection

Evolution of the Government’s
Role in Health Care
Preamble of the U.S Constitution
“Promote the general welfare” of the people
Marine Hospital Service
The Shattuck Report
Hill-Burton Act

Evolution of the Government’s
Role in Health Care (cont.)
Medicare & Medicaid
The Civil Rights Act of 1964
National Environmental Policy Act
Americans with Disabilities Act (ADA)
Affordable Care Act (ACA) of 2010

Federal Government
Executive
Office of the President
Legislative
Congress
Judicial
Federal Court System

U.S. Public Health Agencies
National Institutes of Health
Food and Drug Administration
Centers for Disease Control and Prevention
Indian Health Service
Health Resources and Services Administration
Substance Abuse and Mental Health Services Administration
Agency for Healthcare Research and Quality
U.S. Public Health Service Corps

Human Services Agencies
Centers for Medicare and Medicaid Services
Administration for Children and Families
Administration on Aging
Department of Education
Department of Labor

Legislative Branch
U.S. Congress
Has two houses with equal power:
Senate
House of Representatives

Judicial Branch
94 federal districts courts
12 circuit courts of appeals
U.S. Supreme Court
Several specialized courts

State Government
Executive
Legislative
Judicial

Local Government
Public health
Public education
Drinking water
Sewage disposal
Police protection
Solid waste management

Different Types of Law
Constitutional law
Statutory law
Judicial or common law
Civil or criminal

Regulation of Nursing Practice
Nurse practice acts of each state control:
Requirements for entry into practice
Standards for acceptable practice
Standards for continuing competence
Disciplinary actions
Board of Nursing

Licensure of Nursing Practice
National Council Licensing Examination for Registered Nurses (NCLEX-RN)

Nursing Practice and Law
Negligence and malpractice
Correctional settings
Forensic nursing

Chapter 8
Economics of Health Care

Economic Approach to Health Care
Competition in the market
Healthcare market
Demand
Supply
Competition

Competition Versus Regulation
Standards of participation
Cost containment and value

Market Failure in Health Care
Free market competition
Market failure
Supplier-influenced demand
Third-party payer
Imperfect market

Rising Costs and Today’s Healthcare System
Social Security Act of 1935
1959 Federal Employees Health Benefit Act and Blue Cross
1960’s Medicaid (Title XIX) and Medicare (Title XVIII)
Increased costs
Gross domestic product (GDP)

Rising Costs and Today’s Healthcare System (cont.)
Decreased access
Rising costs/inability to pay
Increased number of people covered by Medicare and Medicaid; decreased number covered by private insurance
More employers offering insurance; fewer employees are purchasing it
Private insurance does not guarantee financial access to care
Public programs offer inadequate prenatal and mental health care programs
Negative outcomes for the uninsured/underinsured

Rising Costs and Today’s Healthcare System (cont.)
Influences on costs and access
Increased sources of funds from governments
Inflation
Drug cost increase
Advanced technology is expensive
Higher personnel wages and benefits costs
Change in population demographics
Excess
Medical excess
Administrative excess
Emphasis on cure instead of prevention

Paying for Health Care
Out-of-pocket payments and charity
Cost sharing
Health insurance
Private insurance
Employment-based insurance
Experience rating
Community rating
Health insurance purchasing cooperatives
Self-insurance

Paying for Health Care (cont.)
Publicly funded insurance and direct care programs
Medicare
Part A
Inpatient hospital care
Benefit period
Skilled nursing facility
Home health agency
Hospice
Part B and Part D
Medicare Advantage
“Medigap” insurance

Paying for Health Care (cont.)
Medicaid
Entitlement/welfare program
Based on income and assets
Categorically needy
Medically needy
Personal Responsibility and Work Opportunity Act
Temporary Assistance for Needy Families (TANF)

Paying for Health Care (cont.)
Children’s Health Insurance Program (CHIP)
Federally funded
CHAMPUS
Other public direct care programs:
Public Health Service Act of 1994
Affordable Care Act (ACA) of 2010

Cost Containment, Cost Analysis, and Quality
Cost-containment strategies
Controlling quantity of supply
Controlling price
Controlling quantity of demand
Competition
Prioritizing through cost analysis

Cost Containment, Cost Analysis, and Quality (cont.)
Cost analysis
Cost-of-illness analysis
Cost–benefit analysis
Cost-effectiveness analysis
Technology assessment

Public Health, Managed Care, and the Economics of Prevention
Opportunities for collaboration
Cost-containment efforts
Shift from acute services to preventive
Counterforces to collaboration
Safety net
Dumping of services
Coordination of state reporting
Nature of for-profit firms
Economics of alternative therapies

Significance of Economics for Community Health Nursing Practice
Disease prevention/health promotion
Consumer-driven health care
Nurses can help consumers understand price and quality issues
Gaining third-party reimbursement—an important labor market change for nurses
Coalition building, research, lobbying, negotiating with insurers, influencing policymaking

Economics and Nightingale’s Legacy
Market justice
Social justice